In a population-based cohort study reported in the Journal of Clinical Oncology, Veena Shankaran, MD, MS, and colleagues found that patients with cancer were at a significantly increased risk of past-due credit card payments and other adverse financial events vs matched noncancer controls.

As stated by the investigators, “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 vs individuals without cancer.”

Veena Shankaran, MD, MS

Study Details

In the study, western Washington state Surveillance, Epidemiology, and End Results (SEER) cancer registry (cancer cases) and voter registry (noncancer controls) records from 2013 to 2018 were linked to quarterly credit records from TransUnion. Controls were matched with cases for age, sex, and zip code, and assigned an index date corresponding to case diagnosis date.

Cases and controls were compared for past-due credit card payments and any of the following adverse financial events at 24 months from diagnosis/index date: third-party collections, charge-offs, tax liens, delinquent mortgage payments, foreclosures, and repossessions.

Key Findings

Among 63,574 cases vs 127,148 controls (mean age = 66 years) with no adverse financial events at baseline, adverse financial events (4.3% v 2.4%, P < .0001) and past-due credit payments (2.6% vs 1.9%, P < .0001) were more common among cases at 24 months. Rates of all individual adverse financial events were more common in patients with cancer, except for foreclosures and liens; both were uncommon in both cohorts. The adverse financial event rate was significantly higher in Black patients with cancer (13.8% of case cohort) vs non-Black cases (15.2% vs 4.2%, P < .0001).

In multivariate analysis adjusting for age, sex, average baseline credit line, area deprivation index, and diagnosis/index year, cases had a significantly increased risk of adverse financial events (odds ratio [OR] = 1.71, 95% confidence interval [CI] = 1.61–1.81, P < .0001) and past-due credit payments (OR = 1.28, 95% CI = 1.19–1.37, P < .0001).

In analysis that incorporated cases and matched controls with prebaseline adverse financial events into the cohorts (92,762 cancer cases; 185,524 controls), rates of adverse financial events at 24 months were 18.2% vs 10.5% (P < .0001), with rates of all individual adverse financial events being significantly higher among cases. On multivariate analysis, risk of adverse financial events was significantly higher for cases (OR = 1.50, 95% CI = 1.44–1.56, P < .0001).

The investigators concluded, “Patients with cancer were at [a] significantly increased risk of experiencing adverse financial events 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.”

Dr. Shankaran, of the Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, and the Division of Medical Oncology, University of Washington School of Medicine, is the corresponding author for the Journal of Clinical Oncology article.

Disclosure: The study was supported by the Kathryn Butler Foundation and Texas4000 Foundation. For full disclosures of the study authors, visit ascopubs.org.