Navigator-Assisted Hypofractionation (NAVAH) Phase I Clinical Trial of Breast Cancer Patients: Implications for Assessing Personal Versus Familial Financial Toxicity via the Comprehensive Score for Financial Toxicity-Functional Assessment of Chronic Illness Therapy (COST-FACIT) Survey Instrument.

Abstract

Objectives: The COST-FACIT survey has been used to objectively measure financial toxicity (FT). It consists of 11 questions related to FT of an individual and a 12th question ("My illness has been a financial hardship to my family and me"), providing a glimpse beyond individual FT into familial FT. This question does not contribute to the score, and in relation to the first 11 questions, it has not been rigorously evaluated in the past. We present findings from our ongoing phase I clinical trial to evaluate the correlation of familial FT to individual FT.

Methods: This study included African-American adult (18+) breast cancer patients with pathologically confirmed breast cancer undergoing adjuvant radiation therapy (RT). Patients were guided by a patient navigator during and after treatment. COST-FACIT results were amalgamated to find FT in patients before RT. Grade 0 (absent) FT is represented by values from 26 to 44, grade 1 (mild) FT is represented by values from 14 to 25, grade 2 (moderate) FT represented by values from 1 to 13, and grade 3 (severe) FT is represented by a value of 0. Question 12 ranges from 0 to 4, with a higher number meaning more familial distress. The r -value of the comparison between the answer to COST-FACIT question 12 and the COST-FACIT FT score was used to identify a relationship between familial FT and the FT experienced by the individual.

Results: Nearly 90% of patients experiencing individual FT perceive it in their family. Individual FT is strongly correlated with familial FT ( P =0.0001). Overall, patients with higher levels of individual FT indicate higher levels of familial FT, whereas those with lower levels of individual FT indicate lower levels of familial FT.

Conclusion: Our findings indicate a strong correlation between individual FT and familial FT, warranting further investigation into the interconnected impacts on patients and caregivers to better address financial toxicity in cancer care.