For cancer patients, the stress of the disease is often compounded by the worry and distress of paying for treatment—a burden known as “financial toxicity”. Measuring this distress is the first step to helping patients. However, it requires a scientifically proven tool. A study from Universitas Padjadjaran along with co-authors from Europe has successfully validated the Indonesian version of the FACIT-COST, the world’s most widely used questionnaire for measuring subjective financial toxicity.

What Was the Study About?

While the FACIT-COST questionnaire is used globally, it has never been formally validated for use in Indonesia. This study aimed to test the official Indonesian version to ensure it is a reliable and accurate tool for measuring the financial distress of local patients. Researchers conducted a prospective study with 300 female breast cancer patients in Bandung, Indonesia, performing a series of rigorous psychometric tests to check the questionnaire’s structure, consistency, and ability to detect changes over time.

What is the FACIT-COST Questionnaire?

The FACIT-COST is a cancer-specific questionnaire that measures subjective financial toxicity—the personal distress a patient feels about the financial burden of their care. It contains of patient’s worries, their perceived financial adequacy, and their sense of control over their finances. Validating this tool is crucial because a questionnaire developed in one country cannot simply be translated for use elsewhere. It must be scientifically tested to ensure it works correctly within a different cultural, economic, and healthcare setting like Indonesia’s.

Key Findings

The study confirmed the tool is effective for use in Indonesia, uncovering several important insights:

• The Indonesian Version is Valid and Reliable.

The research concluded that the Indonesian FACIT-COST has acceptable psychometric performance and can be used to accurately measure subjective financial toxicity. It showed no ceiling or floor effects, meaning it is sensitive enough to capture a wide range of patient experiences.

• It Measures Two Key Aspects of Financial Distress.

In the Indonesian context, the tool works best by measuring two distinct factors: 1) the negative emotional experiences of the financial burden (like worry and frustration) and 2) the patient’s perceived ability to manage that burden.

• It Accurately Identifies At-Risk Patients.

The questionnaire successfully distinguished between different patient groups as expected. For instance, patients who were younger, had lower incomes, lived in rural areas, or had metastatic cancer all showed significantly higher levels of financial toxicity.

• It is Consistent and Sensitive to Change.

The tool demonstrated excellent test-retest reliability, meaning patients gave consistent answers over time. It was also able to accurately detect when a patient’s financial situation improved or worsened.

Why It Matters

This is the first study to validate this crucial tool specifically for a breast cancer population and for use in Indonesia. Healthcare providers in the country now have a trustworthy instrument to screen for and better understand the financial distress their patients are facing. By using this tool to identify patients experiencing high financial toxicity, doctors and hospitals can refer them to social support services. This can help prevent devastating consequences, such as patients stopping their treatment due to cost, and ultimately improve the quality of cancer care across Indonesia.

This is adapted from: Pangestu, S., Purba, F. D., Setyowibowo, H., Mukuria, C., & Rencz, F. (2024). Validity, test-retest reliability, and responsiveness of the Indonesian version of FACIT-COST measure for subjective financial toxicity. Health and Quality of Life Outcomes, 22, Article 89. https://doi.org/10.1186/s12955-024-02303-5