Prospective Survey of Financial Toxicity Measured by the Comprehensive Score for Financial Toxicity in Japanese Patients With Cancer

PURPOSE We previously reported on the pilot study assessing the feasibility of using the Japanese translation of the Comprehensive Score for Financial Toxicity (COST) tool to measure financial toxicity (FT) among Japanese patients with cancer. In this study, we report the results of the prospective survey assessing FT in Japanese patients with cancer using the same tool. PATIENTS AND METHODS Eligible patients were receiving chemotherapy for a solid tumor for at least 2 months. In addition to the COST survey, socioeconomic characteristics were collected by using a questionnaire and medical records. RESULTS Of the 191 patients approached, 156 (82%) responded to the questionnaire. Primary tumor sites were colorectal (n = 77; 49%), gastric (n = 39; 25%), esophageal (n = 16; 10%), thyroid (n = 9; 6%), head and neck (n = 4; 3%), and other (n = 11; 7%). Median COST score was 21 (range, 0 to 41; mean ± standard deviation, 12.1 ± 8.45), with lower COST scores indicating more severe FT. On multivariable analyses using linear regression, older age (β, 0.15 per year; 95% CI, 0.02 to 0.28; P = .02) and higher household savings (β, 8.24 per ¥15 million; 95% CI, 4.06 to 12.42; P < .001) were positively associated with COST score; nonregular employment (β, −5.37; 95% CI, −10.16 to −0.57; P = .03), retirement because of cancer (β, −5.42; 95% CI, −8.62 to −1.37; P = .009), and use of strategies to cope with the cost of cancer care (β, −5.09; 95% CI, −7.87 to −2.30; P < .001) were negatively associated with COST score. CONCLUSION Using the Japanese version of the COST tool, we identified various factors associated with FT in Japanese patients with cancer. These findings will have important implications for cancer policy planning in Japan.

Download Full-text

Cost savings of biosimilars in oncology: A single institution experience.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.29_suppl.10 ◽

2020 ◽

Vol 38 (29_suppl) ◽

pp. 10-10

Author(s):

Megan Mullalley ◽

Whitney Mortensen ◽

Phillip Barnette ◽

Bradley Hunter ◽

Terence Duane Rhodes ◽

...

Keyword(s):

Single Dose ◽

Lower Cost ◽

Cost Savings ◽

Financial Toxicity ◽

Single Institution ◽

Patients With Cancer ◽

Medical Oncologists ◽

Oncology Care ◽

Intermountain Healthcare ◽

The Cost

10 Background: Biosimilar medications have increasingly gained regulatory approvals in recent years. Numerous conditions in the fields of hematology, oncology, rheumatology, and endocrinology have a biosimilar treatment option available. Some biosimilar agents can be obtained at a significantly lower cost than reference medications. Methods: Intermountain Healthcare Oncology Pharmacy and Therapeutics (P&T) committee manages and maintains the formulary of accepted drugs. The committee consists of pharmacists, medical oncologists and oncology nurses. Biosimilar medications were approved in place of reference medications for the following: pegfilgrastim, bevacizumab, trastuzumab, and rituximab. Results: Annually, we administer about 6,450 combined doses of pegfilgastrim, bevacizumab, trastuzumab, and rituximab. Assuming 70% conversion from the reference medication to biosimilar agent, transitioning from the above listed reference medications to biosimilar would save an estimated $6.3 million annually (Table). This includes a $1.75 million savings from transitioning to rituximab alone. In addition, transitioning trastuzumab from a single dose vial to multi-dose vials is estimated to save an addition $730,000. Conclusions: Biosimilar agents can reduce the cost of oncology care to patients treated at our institution. We are utilizing biosimilar agents as part of our ongoing mission to decrease the financial toxicity of treatment for patients with cancer. [Table: see text]

Download Full-text

A prospective survey of comprehensive score for financial toxicity in Japanese cancer patients: report on a pilot study

ecancermedicalscience ◽

10.3332/ecancer.2018.847 ◽

2018 ◽

Vol 12 ◽

Cited By ~ 5

Author(s):

Kazunori Honda ◽

Bishal Gyawali ◽

Masashi Ando ◽

Keiji Sugiyama ◽

Seiichiro Mitani ◽

...

