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COST: A FACIT Measure of Financial Toxicity

For financial toxicity



Developed in conjunction with the University of Chicago, the COST is a patient-reported outcome measure that describes the financial distress experienced by cancer patients. Since its initial publication, an additional item from the FACIT System has been included to screen for financial toxicity and to provide a good global summary item for financial toxicity.


COST: A FACIT Measure of Financial Toxicity (FACIT-COST)






Cancer patients 18 years and older


Past 7 days


5 point Likert type scale


Paper and electronic


Self-administration and interview when applicable


Financial Toxicity


Less than 5 minutes


Manual scoring template, some items are reverse scored. Total scores possible.


Language Availability

Available translations of the COST can be obtained by registering for permission. Users are not permitted to translate the COST without permission from Permission from to translate the COST may also be contingent upon timeline expectations and availability of FACIT staff. Translations must undergo a rigorous methodology under the guidance of which includes multiple translators, QA steps and cognitive interviews with patients. For commercial use, FACITtrans is the approved translation vendor to translate the FACIT measurement system.

Please contact us for more information.

Language Availability


Licensing fees are assessed on a per trial/per measure basis for commercial use. There is no fee for use of the English version, but a license should be obtained.

Non-commercial use is assessed on a case-by-case basis. Licensing fees are typically not applied to investigator-initiated research, students, or clinical use.

To license an available version of this measure for commercial or non-commercial use, please complete our registration form. All of the information provided in the form will be kept strictly confidential. For questions, please contact us.

Selected References

Selected References

de Souza J.A., Yap B.J., Wroblewski K., Blinder V., Araújo F.S., Hlubocky F.J., Nicholas L.H., O'Connor J.M., Brockstein B., Ratain M.J., Daugherty C.K., Cella D. Measuring financial toxicity as a clinically relevant patient-reported outcome: The validation of the COmprehensive Score for financial Toxicity (COST). Cancer 2017 Feb 1;123(3):476-484. doi: 10.1002/cncr.30369. Epub 2016 Oct 7. PMID: 27716900; PMCID: PMC5298039.

Sadigh, G., Switchenko, J., Weaver, K.E. et al. Correlates of financial toxicity in adult cancer patients and their informal caregivers. Support Care Cancer (2021).

Ezeife D.A., Morganstein B.J., Lau S., Law J.H., Le L.W., Bredle J., Cella D., Doherty M.K., Bradbury P., Liu G., Sacher A., Shepherd F.A., Leighl N.B. Financial Burden Among Patients with Lung Cancer in a Publically Funded Health Care System. Clin Lung Cancer 2019 Jul;20(4):231-236. doi: 10.1016/j.cllc.2018.12.010. Epub 2018 Dec 22. PMID: 30797721.

Huntington S.F., Weiss B.M., Vogl D.T., Cohen A.D., Garfall A.L., Mangan P.A., Doshi J.A., Stadtmauer E.A. Financial toxicity in insured patients with multiple myeloma: a cross-sectional pilot study. Lancet Haematol2015 Oct;2(10):e408-16. doi: 10.1016/S2352-3026(15)00151-9. Epub 2015 Sep 17. PMID: 26686042.

Patel MR, Zhang G, Heisler M, Song PXK, Piette JD, Shi X, Choe HM, Smith A, Resnicow K. Measurement and validation of the Comprehensive Score for financial toxicity (COST) in a population with diabetes. Diabetes Care, 2022 (In Press).

Bonomi, A.E., Cella, D.D., Hahn, E.A., Bjordal, K., Sperner, B., Gangeri, L., Bergman, B., Willems, J., Hanquet, P., & Zittoun, R. Multilingual translation of the Functional Assessment of Cancer Therapy (FACT) quality of life measurement system. Quality of Life Research 1996; 5: 309-320.

Eremenco, S., Arnold, B., Cella, D. A comprehensive method for the translation and cross-cultural validation of health status questionnaires. Evaluation & the Health Professions 2005; 28(2): 212-232.

Webster K., Cella D., Yost K. The Functional Assessment of Chronic Illness Therapy (FACIT) measurement system: Properties applications, and interpretation. Health and Quality of Life Outcomes 2003; 1(1): 79-85.

Yost K.J., Eton D.T. Combining distribution- and anchor-based approaches to determine minimally important differences: The FACIT experience. Evaluation & the Health Professions 2005; 28(2): 172-191.

Related Measures

Related Measures


Functional Assessment of Cancer Therapy - General


Functional Assessment of Cancer Therapy - General - 7 Item Version


Functional Assessment of Cancer Therapy - General Population

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