Studies have shown that millions of people in the United States are financially vulnerable because of low income, limited savings, or high levels of debt. In 2021, 32% of U.S. adults reported being unable to cover an unexpected expense of $400. A recent study by researchers at the American Cancer Society and the National Cancer Institute has found that an individual’s financial vulnerability may affect cancer outcomes.

The study—published by Warren et al in the Journal of Clinical Oncology—assessed the prevalence of specific major adverse financial events, such as bankruptcies, liens, and evictions, before a cancer diagnosis and their potential association with later-stage cancer at diagnosis. The report found that one-third of newly diagnosed patients had a major adverse financial event before a cancer diagnosis and that these patients were more likely to have advanced disease than patients who had not experienced adverse financial events.

Study Methodology

The researchers identified patients between the ages of 20 and 69 diagnosed with cancer from 2014 to 2015 using data from the Surveillance, Epidemiology, and End Results (SEER) population-based registries for Seattle, Louisiana, and Georgia. Registry data were linked with LexisNexis consumer data to identify patients with a history of court-documented adverse financial events before a cancer diagnosis. The association of adverse financial events and later-stage cancer diagnoses (stages III and IV) was assessed using separate sex-specific multivariable logistic regression.

Key Results

The researchers found that among the 101,649 patients with cancer linked to LexisNexis data, 36,791 (36.2%) had a major adverse financial event reported before diagnosis. The mean and median timing of the adverse financial event closest to diagnosis were 93 and 77 months, respectively. Adverse financial events were most common among non-Hispanic Black, unmarried, and low-income patients.

Individuals with previous adverse financial events were more likely to be diagnosed with later-stage cancer than individuals with no adverse financial events (males: odds ratio [OR] = 1.09, 95% confidence interval [CI] = 1.03–1.14, P < .001; females: OR = 1.18, 95% CI = 1.13–1.24, P < .0001) after adjusting for age, race, marital status, income, registry, and cancer type. Associations between adverse financial events before diagnosis and later-stage disease did not vary by the timing of an adverse financial event.

“One-third of newly diagnosed patients with cancer had a major adverse financial event before their diagnosis. Patients with adverse financial events were more likely to have later-stage diagnosis, even accounting for traditional measures of socioeconomic status that influence the stage at diagnosis. The prevalence of prediagnosis adverse financial events underscores financial vulnerability of patients with cancer before their diagnosis, before any subsequent financial burden associated with cancer treatment,” concluded the study authors.

Improving Equitable Access to Care

In a statement commenting on the results of the study, senior author Robin Yabroff, PhD, MBA, Scientific Vice President, Health Services Research at the American Cancer Society, said: “Patients with a previous adverse financial event not only face greater likelihood of more advanced cancer, but also may encounter substantial barriers to receiving recommended care and experience worse health outcomes for their newly diagnosed cancer because of their preexisting financial vulnerability. Understanding patients’ financial vulnerability within health-care settings may inform efforts to improve equitable access to oncology care.”

Disclosure: Funding for this study was provided by the National Cancer Institute, the Washington State Department of Health, Fred Hutchinson Cancer Center, and the Centers for Disease Control and Prevention. For full disclosures of the study authors, visit ascopubs.org.