| Objective: This study aimed to introduce the COmprehensive Scores for financial Toxicity based on the patient-reported outcome measure(COST-PROM).According to the language and cultural background of China,the scale was translated and revised into the Chinese version,and its reliability and validity were tested.The classification standard of the Chinese version of COST-PROM was established,and the threshold of each grade was explored.Besides,taking non-small cell lung cancer(NSCLC)as an example,the applicability of Chinese version of COST-PROM was investigated in this study.Meanwhile,the risk factors of the financial toxicity were explored,and the link between financial toxicity and quality of life was clarified to provide theoretical basis for financial toxicity management of cancer patients.Methods:(1)After obtaining the authorization of development team of the source scale,the source scale was translated into simplified Chinese according to the Functional Assessment of Chronic Illness Therapy translation method to form a Chinese version.A total of 114 cancer patients were selected to complete the Chinese version of COST-PROM.Content validity,structural validity,internal consistency,and test-retest reliability were adopted to measure its reliability and validity.(2)Taking the financial hardship subscale of EORTC QLQ-C30 as a reference criteria,the ROC curve and the biggest Youden’s index were operated to acquire the grading criteria and thresholds of the Chinese version of the COST-PROM.(3)The patients with NSCLC who were hospitalized in a tertiary specialized cancer hospital from September 1,2022 to November 30,2022 were selected to identify the current condition of financial toxicity of NSCLC patients.Multivariable linear regression analysis was conducted to investigate the risk factors of financial toxicity and Pearson correlation was used to perform the association between financial toxicity and quality of life.Results:(1)The Chinese version of the COST-PROM contains a total of 11 items,complete content and concise entries.The content validity index of the scale was > 0.80,and 72.091% of the total variation could be explained by the three common factors that were extracted via exploratory factor analysis.The total Cronbach’s α coefficient was0.874 and the test-retest reliability was 0.972(P<0.05).(2)The correlation coefficient between the Chinese version of COST-PROM and the EORTC QLQ-C30 financial hardship subscale was-0.926(P < 0.001),and the areas under ROC curve were all >0.90.The optimal cut-off score for identifying the financial toxicity of the Chinese version of COST-PROM was 23.5,and that for mild and moderate was 16.5,for moderate and severe were 12.5.Consequently,it was classified by following criteria: no financial toxicity(≥24 score),mild(17-23 score),moderate(13-16 score),severe(≤12 score).(3)The financial toxicity of 174 NSCLC patients treated with cancer drugs was(17.3±0.6)score,and 32% of patients reported severe financial toxicity.Multivariate results presented that age and monthly household income could predict accounting for 48.6% of the total variation in financial toxicity.Pearson correlation analysis showed a weak correlation between financial toxicity and quality of life in NSCLC patients(r=0.329,P < 0.001).Conclusion: The Chinese version of COST-PROM presents great reliability and validity,which is suitable for application in the cultural background of China.The classification criteria make it more consummate and its applicability is superior,providing an effective and reliable tool for evaluating the level of financial toxicity in cancer patients in China.Age and monthly household income are important factors affecting financial toxicity of NSCLC patients.In addition,financial toxicity of NSCLC patients affects quality of life to a certain extent. |
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