Cancer Diagnosis Associated With Increased Risk of Adverse Financial Events

Adverse financial effects (AFEs) and past-due credit card payments were found to be more prevalent in patients who have received a cancer diagnosis, although more information is needed to determine how this relate to treatment decisions and quality of life, according to a study published in the Journal of Clinical Oncology.

When age, sex, average baseline credit, area deprivation index, and diagnosis year was adjusted, patients with cancer had a higher risk of AFEs (OR, 1.71; 95% CI, 1.61-1.81; P <.0001), as well as past-due credit payments (OR, 1.28; 95% CI, 1.19-1.37; P <.0001) compared with those in the control group.

A total of 190,722 patients were identified from either Western Washington SEER cancer registry and included 63,574 cases and a random sample of voter registry records known as controls of 127,148.

More patients in the cases group had an unknown area deprivation index compared with the control group. Notably, the distribution of cases and controls across different area deprivation index categories was similar, although a small proportion of individuals in both groups resided in high area deprivation index neighborhoods. A lower baseline of available credit was observed in the cases group, with an average mean credit line of $12,486. In total, 13.8% of patients were Black.

At 24 months, there was evidence of more AFEs (4.3% vs 2.4%; P <.0001) and higher rates of past-due credit card payments (2.6% vs 1.9%; P <.0001) in the cases group compared with the control group. Additionally, more patients who were Black experienced AFEs than those who were not (15.2% vs 4.2%; P <.0001) in the cases vs controls group, respectively.

The most common AFEs were third-party collections, charge-offs, and delinquent mortgage payments. However, foreclosures and repossessions were less common. In the cases group, all events were more common, with the exception of foreclosures and liens which were uncommon and not significantly higher in the cancer population.

Patients who had received a cancer diagnosis were associated with all AFE severity types following adjustment, including severe AFE (OR, 1.87; 95% CI, 1.76-1.99), more severe AFE (OR, 1.23; 95% CI, 1.08-1.40), and most severe AFE (OR, 1.45; 95% CI, 1.04-2.02). A subgroup consisting of 5-year cancer survivors with matched controls showed a greater proportion of both groups experienced AFE, but those with cancer remained at an increased risk at 9.0% and 6.1% in the control group (OR, 1.41; 95% CI, 1.32-1.50; P <.0001).

The sensitivity analysis found the mean number of prior AFEs was 0.26 in the cases group compared with 0.16 in the control group. Patients in the cases group had a lower baseline available credit of $9,716 vs $11,136 in the control group (P <.0001).

Additionally, a separate analysis was conducted that included patients who died within 24 months of diagnosis. The analysis found that 5.3% of patients with cancer had AFEs post-diagnosis compared with 4.3% of those with cancer who survived after 24 months. The logistic regression analysis found those with cancer had an increased risk of AFEs compared with those in the controls (OR, 2.19; 95% CI, 2.1-2.3; P <.0001).

Reference

Shankaran V, Li L, Fedorenko C, et al. Risk of adverse financial events in patients with cancer: evidence from a novel linkage between cancer registry and credit records. J Clin Oncol. 2022;40(8):884-891. doi:10.1200/JCO.21.01636