Patients with cancer who developed financial toxicity and falling credit scores faced higher mortality risks, according to findings from a study presented at the American College of Surgeons (ACS) Clinical Congress 2025 and published in the Journal of the American College of Surgeons.
“Our work shows that as somebody’s credit score drops, their mortality risk increases,” said lead author Benjamin C. James, MD, MS, FACS, Associate Professor of Surgery at Harvard Medical School and Chief of General Surgery at Beth Israel Deaconess Medical Center. “This gives providers one more data point to intervene upon.”
Study Methods and Findings
Researchers explored factors associated with objective financial toxicity and mortality by looking at patients diagnosed with cancer between 2010 and 2019 in Massachusetts as well as their credit bureau data.
Looking through the Massachusetts Cancer Registry identified 42,451 patients, including 8.5% who developed financial toxicity, which was defined as a credit score below 600 points 18 months after a cancer diagnosis.
Multivariable logistic regression showed that nonmodifiable factors of younger age and race were associated with increased odds of financial toxicity. In patients aged 21 to 34, the adjusted odds ratio (aOR) was 1.84 (95% confidence interval [CI] = 1.48–2.27); it was 1.84 (95% CI = 1.58–2.15) in patients between 35 and 44 years. Black patients had an aOR of 1.71 (95% CI = 1.43–2.03) and Hispanic patients had an aOR of 1.27 (95% CI = 1.05–1.55).
Modifiable characteristics also led to higher odds for financial toxicity, including marriage status of separated or divorced (aOR = 1.52; 95% CI = 1.33–1.73), lower levels of higher education (aOR = 1.18; 95% CI = 1.04–1.33), and current smoking status (aOR = 1.43; 95% CI = 1.20–1.70).
Financial factors for financial toxicity included public insurance (aOR = 1.35; 95% CI = 1.20–1.51) and living in poorer neighborhoods (10%-20% poverty, aOR = 1.28; 95% CI = 1.11–1.49; >20% poverty, aOR = 1.29; 95% CI = 1.06–1.56). Patients with lower incomes faced the greatest risk for financial toxicity related to those with higher incomes (aOR for <$30,000 vs $50,000 to $69,000 = 3.66; 95% CI = 3.08–4.36).
“The data we have to date shows a difference in access to care based on socioeconomic status. But access to care is different than showing an adverse clinical outcome as a result,” Dr. James noted. “This isn’t just about stress; it’s literally about people dying unrelated to the cancer itself or made worse by their financial toxicity.”
Disclosure: For full disclosures of the study authors, visit journals.lww.com.
