Constructing the scale to measure financial toxicity in cancer patients for Low-middle income countries (FT-LM) by using the modified Delphi method.

backgroundLower socioeconomic status is associated with increased incidence and poorer treatment outcomes among cancer patients. Most of the studies related to financial toxicity have been done in high income countries and hence tools to capture the same are not relevant to our context. This study incorporated multiple cancer hospitals of Nepal with an intent to develop a scale for assessing the financial toxicity in cancer patients in Low middle income countries (LMICs), recognizing a gap in existing literature and measurement tools predominantly developed for high income countries.

methodsThe study employed a modified Delphi method to develop and finalize the financial toxicity scale. A series of questionnaires or 'rounds' were used to gather information in a very organised way. Rounds are held until group consensus is reached. The robustness of the final items and scale in effectively capturing the financial distress in cancer patients was evaluated by descriptive statistical analyses (Interquartile Range ≤ 1, and Level of Agreement ≥ 75%), content validity analysis (I-CVI ≥ 0.78) and Kendall's Coefficient of Concordance analysis using SPSS software version 27.

resultsThrough three rounds of modified Delphi surveys and retaining only the items that fulfilled the statistical criteria, a scale with 18 items was constructed. The agreement level increased substantially from the first to the third round suggesting a more uniform agreement among the experts for the scale with Kendall's Coefficient of Concordance analysis (X2 (17, N = 42) = 436.859, W = 0.612, p < 0.01) after third round. The constructed scale comprised of 18 items organized into five overarching thematic areas: "Affordability of treatment", "Compromising on family needs", "Compromising on treatment", "Mental stress" and "Leaving treatment due to financial issues".

conclusionEmploying qualitative and quantitative methods, the study used extensive literature reviews, expert opinions, and Delphi surveys to develop a scale for measuring financial toxicity. Notably, the practical implications of this study extend to various stakeholders, offering valuable insights for cancer treating institutes, and policymakers to look for essential mitigation strategies relating to financial distress in cancer patients.