Researchers have found that financial fallout can follow patients with cancer and their families as financial bankruptcy, lower credit scores, and other types of financial challenges in the years following a cancer diagnosis, according to two new studies presented by Gomez-Mayorga et al and Bogdanovski et al at the American College of Surgeons (ACS) Clinical Congress 2024. The findings demonstrated that a cancer diagnosis may take a toll on more than a patient’s health.
Background
The studies followed up on findings from the 2015 North American Thyroid Cancer Survivorship study, which revealed that 50% of thyroid cancer survivors may encounter financial toxicity as a result of their diagnoses.
“These are the first studies to provide numerical evidence of financial toxicity among cancer survivors,” Dr. James said. “Previous data on this topic largely relies on subjective survey reviews,” explained senior study author Benjamin C. James, MD, FACS, Associate Professor of Surgery at Harvard Medical School and Chief of General Surgery at Beth Israel Deaconess Medical Center.
First Study
In the first study, researchers used patient registry data and Experian credit bureau data to evaluate the objective financial markers of financial toxicity among 99,175 patients with a cancer diagnosis from 2010 to 2019 and 188,875 patients without cancer.
The researchers found that the patients with cancer had higher rates of total debt collections, medical collections, and bankruptcies. For instance, the patients who had cancer were nearly five times more likely to experience bankruptcy and had average credit scores that were nearly 80 points lower compared with those who didn’t have cancer.
Second Study
In the second study, researchers identified a number of factors that correlated with lower credit scores among a group of 7,227 patients with colorectal cancer.
The researchers discovered that the patients who underwent radiation therapy alone had credit scores that were 62 points lower compared with those who underwent surgery alone, which was used as the standard group. The patients who underwent chemotherapy had credit scores that were 14 points lower compared with those who underwent surgery alone. For those who had combination treatments, the difference in credit scores compared with surgery alone varied from 2.59 points higher with surgery and chemoradiation to 15.92 points lower for surgery and radiation.
Additionally, declines in credit scores were larger among the patients with bladder, hepatic, lung, and colorectal cancers—persisting for up to 9.5 years following diagnosis. However, the researchers did not directly correlate cancer prognosis with financial toxicity, since some more aggressive cancer types caused less financial toxicity compared with cancer types with a positive prognosis.
“There are certain factors that are associated with worse financial toxicity, including being under the age of 62, identifying as Black or Hispanic, not being married, having an area deprivation index below the median, not owning a home, and having an income below a median of $52,000 a year,” Dr. James emphasized.
Conclusions
The researchers suggested that their use of objective, numerical data to evaluate financial toxicity may provide significant insights. Credit bureaus like Experian are not permitted to share information that identifies individuals, and their data doesn’t meet the privacy standards that health-care providers must follow under the Health Insurance Privacy and Accountability Act.
To accomplish this study, the Massachusetts Cancer Registry securely provided identifiable data to Experian, which then combined it with their credit data and removed any personal details before returning it to the researchers. This complex and careful process took nearly 5 years to complete.
“We are looking years after a diagnosis and we see that the credit score goes down and it never comes back up, which is a first in the scientific community,” Dr. James stressed. “This persistence of financial challenges, even in a state with relatively high insurance coverage, calls for broader policy changes and reforms, including reconsidering debt collection practices. Further research is needed, but I think financial security should be a priority in cancer care,” he concluded.
Disclosure: For full disclosures of the study authors, visit abstractsonline.com and abstractsonline.com.
