Measuring financial toxicity as a clinically relevant patient-reported outcome: The validation of the COmprehensive Score for financial Toxicity (COST).
Measuring financial toxicity as a clinically relevant patient-reported outcome: The validation of the COmprehensive Score for financial Toxicity (COST).
复制标题
作者：
de Souza JA;Yap BJ;Wroblewski K;Blinder V;Araújo FS;Hlubocky FJ;Nicholas LH;O'Connor JM;Brockstein B;Ratain MJ;Daugherty CK;Cella D
癌症及其治疗导致患者的经济困境增加。据作者所知，迄今为止，尚未验证标准化的患者报告结局指标来评估这种痛苦。招募了接受化疗至少2个月的AJCC IV期实体瘤患者。金融毒性是通过金融毒性综合评分（COST）衡量的。作者收集了有关患者特征、临床试验参与、医疗保健使用、讨论费用的意愿、心理困扰（情绪状态简介[POMS]）和健康相关生活质量（HRQOL）的数据，这些数据通过癌症治疗功能评估：一般（FACT‐G）和欧洲癌症研究与治疗组织（EORTC）QOL问卷进行测量。使用标准量表构建技术评估COST测量的重测信度、内部一致性和有效性。使用多变量分析评估了所产生的因素和其他变量之间的关联。共有375例晚期癌症患者接受了研究，其中233例（62.1%）同意参与。COST指标表现出较高的内部一致性和重测信度。因素分析揭示了一个连贯的，单一的，潜在的变量（金融毒性）。发现COST值与收入（相关系数[r] = 0.28; P<.001）、心理社会困扰（r =-0.26; P<.001）和HRQOL相关，如FACT-G（r = 0.42; P<.001）和EORTC QOL工具（r = 0.33; P<.001）所测量的。与经济毒性相关的独立因素有种族（P = 0.04）、就业状况（P<0.001）、收入（P = 0.003）、住院人数（P = 0.01）和心理困扰（P = 0.003）。讨论费用的意愿与财务困境的程度无关（P = 0.49）。COST测量证明了测量财务毒性的可靠性和有效性。其与HRQOL的相关性表明，经济毒性是一种临床相关的以患者为中心的结局。癌症2017;123：476-484。© 2016美国癌症协会。金融毒性综合评分（COST）在一个新的癌症患者样本中得到了验证。与经济毒性相关的独立因素包括种族、就业、收入、住院人数和心理困扰。
Cancer and its treatment lead to increased financial distress for patients. To the authors' knowledge, to date, no standardized patient‐reported outcome measure has been validated to assess this distress. Patients with AJCC Stage IV solid tumors receiving chemotherapy for at least 2 months were recruited. Financial toxicity was measured by the COmprehensive Score for financial Toxicity (COST) measure. The authors collected data regarding patient characteristics, clinical trial participation, health care use, willingness to discuss costs, psychological distress (Brief Profile of Mood States [POMS]), and health‐related quality of life (HRQOL) as measured by the Functional Assessment of Cancer Therapy: General (FACT‐G) and the European Organization for Research and Treatment of Cancer (EORTC) QOL questionnaires. Test‐retest reliability, internal consistency, and validity of the COST measure were assessed using standard‐scale construction techniques. Associations between the resulting factors and other variables were assessed using multivariable analyses. A total of 375 patients with advanced cancer were approached, 233 of whom (62.1%) agreed to participate. The COST measure demonstrated high internal consistency and test‐retest reliability. Factor analyses revealed a coherent, single, latent variable (financial toxicity). COST values were found to be correlated with income (correlation coefficient [r] = 0.28; P<.001), psychosocial distress (r = ‐0.26; P<.001), and HRQOL, as measured by the FACT‐G (r = 0.42; P<.001) and by the EORTC QOL instruments (r = 0.33; P<.001). Independent factors found to be associated with financial toxicity were race (P = .04), employment status (P<.001), income (P = .003), number of inpatient admissions (P = .01), and psychological distress (P = .003). Willingness to discuss costs was not found to be associated with the degree of financial distress (P = .49). The COST measure demonstrated reliability and validity in measuring financial toxicity. Its correlation with HRQOL indicates that financial toxicity is a clinically relevant patient‐centered outcome. Cancer 2017;123:476–484. © 2016 American Cancer Society. The COmprehensive Score for financial Toxicity (COST) is validated in a novel sample of patients with cancer. Independent factors found to be associated with financial toxicity include race, employment, income, number of inpatient admissions, and psychological distress.