Demystifying financial toxicity measures: semi-structured interviews comparing COST-FACIT and ENRICh among cancer survivors on targeted oral anticancer medications (TOAMs)

PURPOSE: Despite increasing efforts to address financial toxicity among patients with cancer, approaches to best identify patients for targeted intervention remain unclear. We compared qualitative accounts of financial toxicity among patients receiving targeted oral anticancer medications (TOAMs) to their scores in two screening tools, the COmprehensive Score for financial Toxicity-Functional Assessment of Chronic Illness Therapy (COST-FACIT) and the Economic Strain and Resilience in Cancer (ENRICh). METHODS: We conducted mixed-methods analysis of adult patients at a comprehensive cancer center. Patients had confirmed cancer diagnoses and orders for TOAMs in the last 3 months. Participants completed surveys (n = 108), and a subset with COST-FACIT scores indicating financial toxicity participated in semi-structured interviews (n = 20). We applied the Framework Method to examine qualitative accounts and developed joint matrices to assess how well each measure identified financial toxicity. RESULTS: Qualitative accounts highlighted two elements of financial toxicity: financial strain and financial worry. For participants with extreme accounts of financial strain and financial worry (n = 6), COST-FACIT and ENRICh scores indicated medium to high levels of financial toxicity. For the rest (n = 14), qualitative accounts of financial strain and financial worry were not completely captured by COST-FACIT and/or ENRICh. CONCLUSION: Our findings suggest a single measure may not adequately identify financial toxicity and differentiate between strain and worry. A stepwise, wholistic approach may better identify and connect patients to appropriate resources. IMPLICATIONS FOR CANCER SURVIVORS: Interventions that address financial toxicity in this group may need to use more than one measure to identify and route patients to targeted intervention.