| Objectives:This study was aimed to introduce the international scale COST,which was designed to measure the financial toxicity among older cancer patients in China and to indigenize it through optimization.Further,this study was to explore and verify the dimensionality of the optimized scale,and to analysis its applicability and practicability in the older cancer patients of Chinese backgrounds.Methods:1.The original COST scale was revised according to Chinese social-cultural backgrounds and the characteristics of older cancer patients.The items was established through literature review,the formal investigation were determined through experts evaluation and group discussion.205 old cancer patients were selected as study objects from three grade A hospitals in Jinan from August to September 2021.All of the data were recorded into Epidata3.1 and were processed by SPSS 26.0 and Mplus8.0.The survey results were used to evaluate the psychometric indicators of the optimized version of the scale.The reliability and validity of the optimized version of COST scale were evaluated using Cronbach’s a coefficient,test-retest reliability and construct validity.2.During October and November of 2021,questionnaire survey was used to issue general condition questionnaire,a optimized version of COST,324 old cancer patients from three grade A hospitals in Jinan by cluster sampling method.All of the data were recorded into Epidata3.1 and were processed by SPSS 26.0 and Mplus8.0.Survey to understand the status of financial toxicity of cancer patients,analyze their influencing factors,and explore potential types in older cancer patients through latent profile analysis(LPA).Results:1.The optimized version of the COST scale contains 10 items.The total Cronbach’s a coefficient of the optimized version of COST was 0.891 and the test-retest reliability(ICC)was 0.851.Two common factors were extracted by EFA,explaining 65.03%of the total variation.Each item has a higher factor load in its corresponding dimension(>0.4),KMO=0.815,x2=593.62.The CFA results proved that the two-factor model has a good fit:χ2/df=2.071,RMSEA=0.103,GFI=0.880,AGFI=0.806,CFI=0.939,IFI=0.941,NFI=0.891,RFI=0.856,TRL=0.894.2.Use the optimized version of the COST scale to measure the financial toxicity level of old cancer patients.324 patients with an average age of(69.0±5.8)years.The total score of the scale is(12.6±9.8)points,and 54%of the patients had financial toxicity scores less than the median score of 11.The age,monthly family income,employment state,degree of education,the type of medical insurance,and living alone were the influencing factors of financial toxicity.The multiple linear regression results showed that the age,monthly family income and degree of education has significantly influenced financial toxicity among older cancer survivors.3.The LPA of the financial toxicity characteristics of old cancer patients in the survey.The outcome indicators indicate that there are three categories(subgroups)of patients based on this trait.They are defined as:"high-anxiety financial toxicity"(53%,n=172),"mediumforced financial toxicity"(35.5%,n=114),"low-burden financial toxicity"(11.5%,n=38).The result of the multiple logistic models indicated that age,monthly family income,degree of education,employment status and living alone both significantly predicted the financial toxicity.Conclusions:1.The optimized COST scale was proved to have good psychometric properties and practical performance.It could be used as a standardized measuring tool for the measure financial toxicity based on the experience of older cancer patients.2.There was heterogeneity in the financial toxicity among older cancer patients.At three subgroups of older cancer patients were identified,as those who experience different levels of financial toxicity.The identification of patients with different characteristics can be used to guide "patient-centered" supportive interventions to reduce financial toxicity. |
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