Assessing financial toxicity with COST-FACIT: experience from a tertiary care cancer center.
7 affiliations
- 1Advocate Health Care, Oak Lawn, IL, USA.
- 2Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA.
- 3Center for Populations Health Research, Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA.
- 4Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
- 5Case Western University, Cleveland, OH, USA.
- 6Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA. [email protected].
- 7Blood and Marrow Transplant Program, Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic, 9500 Euclid Ave CA60, Cleveland, OH, 44195, USA. [email protected].
Abstract
Purpose
Financial toxicity (FT) refers to the direct and indirect consequences of cancer diagnosis and treatment and is a key mediator of quality of life (QOL) and survival in cancer patients. To address this, financial navigation (FN) programs have been implemented in many cancer centers. At our large tertiary care cancer center, the FN program uses the Comprehensive Score for Financial Toxicity (COST) to screen patients undergoing first cancer treatment. We aimed to better understand FT, risk factors, and association with outcomes in our cancer population.Methods
We identified 1906 patients with any cancer diagnosis and a completed COST between 6/2021 and 2/2024. Sociodemographic data including the Area Deprivation Index (ADI), disease, and treatment characteristics as well as patient-reported outcomes (PROMIS10, PHQ9 and NCCN DT) were collected. Risk factors for FT and association of FT on overall survival (OS) were analyzed.Results
Median age was 65 years (IQR 56-72); 54% female, 82% white, 57% married, 47% insured privately, and 35% with Medicare. Younger age, race/ethnicity, insurance type, tobacco use, and higher ADI were associated with higher FT. Higher distress (NCCN DT, N = 1001) and lower physical (N = 1474) and mental (N = 1505) health (PROMIS10) were also associated with higher FT. FT was not associated with time to treat (TTT) or OS. However, higher ADI was significantly associated with TTT (HR 0.98, 95% CI 0.96-1.00, p = 0.04) but not OS.Conclusions
Our study provides insights into risk factors for FT in a large cancer population. We did not demonstrate a significant association of FT on survival. Further analysis in specific disease groups is needed to better understand these relationships.
Related
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- Financial Toxicity Among Disaggregated Asian American Cancer Survivors
- Financial concerns: a critical gap in survivors’ experience of the implementation of the national standards for cancer survivorship care
BibTeX
@article{khan2026assessing,
title = {{Assessing financial toxicity with COST-FACIT: experience from a tertiary care cancer center.}},
author = {Mahir Khan and Elizabeth N Dewey and Colleen Strzalka and Aarushi Bhan and Heather McKee Hurwitz and Holly Stegh and Renata Hurn and Jacqueline Tomer and Sujata Patil and Kim Bell and Betty K Hamilton},
journal = {Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer},
year = {2026},
month = oct,
doi = {10.1007/s00520-026-11344-z},
url = {https://europepmc.org/article/MED/42891838},
note = {CC BY},
}
RIS
TY - JOUR
TI - Assessing financial toxicity with COST-FACIT: experience from a tertiary care cancer center.
AU - Mahir Khan
AU - Elizabeth N Dewey
AU - Colleen Strzalka
AU - Aarushi Bhan
AU - Heather McKee Hurwitz
AU - Holly Stegh
AU - Renata Hurn
AU - Jacqueline Tomer
AU - Sujata Patil
AU - Kim Bell
AU - Betty K Hamilton
PY - 2026
DA - 2026/10/17
JO - Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
DO - 10.1007/s00520-026-11344-z
UR - https://europepmc.org/article/MED/42891838
AB - Purpose Financial toxicity (FT) refers to the direct and indirect consequences of cancer diagnosis and treatment and is a key mediator of quality of life (QOL) and survival in cancer patients. To address this, financial navigation (FN) programs have been implemented in many cancer centers. At our large tertiary care cancer center, the FN program uses the Comprehensive Score for Financial Toxicity (COST) to screen patients undergoing first cancer treatment. We aimed to better understand FT, risk factors, and association with outcomes in our cancer population.Methods We identified 1906 patients with any cancer diagnosis and a completed COST between 6/2021 and 2/2024. Sociodemographic data including the Area Deprivation Index (ADI), disease, and treatment characteristics as well as patient-reported outcomes (PROMIS10, PHQ9 and NCCN DT) were collected. Risk factors for FT and association of FT on overall survival (OS) were analyzed.Results Median age was 65 years (IQR 56-72); 54% female, 82% white, 57% married, 47% insured privately, and 35% with Medicare. Younger age, race/ethnicity, insurance type, tobacco use, and higher ADI were associated with higher FT. Higher distress (NCCN DT, N = 1001) and lower physical (N = 1474) and mental (N = 1505) health (PROMIS10) were also associated with higher FT. FT was not associated with time to treat (TTT) or OS. However, higher ADI was significantly associated with TTT (HR 0.98, 95% CI 0.96-1.00, p = 0.04) but not OS.Conclusions Our study provides insights into risk factors for FT in a large cancer population. We did not demonstrate a significant association of FT on survival. Further analysis in specific disease groups is needed to better understand these relationships.
SN - 0941-4355
SN - 1433-7339
ER -