In a study reported in the Journal of Clinical Oncology, Khor et al found that prediagnosis financial hardship was associated with a diagnosis of cancer at later stages, particularly for cancers with organized screening programs and those detectable via physical examination.
Study Details
The case-control study used data from adult patients diagnosed with stage I to IV solid tumors between 2014 and 2017 from the Western Washington State SEER (Surveillance, Epidemiology, and End Results) registry, and credit report data from TransUnion and health-care claims. Financial hardship was defined as at least one record of collections, charge-offs, delinquent mortgage payments, tax liens, foreclosures, repossessions, or bankruptcies within 2 years before cancer diagnosis. The association between financial hardship and late-stage diagnosis (stages III and IV) was evaluated.
Key Findings
Among 50,148 patients with cancer (mean age = 64 years, 52% female, 85% White) included in the analysis, 30% had prediagnosis financial hardship.
Overall, financial hardship was associated with significantly increased risk of late-stage diagnosis (adjusted risk ratio [RR] = 1.14, 95% confidence interval [CI] = 1.11–1.17). The increase in risk was greater for cancers with organized screening programs (adjusted RR = 1.25, 95% CI = 1.21–1.29) and for cancers detectable by physical examination (adjusted RR = 1.44, 95% CI = 1.31–1.59). No increase in risk was observed for cancers without organized screening or those not detectable by physical examination (adjusted RR = 1.00, 95% CI = 0.94–1.07).
Variations in risk were observed among individual cancer sites. Among patients with breast cancer, 70% of the increased risk for late-stage diagnosis was attributable to not having undergone screening.
The investigators concluded: “[Financial hardship] significantly affects cancer stage at diagnosis, especially for cancers with organized screening and physical examinations. In breast cancer, this association is largely attributed to lack of screening. These findings underscore [financial hardship] as an important social determinant of health and the need for targeted interventions to improve screening access.”
Sara Khor, PhD, of Comparative Health Outcomes, Policy, and Economics Institute, University of Washington, Seattle, is the corresponding author for the Journal of Clinical Oncology article.
DISCLOSURE: The study was supported by the Kathryn Butler Foundation and Texas 4000 Foundation. For full disclosures of the study authors, visit ascopubs.org.