Keyword(s):

Pilot Study ◽

Cancer Patients ◽

Financial Toxicity ◽

Prospective Survey ◽

Comprehensive Score

Download Full-text

Do Patients and Oncologists Discuss the Cost of Cancer Treatment? An Observational Study of Clinical Interactions Between African American Patients and Their Oncologists

Journal of Oncology Practice ◽

10.1200/jop.2016.015859 ◽

2017 ◽

Vol 13 (3) ◽

pp. e249-e258 ◽

Cited By ~ 15

Author(s):

Lauren M. Hamel ◽

Louis A. Penner ◽

Susan Eggly ◽

Robert Chapman ◽

Justin F. Klamerus ◽

...

Keyword(s):

Social Support ◽

African American ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Financial Toxicity ◽

Younger Patients ◽

Patients With Cancer ◽

The Cost ◽

Clinical Interactions ◽

The Impact

Purpose: Financial toxicity negatively affects patients with cancer, especially racial/ethnic minorities. Patient-oncologist discussions about treatment-related costs may reduce financial toxicity by factoring costs into treatment decisions. This study investigated the frequency and nature of cost discussions during clinical interactions between African American patients and oncologists and examined whether cost discussions were affected by patient sociodemographic characteristics and social support, a known buffer to perceived financial stress. Methods Video recorded patient-oncologist clinical interactions (n = 103) from outpatient clinics of two urban cancer hospitals (including a National Cancer Institute–designated comprehensive cancer center) were analyzed. Coders studied the videos for the presence and duration of cost discussions and then determined the initiator, topic, oncologist response to the patient’s concerns, and the patient’s reaction to the oncologist’s response. Results: Cost discussions occurred in 45% of clinical interactions. Patients initiated 63% of discussions; oncologists initiated 36%. The most frequent topics were concern about time off from work for treatment (initiated by patients) and insurance (initiated by oncologists). Younger patients and patients with more perceived social support satisfaction were more likely to discuss cost. Patient age interacted with amount of social support to affect frequency of cost discussions within interactions. Younger patients with more social support had more cost discussions; older patients with more social support had fewer cost discussions. Conclusion: Cost discussions occurred in fewer than one half of the interactions and most commonly focused on the impact of the diagnosis on patients’ opportunity costs rather than treatment costs. Implications for ASCO’s Value Framework and design of interventions to improve cost discussions are discussed.

Download Full-text

Relationship between the cancer-specific comprehensive score for financial toxicity (COST), patient-reported outcome, and health-related quality of life (HRQOL) in patients with advanced cancers.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.31_suppl.222 ◽

2014 ◽

Vol 32 (31_suppl) ◽

pp. 222-222 ◽

Cited By ~ 2

Author(s):

Jonas A. De Souza ◽

Bonnie J. Yap ◽

Fay J. Hlubocky ◽

Christopher Daugherty

Keyword(s):

