Development and validation of FinTox: A new screening tool to assess cancer‐related financial toxicity

Abstract

Abstract Purpose This study aimed to develop and validate FinTox, a concise tool for screening and managing financial toxicity in oncology settings. Methods Development involved qualitative interviews with healthcare providers and patients, and feedback from a 7‐member expert panel resulting in a 5‐item measure that evaluates financial strain, psychological responses, and care modifications. Psychometric evaluations examined factor structure, internal consistency, test–retest reliability, and concurrent and convergent validity. Associations between FinTox scores and sociodemographic/medical factors were also analyzed using univariate and multivariable regression models. Results Twelve healthcare providers and 20 patients were interviewed, and 268 patients (69.8% female, 47.4% non‐Hispanic White) completed surveys including FinTox, the Comprehensive Score for Financial Toxicity (COST), health‐related quality of life (HRQOL) measures, and sociodemographic questions. FinTox demonstrated excellent internal consistency (Cronbach's alpha = 0.90) and test–retest reliability (ICC = 0.95). Significant correlations with the COST (r = −0.62, p < 0.001) and HRQOL measures corroborated content and convergent validity. Diagnostic accuracy was evidenced by a sensitivity of 72.3%, specificity of 85.2%, positive predictive value of 83.2%, and negative predictive value of 70.3%. Higher FinTox scores were also associated with receiving care at a safety‐net hospital, Black race, household income <600% of the federal poverty level, and Stage 4 cancer. Conclusion FinTox's robust psychometric properties and diagnostic accuracy position it as a reliable tool for detecting financial toxicity. Future research should evaluate its responsiveness to changes over time and integration into clinical workflows.

Keywords

• financial hardship
• financial toxicity
• measure
• psychometric validation
• screening tool