For Cancer Patients, A New Tool Predicts Financial Pain

Sample statements from the Comprehensive Score for Financial Toxicity (COST) tool questionnaire.

Sample statements from the Comprehensive Score for Financial Toxicity (COST) tool questionnaire.

The cost of health care in the United States is rising faster than the gross domestic product. The cost of cancer care is rising faster than the cost of health care, and the cost of new cancer drugs is rising faster than the cost of overall cancer care.

This rapid escalation is causing a new side effect for cancer. Along with the distress that comes with a cancer diagnosis and the discomforts of treatment, more patients now have to deal with “financial toxicity,” the expense, anxiety and loss of confidence confronting those who face large, unpredictable costs, often compounded by decreased ability to work.

Jonas de Souza, MD

Jonas de Souza, MD

Financial pain may extend beyond treatment. A recent study from the Centers for Disease Control and Prevention found that 30 percent of cancer survivors are not able to return to work, or have decreased ability to work. Annual medical expenditures increase by more than $4,000 for males who have had cancer and by nearly $3,300 for females.

In the July issue of Cancer, a team of University of Chicago cancer specialists describe the first tool — 11 questions, assembled and refined from conversations with more than 150 patients with advanced cancer — to measure a patient’s risk for, and ability to tolerate, financial stress. The researchers named their patient-reported outcome measure COST (COmprehensive Score for financial Toxicity).

“Few physicians discuss this increasingly significant side effect with their patients,” said study author Jonas de Souza, MD, a head-and-neck cancer specialist at the University of Chicago Medicine. “Physicians aren’t trained to do this. It makes them, as well as patients, feel uncomfortable,” he said. “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.”

Read more about the COST tool in our Newsroom.

de Souza J.A., Fay J. Hlubocky, Kristen Wroblewski, Mark J. Ratain, David Cella & Christopher K. Daugherty (2014). The development of a financial toxicity patient-reported outcome in cancer: The COST measure, Cancer, n/a-n/a. DOI:


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