Social Desirability ◽

Convergent Validity ◽

Patient Reported Outcome ◽

Small Sample ◽

Mood States ◽

Financial Toxicity ◽

Divergent Validity ◽

Patient Reported ◽

The Cost ◽

Comprehensive Score

222 Background: Financial toxicity is an important Patient Reported Outcome (PRO). Its relationship with HRQOL has not been previously described. Therefore, we report the relationship between financial toxicity and HRQOL in patients with advanced cancers. Methods: HRQOL was measured by the EORTC QLC-C30 global health status and its functional scales. Financial toxicity was assessed by the COST (COmprehensive Score for financial Toxicity), a cancer-specific PRO measure developed in 155 patients with advanced cancers. The Personal Financial Wellness Scale (PFW), a non-cancer specific financial measure, as well as the EORTC perceived financial impact (FI), were used to assess convergent validity. The Marlowe-Crowne Social Desirability Scale and the Brief Profile of Mood States were included to demonstrate divergent validity (i.e., no significant relationship should exist between self-reported financial toxicity and social desirability and total mood disturbance). Spearman’s correlation coefficients were used to assess the strength of relationships. Results: Fifty patients were assessed. All participants were diagnosed with advanced cancers, were receiving treatment at the time of participation, and had received treatment for at least 3 months. A negative correlation existed between the COST and HRQOL as measured by the EORTC (r = -0.32, p < 0.05). The highest correlation was found between COST and the EORTC Emotional Functioning Scale (r = - 0.34, p < 0.05). The COST had high correlations with the PFW scale (r = 0.86, p<0.0001) and FI (r = 0.74, p < 0.0001), indicating convergent validity. The association between financial toxicity and social desirability and mood states were not statistically significant (r = 0.16, p = 0.28 and 0.20, p = 0.15, respectively), indicating divergent validity. Conclusions: Results demonstrate an inverse relationship between patient-reported HRQOL and financial toxicity, suggesting that higher financial toxicity is associated with worse HRQOL in this small sample of patients. There was no correlation between COST and social desirability and mood disturbances, as expected.

Download Full-text

Attitudes about chemotherapy for Japanese patients with or without cancer: Doctors, nurses, and the general public

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.17062 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 17062-17062

Author(s):

K. Kubota ◽

K. Nagai ◽

Y. Nishiwaki ◽

T. Sugiura ◽

S. Tsuchiya ◽

...

Keyword(s):

Cancer Patients ◽

Cost Benefit ◽

Japanese Patients ◽

Control Group ◽

Intensive Chemotherapy ◽

Prospective Survey ◽

Personal Cost ◽

Patients With Cancer ◽

Study Results ◽

Minimal Benefit

17062 Background: A prospective survey in England demonstrated that patients with cancer were much more likely to accept radical treatment with minimal chance of benefit than people who did not have cancer (Slevin et al. Br Med J 1990; 300: 1458–60). We compared responses of Japanese patients with cancer with those of a control group of physicians, nurses, and patients without cancer in assessing personal cost-benefit of chemotherapy using the same questionnaire with Slevin's study. Methods: Subjects were asked with questionnaires whether of not to accept intensive and mild chemotherapy with a supposed minimum chance of effectiveness. 153 patients with cancer, 265 controls, 213 doctors, 397 nurses, and 51 patients without cancer were subjects of the study. Results: Percentage of subjects who accepted intensive chemotherapy with a supposed minimum chance of effectiveness (1% chance of cure, 3-month prolonging life, 1% relief of symptoms) by subject group were as follows: cancer patients; 62/55/52, doctors; 27/32/4, nurses; 11/12/5, non-cancer patients; 35/40/36, controls; 23/24/15, respectively. Conclusions: More patients with cancer than people without cancer accepted treatments giving the minimal benefit for cure, prolonging life or palliation of symptoms. Interestingly, the results in Japanese survey were similar to the previous study in England. No significant financial relationships to disclose.

Download Full-text

Re-Validation of the COmprehensive Score for Financial Toxicity (COST): Assessing the Scale’s Utility in Chronic Disease Populations

Health Services Insights ◽

10.1177/11786329211057352 ◽

2021 ◽

Vol 14 ◽

pp. 117863292110573

Author(s):

G Pavela ◽

M Fifolt ◽

SE Tison ◽

M Allison ◽

BS Burton ◽

...

