Translation and Validation of COST - FACIT (Version 2) Questionnaire into Hindi and Marathi to Assess Financial Toxicity in Indian Cancer Patients

Abstract

Background Cancer is one of the most expensive and exhaustive medical conditions with a huge impact on the financial condition of the patient and their family members. A lot of advancements have led to improvement in the survival of the patients but at a raised cost. Comprehensive Score for financial Toxicity - Functional Assessment of Chronic Illness Therapy (COST - FACIT Version 2) is one such validated and widely used tool. Assessing the financial burden in our country is still far more challenging as COST - FACIT is available in the English language but not in any regional language. Hence, we decided to validate this tool in Hindi and Marathi languages. Material and Methods A single-center, cross-sectional study was conducted in the Department of Uro-Oncology at the Tata Memorial Hospital. The original version of the COST - FACIT (Version 2) was translated from English into Hindi and Marathi languages, following the FACIT translation method and tested for content validity that included two forward translations, followed by reconciliation and a backward translation. The questionnaires were then approved by the FACIT team, and pilot testing was done for 20 patients (10 for each Hindi and Marathi language). Each of these 20 patients, after filling up the questionnaire themselves, was interviewed for any difficulty encountered during answering the questionnaire. Based on the suggestions or interpretations of this pilot testing, the necessary changes were incorporated in the final Hindi and Marathi questionnaires. Results A total of 20 patients (10 each for Hindi and Marathi) were included for pilot testing of the questionnaire. The median age of the entire cohort was 61 years (27–79). The questionnaires showed good content and face validity and demonstrated a high internal consistency (Cronbach's α: 0.85 for Hindi, 0.89 for Marathi). Conclusion The questionnaire COST - FACIT (Version 2) has been approved and validated in Hindi and Marathi languages by the FACIT team for use in clinical practice and studies.

Measures of financial toxicity in cancer survivors: a systematic review

“…Nineteen studies were included and comprised 8582 participants in total, with sample sizes ranging from 12 to 4297 participants per study. The 19 studies represented six measures of cancer FT. Fourteen studies were based on the Comprehensive Score for Financial Toxicity–Functional Assessment of Chronic Illness Therapy (COST-FACIT) Version1 (v1) [ 4 , 20 , 21 , 23 , 25 , 27 , 28 , 35 ] and Version 2 (v2) [ 18 , 19 , 21 , 24 , 26 , 29 ]. The original COST-FACIT version (V1) consists of 11 items, and the most recent second version (V2) has 12 items.…”

“…All measures used a five-point Likert scale, and the total number of items ranged from 9 to 16. Three studies were conducted in India [ 19 , 24 , 30 ], the USA [ 21 , 22 , 33 ], and China (includes the mainland and Hong Kong) [ 18 , 29 , 34 ], two studies in Italy [ 26 , 32 ], and one study each in Australia [ 4 ], Brazil [ 20 ], Japan [ 23 ], Turkey [ 28 ], Canada [ 31 ], Korea [ 35 ], Tunisia [ 25 ], and Iran [ 27 ]. Most studies focused on multiple cancers except two, which only included people with head and neck cancer [ 19 , 30 ]…”

“…of items 11 Mode of administration: self-administered questionnaires 0-44 Five-point Likert scale Honda [ 23 ] COST-FACIT V-1 Country: Japan Language: English and Japanese Age: median 65 years (range 30–72) Females: 73% Cancer type: Mixed solid tumours (100%) Setting: Oncology outpatient Treatment: CT + targeted therapy (73%), not receiving treatment (27%) 12 No. of items 11 Mode of administration: Self-administered questionnaires 0–44 Five-point Likert scale Joshi [ 24 ] COST-FACIT V-2 Country: India Language: English, Hindi, and Marathi Age: not reported Females: not reported Cancer types: Mixed solid tumours (100%) Setting: Uro-oncology department Treatment: not reported 20 No. of items 11 Mode of administration: Self-administered questionnaires and interview 0–44 Five-point Likert scale Mejri [ 25 ] COST-FACIT V-1 Country: Tunisia Language: Arabic Age: median 52 years (SD 12) Females: 71% Cancer type: Mixed solid tumours (90%), other (10%) Setting: Oncology clinic Treatment: CT, surgery, RT 179 No.…”

“…Additionally, five studies [ 4 , 18 , 22 – 24 ] of the COST-FACIT measure did not report evidence on the measurement invariance, and one study [ 20 ] reported negative CFA. The absence of such evidence or negative CFA findings regarding measurement invariance may imply that the relationship between items and latent constructs varies across different cultures [ 37 ].…”

Translation and Pilot Validation of Hindi, Marathi, and Bangla Translation of Quality-of-Life EORTC Radiation Proctitis Module (PRT-20) for Routine Clinical Use

“…Administering QLQ in a language that is understood well by the patient is therefore important. 8 9 10 11 12 13 14 In this study, we translated QLQ PRT-20 into Hindi, Marathi, and Bangla. The translation process was carried out according to the standard guidelines proposed by the EORTC.…”