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Economic and Financial Impacts of Cancer · Journal article
Journal of Cancer Survivorship · September 4, 2026
Early or partial results. Treat as a signal, not a conclusion.
This single-centre mixed-methods study compared how well two financial toxicity screening tools (COST-FACIT and ENRICh) captured qualitative accounts of financial strain and worry in cancer survivors on targeted oral anticancer medications. Among 20 interviewed patients selected for elevated COST-FACIT scores, only 6 with extreme qualitative financial accounts had corresponding high scores on both measures; the remaining 14 showed discordance, suggesting neither tool alone fully captures the construct.
Mixed-methods validation study with survey and semi-structured interviews. Adult patients with confirmed cancer diagnoses and orders for targeted oral anticancer medications in the last 3 months at a comprehensive cancer center. Intervention: Completion of COST-FACIT and ENRICh screening tools; qualitative interviews about financial toxicity. Compared with: Qualitative accounts of financial toxicity compared to scoring on two measures (COST-FACIT and ENRICh). n = 108. Single comprehensive cancer center (location not specified).
Survey participation: 108 adult patients with cancer on targeted oral anticancer medications Qualitative interviews: 20 patients with COST-FACIT scores indicating financial toxicity Among 20 interviewed: 6 participants had extreme accounts of financial strain and worry with concordant medium-to-high measure scores
No gold standard for financial toxicity used; no objective measure of financial hardship reported Qualitative interviews: 20 patients with COST-FACIT scores indicating financial toxicity
Clinicians should be aware that neither COST-FACIT nor ENRICh alone fully identifies financial toxicity in patients on oral anticancer medications; a stepwise, multi-measure approach may be needed to adequately screen and differentiate between financial strain and worry, allowing targeted intervention referrals.
Mixed-methods validation study of two screening tools in a single centre with small qualitative sample (n=20), generating hypothesis that multi-measure approach may be needed rather than establishing superior measurement strategy.
As stated by the source record.
Quoted from the source exactly as published.
Clinicians should be aware that neither COST-FACIT nor ENRICh alone fully identifies financial toxicity in patients on oral anticancer medications; a stepwise, multi-measure approach may be needed to adequately screen and differentiate between financial strain and worry, allowing targeted intervention referrals.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
PURPOSE: Despite increasing efforts to address financial toxicity among patients with cancer, approaches to best identify patients for targeted intervention remain unclear. We compared qualitative accounts of financial toxicity among patients receiving targeted oral anticancer medications (TOAMs) to their scores in two screening tools, the COmprehensive Score for financial Toxicity-Functional Assessment of Chronic Illness Therapy (COST-FACIT) and the Economic Strain and Resilience in Cancer (ENRICh). METHODS: We conducted mixed-methods analysis of adult patients at a comprehensive cancer center. Patients had confirmed cancer diagnoses and orders for TOAMs in the last 3 months. Participants completed surveys (n = 108), and a subset with COST-FACIT scores indicating financial toxicity participated in semi-structured interviews (n = 20). We applied the Framework Method to examine qualitative accounts and developed joint matrices to assess how well each measure identified financial toxicity. RESULTS: Qualitative accounts highlighted two elements of financial toxicity: financial strain and financial worry. For participants with extreme accounts of financial strain and financial worry (n = 6), COST-FACIT and ENRICh scores indicated medium to high levels of financial toxicity. For the rest (n = 14), qualitative accounts of financial strain and financial worry were not completely captured by COST-FACIT and/or ENRICh. CONCLUSION: Our findings suggest a single measure may not adequately identify financial toxicity and differentiate between strain and worry. A stepwise, wholistic approach may better identify and connect patients to appropriate resources. IMPLICATIONS FOR CANCER SURVIVORS: Interventions that address financial toxicity in this group may need to use more than one measure to identify and route patients to targeted intervention.
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