Risk of Adverse Financial Events in Patients With Cancer: Evidence From a Novel Linkage Between Cancer Registry and Credit Records

Veena Shankaran · Li Li · Hayley Sanchez · Sara Khor

46 citations0/0 files storedJournal of Clinical Oncology

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Economic and Financial Impacts of Cancer Cancer survivorship and care Global Cancer Incidence and Screening

Abstract

PURPOSE Although financial toxicity is a growing cancer survivorship issue, no studies have used credit data to estimate the relative risk of financial hardship in patients with cancer versus individuals without cancer. We conducted a population-based retrospective matched cohort study using credit reports to investigate the impact of a cancer diagnosis on the risk of adverse financial events (AFEs). METHODS Western Washington SEER cancer registry (cases) and voter registry (controls) records from 2013 to 2018 were linked to quarterly credit records from TransUnion. Controls were age-, sex-, and zip code–matched to cancer cases and assigned an index date corresponding to the case's diagnosis date. Cases and controls experiencing past-due credit card payments and any of the following AFEs at 24 months from diagnosis or index were compared, using two-sample z tests: third-party collections, charge-offs, tax liens, delinquent mortgage payments, foreclosures, and repossessions. Multivariate logistic regression models were used to evaluate the association of cancer diagnosis with AFEs and past-due credit payments. RESULTS A total of 190,722 individuals (63,574 cases and 127,148 controls, mean age 66 years) were included. AFEs (4.3% v 2.4%, P < .0001) and past-due credit payments (2.6% v 1.9%, P < .0001) were more common in cases than in controls. After adjusting for age, sex, average baseline credit line, area deprivation index, and index/diagnosis year, patients with cancer had a higher risk of AFEs (odds ratio 1.71; 95% CI, 1.61 to 1.81; P < .0001) and past-due credit payments (odds ratio 1.28; 95% CI, 1.19 to 1.37; P < .0001) than controls. CONCLUSION Patients with cancer were at significantly increased risk of experiencing AFEs and past-due credit card payments relative to controls. Studies are needed to investigate the impact of these events on treatment decisions, quality of life, and clinical outcomes.

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2012The Oregon Health Insurance Experiment: Evidence from the First Year*2016Financial Insolvency as a Risk Factor for Early Mortality Among Patients With Cancer 2016For Working-Age Cancer Survivors, Medical Debt And Bankruptcy Create Financial Hardships 2011National Estimates of Out-of-Pocket Health Care Expenditure Burdens Among Nonelderly Adults With Cancer: 2001 to 2008 2018Financial Toxicity in Adults With Cancer: Adverse Outcomes and Noncompliance 2012Out‐of‐pocket health care expenditure burden for Medicare beneficiaries with cancer 2019Prevalence and Correlates of Medical Financial Hardship in the USA 2018Neighborhood disadvantage and chronic disease management

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