USE OF ITEM RESPONSE THEORY TO CREATE MULTI-DIMENSIONAL MEASURES OF FINANCIAL TOXICITY IN CANCER
Author(s)
Salene Jones, MA, PhD1, Matt Barnett, MS2, Jean Yi, PhD2, Nora Henrikson, PhD3, Diana Lowry, MPH2, Renae Lydum, BA2, Laura Elizabeth Panattoni, PhD4.
1Associate Professor, Fred Hutchinson Cancer Center, Seattle, WA, USA, 2Fred Hutchinson Cancer Center, Seattle, WA, USA, 3Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA, 4PPD a part of Thermo Fisher Scientific, Seattle, WA, USA.
1Associate Professor, Fred Hutchinson Cancer Center, Seattle, WA, USA, 2Fred Hutchinson Cancer Center, Seattle, WA, USA, 3Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA, 4PPD a part of Thermo Fisher Scientific, Seattle, WA, USA.
OBJECTIVES: Financial toxicity after cancer diagnosis and treatment is common and can lead to worse quality of life and mortality. Valid and reliable measures of financial toxicity will help identify which patients need assistance.
METHODS: People diagnosed with breast cancer (n=598) within the previous two years were recruited through a cancer registry in the Pacific Northwest of the United States. Diagnoses included all forms of breast cancer including recurrences and second primary. Potential participants received invitations through postal mail and text messages to complete the survey either online or via paper survey in the mail. The survey included item banks assessing four dimensions of financial toxicity that had previously been developed through interviews and a survey of cancer survivors. The two-parameter logistic and graded response item response theory (IRT) models were used to evaluate reliability of each item. Correlations with measures of non-adherence and financial hardship evaluated construct validity.
RESULTS: The 15 items assessing depressive symptoms due to finances, 24 items assessing financial anxiety and 22 items assessing financial consequences (material hardship) all had slope parameters over 1, indicating reliability. One financial coping item (tax deduction) had a slope under 0.5 and was removed. Thirty-eight of the remaining 41 items assessing financial coping (behavioral hardship) had slope parameters over 1. The other three items had slopes between 0.75 and 0.99 and were retained due to the importance of the content for assessing financial coping (change insurance, appealed denial, tracked insurance claims). Correlations (r's range 0.2-0.8) between the four financial toxicity measures and other adherence and financial hardship measures were significant at the 0.0001 level and in the expected directions.
CONCLUSIONS: The four financial toxicity measures were valid and reliable. These measures can be used to assess financial barriers to cancer treatments and identify patients that need additional financial assistance.
METHODS: People diagnosed with breast cancer (n=598) within the previous two years were recruited through a cancer registry in the Pacific Northwest of the United States. Diagnoses included all forms of breast cancer including recurrences and second primary. Potential participants received invitations through postal mail and text messages to complete the survey either online or via paper survey in the mail. The survey included item banks assessing four dimensions of financial toxicity that had previously been developed through interviews and a survey of cancer survivors. The two-parameter logistic and graded response item response theory (IRT) models were used to evaluate reliability of each item. Correlations with measures of non-adherence and financial hardship evaluated construct validity.
RESULTS: The 15 items assessing depressive symptoms due to finances, 24 items assessing financial anxiety and 22 items assessing financial consequences (material hardship) all had slope parameters over 1, indicating reliability. One financial coping item (tax deduction) had a slope under 0.5 and was removed. Thirty-eight of the remaining 41 items assessing financial coping (behavioral hardship) had slope parameters over 1. The other three items had slopes between 0.75 and 0.99 and were retained due to the importance of the content for assessing financial coping (change insurance, appealed denial, tracked insurance claims). Correlations (r's range 0.2-0.8) between the four financial toxicity measures and other adherence and financial hardship measures were significant at the 0.0001 level and in the expected directions.
CONCLUSIONS: The four financial toxicity measures were valid and reliable. These measures can be used to assess financial barriers to cancer treatments and identify patients that need additional financial assistance.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
PCR17
Topic
Patient-Centered Research
Topic Subcategory
Instrument Development, Validation, & Translation
Disease
SDC: Oncology