Shim Sungkeun, Kang Danbee, Kim Nayeon, Han Gayeon, Lim Jihyun, Kim Hyunsoo, Park Jeonghyun, Lee Mankyung, Lee Jeong Eon, Kim Seok Won, Yu Jonghan, Chae Byung Joo, Ryu Jai Min, Nam Seok Jin, Lee Se Kyung, Cho Juhee
Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Korea.
Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Korea.
Cancer Res Treat. 2022 Jul;54(3):834-841. doi: 10.4143/crt.2021.784. Epub 2021 Oct 13.
Little is known about the impact of financial toxicity in disease-free breast cancer survivors. We aim to validate the COmprehensive Score for financial Toxicity in Korean (COST-K) and evaluate financial toxicity among disease-free breast cancer survivors.
We conducted linguistic validation following a standardized methodology recommended by Functional Assessment of Chronic Illness Therapy multilingual translation (FACITtrans). For psychometric validation, we conducted a cross-sectional survey with 4,297 disease-free breast cancer survivors at a tertiary hospital in Seoul, Korea between November 2018 and April 2019. Survivors were asked to complete the COST-K and European Organization for Research and Treatment of Cancer Quality of Life Core 30 (EORTC QLQ-C30) questionnaires. The test-retest reliability, internal consistency, and validity of the COST-K were assessed using standard scale construction techniques.
The COST-K demonstrated good internal consistency, with a Cronbach's α of 0.81. The test-retest analysis revealed an intraclass correlation coefficient of 0.78. The COST-K had moderate correlation (r=-0.60) with the financial difficulty item of the EORTC QLQ-C30 and week correlation with the items on acute and chronic symptom burdens (nausea/vomiting, -0.18; constipation, -0.14; diarrhea, -0.14), showing good convergent and divergent validity. The median COST-K was 27 (range, 0 to 44; mean±standard deivation [SD], 27.1±7.5) and about 30% and 5% of cancer survivors experienced mild and severe financial toxicity, respectively. Younger age, lower education, lower household income was associated with higher financial toxicity.
The COST-K is a valid and reliable instrument for measuring financial toxicity in disease-free breast cancer survivors. Considering its impact on the health-related quality of life, more studies need to be conducted to evaluate financial toxicity in cancer survivors and design interventions.
关于无病乳腺癌幸存者中经济毒性的影响，目前所知甚少。我们旨在验证韩国版经济毒性综合评分（COST-K），并评估无病乳腺癌幸存者中的经济毒性。
我们按照慢性病治疗功能评估多语言翻译（FACITtrans）推荐的标准化方法进行语言验证。为进行心理测量学验证，我们于2018年11月至2019年4月在韩国首尔的一家三级医院对4297名无病乳腺癌幸存者进行了横断面调查。要求幸存者完成COST-K和欧洲癌症研究与治疗组织生活质量核心问卷30（EORTC QLQ-C30）。使用标准量表构建技术评估COST-K的重测信度、内部一致性和效度。
COST-K显示出良好的内部一致性，Cronbach's α为0.81。重测分析显示组内相关系数为0.78。COST-K与EORTC QLQ-C30的经济困难项目有中度相关性（r = -0.60），与急性和慢性症状负担项目（恶心/呕吐，-0.18；便秘，-0.14；腹泻，-0.14）相关性较弱，显示出良好的聚合效度和区分效度。COST-K的中位数为27（范围为0至44；均值±标准差[SD]，27.1±7.5），分别约有30%和5%的癌症幸存者经历了轻度和重度经济毒性。年龄较小、教育程度较低、家庭收入较低与较高的经济毒性相关。
COST-K是测量无病乳腺癌幸存者经济毒性的有效且可靠的工具。考虑到其对健康相关生活质量的影响，需要进行更多研究以评估癌症幸存者中的经济毒性并设计干预措施。
