Best of the Best Oral Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2020

Validation of a modified instrument to assess the financial impact of cancer treatment on Australian patients and families (#92)

Richard De Abreu Lourenco 1 , Patsy Kenny 1 , Bora Kim 2 , Lucy Lehane 3 , Judith Fethney 4 , Kate White 2 5
  1. Centre for Health Economics Research and Evaluaion (CHERE), University of Technology, Sydney, NSW, Australia
  2. Cancer Care Research Unit, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
  3. Chris O'Brien Lifehouse, Medical Oncology, Camperdown, NSW, Australia
  4. School of Nursing and Midwifery, University of Sydney, Camperdown, NSW, Australia
  5. Sydney District Nursing, Sydney Local Health District , Sydney, NSW, Australia


Cancer can have a prolonged impact on the financial wellbeing of patients and their families. It is crucial to have a reliable tool to assess and identify those at risk of financial distress and provide supportive measures as necessary.


Purpose: The comprehensive score for financial toxicity (COST) tool was developed to measure the financial distress of cancer patients in the USA. The use of the COST tool in an Australian population has not been validated. This study aims to validate and adapt the COST tool for Australian cancer patients.



18 patients (mean age 58, range 20-83) and 2 family members were interviewed and provided feedback on the clarity and relevance of the COST tool. Qualitative data were mapped against the COST items to assess transferability (or applicability) to an Australian population. Four new items were identified and added to the existing COST tool: (1) financial stability, (2) financial impact of cancer treatment on family, (3) knowledge of available financial assistance and (4) income support services. The resulting 15-item tool was administered to Australian cancer patients. Internal consistency reliability was evaluated with Cronbach’s alpha and mean (SD) scores were calculated.



122 patients completed the modified tool. Cronbach’s alpha was 0.90 for the original 11-item scale, reflecting its transferability to Australia, 0.91 for the 15-item scale and 0.72 for the 4-item scale.  Mean item score (range 0-4) for the 11-item scale was 1.80 (SD 0.97) and 2.10 (SD 1.04) for the additional 4 items, highlighting the relevance of these new items.



This study validates the use of a modified COST tool to measure the financial distress of Australian cancer patients and their families. This is critical to allow health providers to identify cancer patients and families in financial distress so that they can be offered appropriate assistance.