While the cost of health care in the United States rises faster than the gross domestic product, the cost of cancer care is rising faster than health care and the cost of new cancer drugs faster than overall cancer care. Cancer specialists from the University of Chicago have developed a tool, COST (Comprehensive Score for financial Toxicity), to help cancer patients deal with the so-called “financial toxicity” of their diagnosis by calculating their risk and ability to deal with financial stress.
"Few physicians discuss this increasingly significant side effect with their patients," Dr. Jonas de Souza, a head-and-neck cancer specialist at the University of Chicago Medicine, said in a statement. "Physicians aren't trained to do this. It makes them, as well as patients, feel uncomfortable. We aren't good at it. We believe that a thoughtful, concise tool that could help predict a patient's risk for financial toxicity might open the lines of communication. This gives us a way to launch that discussion."
De Souza and his colleagues oversaw a literature review and extensive conversations with over 20 patients in the advanced stages of cancer in addition to nurses, social workers, and six cancer professionals. A total of 147 questions gathered from the research were narrowed down to 58 before 35 additional cancer patients were asked to decide which questions they considered most important. The resulting 30 questions were narrowed down once again to create list of 11 short and concise entries.
Examples of the 11 statements cancer patients are asked to ponder include item 2: “My out-of-pocket medical expenses are more than I thought they would be.” A more optimistic item 7 states: “I am able to meet my monthly expenses.” Patients are asked to choose from five potential responses for each question including: not at all, a little bit, somewhat, quite a bit, or very much.
"We need better ways to find out which patients are most at risk. Then we can help them get financial assistance. If patients know what to expect, they may want their physicians to consider less costly medications,” Souza added. “In the end, 155 patients led us, with some judicious editing, to a set of 11 statements," de Souza said. "This was sufficiently brief to prevent annoying those responding to the questions but thorough enough to get us the information we need."
According to a recent study conducted by the Centers for Disease Control and Prevention, around 30 percent of cancer survivors are either unable to return to work or work with the efficiency they displayed before their diagnosis. Among cancer survivors who were employed at the time of their diagnosis, 25 percent said cancer and its treatment interfered with physical tasks, 14 percent said it hindered mental tasks they were asked to perform, and around 25 percent reported feeling less productive over the course of the work day.
"We need to assess outcomes that are important for patients," said de Souza. "At the end, this is another important piece of information in the shared-decision-making process."
Source: Yap B, Hlubocky F, de Souza J, et al. The development of a financial toxicity patient-reported outcome in cancer: The COST measure. Cancer. 2014.