Medical School, University of Western Australia, Nedlands, Western Australia, Australia.
School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, Western Australia, Australia.
Asia Pac J Clin Oncol. 2021 Aug;17(4):377-387. doi: 10.1111/ajco.13508. Epub 2021 Feb 10.
AIM/BACKGROUND: The FACT COST is a patient-rated measure of financial toxicity, developed and validated in a North American population. We aimed to confirm the validity and reliability of the FACT COST in Australian cancer patients, because the Australian healthcare funding structure is different to that in North America.
A single center, cross-sectional study design investigated financial toxicity in oncology outpatients. Eligible adults had current malignancy, with or without active cancer treatment. The primary endpoint was the degree of financial toxicity experienced via the COST questionnaire; secondary endpoints included health-related quality of life (Functional Assessment of Cancer Therapy-General), anxiety, and depression (Hospital Anxiety and Depression Scale). Clinical and demographic data were recorded. Statistical analysis determined the internal consistency, test-retest reliability and validity of COST, and correlations between COST score and secondary endpoints.
A total of 257 patients participated (79% response rate). Fifty-three percent were female; median age 63 years (range 19-88). COST scores were skewed toward less financial toxicity, median 26 (SD 10.3, range 1-43), lower scores indicating higher toxicity. High internal consistency (Cronbach's α = 0.884), test-retest reliability (ICC = 0.801), and convergent validity were demonstrated. Financial toxicity was greatest in younger participants, those with more inpatient admissions, those with a change in employment status following diagnosis, and those in the lowest income quintile. Financial toxicity was associated with worse health-related quality of life, and greater depression and anxiety.
The COST measure of financial toxicity demonstrated acceptable validity parameters in an Australian outpatient population. Greater financial toxicity was associated with worse psychological well-being and with certain patient demographics.
目的/背景：FACT-COST 是一种患者自评的经济毒性测量工具，由北美人群开发和验证。我们旨在确认 FACT-COST 在澳大利亚癌症患者中的有效性和可靠性，因为澳大利亚的医疗保健资金结构与北美的不同。
一项单中心、横断面研究设计调查了肿瘤门诊患者的经济毒性。符合条件的成年人有当前的恶性肿瘤，无论是否有积极的癌症治疗。主要终点是通过 COST 问卷评估的经济毒性程度；次要终点包括健康相关生活质量（癌症治疗功能评估-一般）、焦虑和抑郁（医院焦虑和抑郁量表）。记录临床和人口统计学数据。统计分析确定了 COST 的内部一致性、重测信度和有效性，以及 COST 评分与次要终点之间的相关性。
共有 257 名患者参与（79%的应答率）。53%为女性；中位年龄 63 岁（范围 19-88）。COST 评分偏向于较少的经济毒性，中位数为 26（SD 10.3，范围 1-43），得分越低表明毒性越高。高内部一致性（Cronbach's α=0.884）、重测信度（ICC=0.801）和收敛效度得到证实。年轻患者、住院次数较多的患者、诊断后就业状况发生变化的患者以及收入最低五分位数的患者经济毒性最大。经济毒性与较差的健康相关生活质量以及更大的抑郁和焦虑相关。
在澳大利亚门诊人群中，COST 经济毒性测量工具具有可接受的有效性参数。更大的经济毒性与更差的心理幸福感以及某些患者人口统计学特征相关。
