Katrina Hueniken1, Catriona M Douglas2,3, Ashok R Jethwa2,3, Maryam Mirshams4, Lawson Eng4, Andrew Hope5, Douglas B Chepeha2,3, David P Goldstein2,3, Jolie Ringash5, Aaron Hansen4, Rosemary Martino6,7, Madeline Li8, Geoffrey Liu4,9,10, Wei Xu1, John R de Almeida2,3. 1. Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada. 2. Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada. 3. Department of Surgical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada. 4. Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada. 5. Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada. 6. Department of Speech-Language Pathology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada. 7. Krembil Research Institute, University Health Network, Toronto, Ontario, Canada. 8. Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada. 9. Department of Medicine, University of Toronto, Toronto, Ontario, Canada. 10. Department of Epidemiology, Dalla Lana School of Public Health, Toronto, Ontario, Canada.
Abstract
BACKGROUND: The treatment of head and neck cancer (HNC) may cause significant financial toxicity to patients. Herein, the authors have presented the development and validation of the Financial Index of Toxicity (FIT) instrument. METHODS: Items were generated using literature review and were based on expert opinion. In item reduction, items with factor loadings of a magnitude <0.3 in exploratory factor analysis and inverse correlations (r < 0) in test-retest analysis were eliminated. Retained items constituted the FIT. Reliability tests included internal consistency (Cronbach α) and test-retest reliability (intraclass correlation). Validity was tested using the Spearman rho by comparing FIT scores with baseline income, posttreatment lost income, and the Financial Concerns subscale of the Social Difficulties Inventory. Responsiveness analysis compared change in income and change in FIT between 12 and 24 months. RESULTS: A total of 14 items were generated and subsequently reduced to 9 items comprising 3 domains identified on exploratory factor analysis: financial stress, financial strain, and lost productivity. The FIT was administered to 430 patients with HNC at 12 to 24 months after treatment. Internal consistency was good (α = .77). Test-retest reliability was satisfactory (intraclass correlation, 0.70). Concurrent validation demonstrated mild to strong correlations between the FIT and Social Difficulties Inventory Money Matters subscale (Spearman rho, 0.26-0.61; P < .05). FIT scores were found to be inversely correlated with baseline household income (Spearman rho, -0.34; P < .001) and positively correlated with lost income (Spearman rho, 0.24; P < .001). Change in income was negatively correlated with change in FIT over time (Spearman rho, -0.25; P = .04). CONCLUSIONS: The 9-item FIT demonstrated internal and test-retest reliability as well as concurrent and construct validity. Prospective testing in patients with HNC who were treated at other facilities is needed to further establish its responsiveness and generalizability.
BACKGROUND: The treatment of head and neck cancer (HNC) may cause significant financial toxicity to patients. Herein, the authors have presented the development and validation of the Financial Index of Toxicity (FIT) instrument. METHODS: Items were generated using literature review and were based on expert opinion. In item reduction, items with factor loadings of a magnitude <0.3 in exploratory factor analysis and inverse correlations (r < 0) in test-retest analysis were eliminated. Retained items constituted the FIT. Reliability tests included internal consistency (Cronbach α) and test-retest reliability (intraclass correlation). Validity was tested using the Spearman rho by comparing FIT scores with baseline income, posttreatment lost income, and the Financial Concerns subscale of the Social Difficulties Inventory. Responsiveness analysis compared change in income and change in FIT between 12 and 24 months. RESULTS: A total of 14 items were generated and subsequently reduced to 9 items comprising 3 domains identified on exploratory factor analysis: financial stress, financial strain, and lost productivity. The FIT was administered to 430 patients with HNC at 12 to 24 months after treatment. Internal consistency was good (α = .77). Test-retest reliability was satisfactory (intraclass correlation, 0.70). Concurrent validation demonstrated mild to strong correlations between the FIT and Social Difficulties Inventory Money Matters subscale (Spearman rho, 0.26-0.61; P < .05). FIT scores were found to be inversely correlated with baseline household income (Spearman rho, -0.34; P < .001) and positively correlated with lost income (Spearman rho, 0.24; P < .001). Change in income was negatively correlated with change in FIT over time (Spearman rho, -0.25; P = .04). CONCLUSIONS: The 9-item FIT demonstrated internal and test-retest reliability as well as concurrent and construct validity. Prospective testing in patients with HNC who were treated at other facilities is needed to further establish its responsiveness and generalizability.
Authors: Mohemmed N Khan; Katrina Hueniken; Mirko Manojlovic-Kolarski; Lawson Eng; Maryam Mirshams; Khaleeq Khan; Colleen Simpson; Michael Au; Geoffrey Liu; Wei Xu; Christopher J Longo; David P Goldstein; Jolie Ringash; Rosemary Martino; Aaron R Hansen; John R de Almeida Journal: Cancer Rep (Hoboken) Date: 2021-08-24