Development of a rapid tool for screening financial toxicity based on the comprehensive score for financial toxicity

Objective

This study aimed to use item response theory (IRT) to develop and validate a short version of the Chinese COmprehensive Score for financial Toxicity (COST-S-C) in patients with cancer.

Methods

A total of 500 patients with cancer participated in the survey. Confirmatory factor analysis (CFA) was used to assess the factor structure of the COST-S-C. A two-parameter IRT model was used to examine the item fit of the COST-S-C. Item discrimination, item characteristic curves (ICCs), item information curves (IICs), and item fit were estimated. Differential item functioning (DIF) was assessed for participants’ gender and age. Reliability, convergent and discriminant validity was examined as well as estimating the optimal cut-off points of the COST-S-C.

Results

The CFA results supported the bi-factor structure of the COST-S-C. The IRT analysis findings revealed that several items showed problems with the ICCs, providing little information in terms of IICs as well as poor discrimination. Item 5 showed a negligible DIF problem with age. A valid 3-item COST-S-C scale and its optimal cut-off point was developed.

Conclusions

The COST-S-C is a valid and quick screening tool used to distinguish patients with cancer who report significant financial toxicity in various medical settings.