Keyword(s):

Psychometric Properties ◽

Internal Consistency ◽

Chronic Conditions ◽

Convergent Validity ◽

Well Being ◽

Financial Toxicity ◽

Patient Reported ◽

Good Internal Consistency ◽

The Cost ◽

Comprehensive Score

Objective: To report the psychometric properties of the COmprehensive Score for financial Toxicity (COST) patient-reported outcome measure (PROM), an 11-item scale previously validated among patients diagnosed with cancer and receiving chemotherapy. Methods: Data come from a cross-sectional survey (n = 2755 response rate of 87%) of participants in a remote digital health coaching intervention collected between January 2017 and February 2019. Results: COST demonstrated very good internal consistency ( Cronbach’s alpha = .89) and good convergent validity. Lower financial toxicity was associated with improved physical and mental well-being HRQOL measures after controlling for covariates ( b = 0.13, P < .0001; b = 0.28, P < .0001, respectively). Supplemental analyses indicated that the COST instrument loaded on 2 factors. Conclusions: The COST measure of financial toxicity has good internal consistency and predictive validity in a sample of patients with chronic conditions. However, contrary to previous research examining the psychometric properties of COST in a sample of individuals with cancer, which found COST to be unidimensional, our analyses indicated that the COST measure of financial toxicity is multidimensional in a sample of individuals with chronic conditions. In particular, the items that asked about “general financial wellbeing” loaded on the second factor while “illness-related financial wellbeing” loaded on the first.

Download Full-text

A prospective survey of comprehensive score for financial toxicity (COST) in Japanese cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.15_suppl.e22128 ◽

2018 ◽

Vol 36 (15_suppl) ◽

pp. e22128-e22128

Author(s):

Kazunori Honda ◽

Bishal Gyawali ◽

Masashi Ando ◽

Kyoko Kato ◽

Yuki Kojima ◽

...

Keyword(s):

Cancer Patients ◽

Financial Toxicity ◽

Prospective Survey ◽

Comprehensive Score

Download Full-text

Whole exome sequencing and deep sequencing of esophageal squamous cell carcinoma and adenocarcinoma in Japanese patients using the Japanese version of the Genome Atlas, JCGA

Esophagus ◽

10.1007/s10388-021-00835-z ◽

2021 ◽

Author(s):

Eisuke Booka ◽

Yasuhiro Tsubosa ◽

Tomoya Yokota ◽

Shuhei Mayanagi ◽

Kenjiro Ishii ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Esophageal Cancer ◽

Cell Carcinoma ◽

Squamous Cell ◽

Somatic Mutations ◽

Molecular Targets ◽

Japanese Version ◽

Japanese Patients ◽

Genetic Alterations ◽

Genome Atlas

Abstract Background Recent comprehensive mutation analyses have revealed a relatively small number of driver mutations in esophageal cancer, implicating a limited number of molecular targets, most of which are also implicated in squamous cell carcinoma. Methods In this study, we investigated genetic alterations in 44 esophageal squamous cell carcinomas (ESCC) and 8 adenocarcinomas (EAC) from Japanese patients as potential molecular targets, based on data from the Japanese version of The Genome Atlas (JCGA). Results Esophageal cancer was characterized by TP53 somatic mutations in ESCC (39/44, 88.6%) and EAC (5/8, 62.5%). In addition to TP53 mutations, somatic mutations in NFE2L2 (16/44, 36.4%), CDKN2A (7/44, 15.9%), and KMT2D (7/44, 15.9%) were more frequently detected in ESCC than in EAC. WRN-truncated type mutations that lead to genomic instability correlate with EAC, but not ESCC. ESCC samples were enriched in ALDH2-associated mutational signature 16 as well as the APOBEC signature. Patients with FAT2 mutations had significantly poorer overall survival compared with those with wild-type status at FAT2 (p < 0.05). Patients with EP300 or PTPRD mutations also had poor progression-free survival compared with respective wild-types (p < 0.05 or p < 0.001). Conclusions These findings may facilitate future precision medicine approaches based on genomic profiling in ESCC and EAC.

Download Full-text