More research has found that financial toxicity hurts patients with cancer. New data presented at the 2023 ASCO Annual Meeting in Chicago found that adverse financial events experienced by patients with cancer increase mortality risk (Abstract 6503).
"Financial toxicity is a growing concern for patients with cancer," noted Hiba M. Khan, MD, MPH, lead study author and Senior Research Fellow in Hematology/Oncology at the University of Washington/Fred Hutchinson Cancer Center. "We felt it was important to see how financial hardship impacts clinical outcomes, such as survival for patients with cancer, so that we can better understand the implications of experiencing financial hardship for a patient with cancer."
Khan's research group has previously found that patients with cancer who experience bankruptcy have a higher mortality risk, and patients with cancer are more likely than patients without cancer to experience adverse financial events less severe than bankruptcy, such as repossessions, third-party collections, charge-offs, and delinquent mortgage payments (J Clin Oncol 2022; doi: 10.1200/JCO.21.01636).
So the aim of this study was to focus on whether or not adverse financial events less severe than bankruptcy also increase mortality risk in patients with cancer. And the data showed that they do. After adjusting for sociodemographic factors including age, sex, cancer type and stage, financial events at diagnosis, and geographical area of residence, the researchers found that patients who experienced third-party collections, charge-offs, tax liens, delinquent mortgage payments, foreclosures, and repossessions within 2 years of being diagnosed with cancer are at higher risk for mortality compared with patients having cancers who do not experience those adverse financial events.
The researchers also analyzed whether this finding was consistent among the most common solid tumor cancers. In conducting separate analyses for each cancer group-prostate, breast, lung, and colon-the research showed patients who experienced adverse financial events had a higher risk for mortality compared to patients who did not experience adverse financial events.
Study Details
For the study, the researchers identified patients in the Western Washington state SEER cancer registry and linked them to quarterly credit reports from TransUnion, a major U.S. credit reporting agency. Patients ages 18 or older who were diagnosed with a solid tumor between 2013 and 2018 and who survived at least 2 years from the date of diagnosis were included.
Cancer patients experiencing any adverse financial event, defined as third-party collections, charge-offs, delinquent mortgage payments, tax liens, foreclosures, and repossessions within 2 years of diagnosis were compared with cancer cases who did not experience these events.
The final analysis included 64,637 patients: 84 percent were White, 53 percent were female, and median age was 64. Of those patients, 12,698 experienced a severe financial event.
The adjusted hazard ratio for mortality among patients who did versus did not experience an adverse financial event was 1.22 (95% CI: 1.145-1.299, p<0.001), with older than age 65, Asian/Pacific Islander, greater area deprivation index (a standardized measure using aspects of a neighborhood-like income, education, and other variables that gives a score to how socioeconomically disadvantaged that neighborhood is with a higher number being associated with a more socioeconomically disadvantaged area), and higher stage of cancer all being characteristics associated with increased risk for mortality.
And when comparing the separate cancer groups, the association between adverse financial event and risk of death was strongest among patients with prostate cancer with the hazard ratio being 1.7 (95% CI: 1.395-2.08, p<0.001).
Strengths & Limitations
Khan noted a few limitations of the work. While adverse financial events are an objective and standard measure of financial health, there may be other, perhaps less severe though meaningful, financial experiences that patients face that are not accounted for with credit records. Additionally, while a large percentage of Americans have credit history, not all do. And that means this analysis may be missing that portion of the population, Khan explained. Also, the data represents patients from the state of Washington and may not be representative of populations from other states or geographic areas.
But a strength of the study is that it's based on credit data, which is widely used by lenders and other financial institutions as a barometer of financial health. "Many of the studies which have informed this work have been done using subjective, survey-based data. While informative and patient-centered, there are certain limitations inherent to this method of data gathering, such as recall and sampling bias," Khan said. "To our knowledge, this is the first study to use credit data linked with statewide oncology registry data to study the impact of adverse financial events on survival."
Next Steps & Data Use
There are several other pieces of this equation to better understand. Khan noted that their group is currently using this data to inform other projects, including studying the impact of adverse financial events on health care utilization and treatment decisions at the end of life in patients with cancer, as well as the impact of out-of-pocket costs on the development of adverse financial events.
The group is also studying financial toxicity associated with oral cancer therapy in prostate cancer. They are working on research assessing using financial navigation as a mechanism for reducing financial toxicity.
Khan said the team hopes that this work leads cancer centers and oncology practices to think about ways to reduce the financial burdens on a system level for patients. "Oncology clinicians can start by simply inquiring about the financial burdens their patients are facing, and working with their cancer centers to identify patient-centered resources to reduce those burdens." She also hopes that the work can be used to inform policy ideas and mitigation strategies to tackle the issue on a larger scale.
"As oncology care is becoming more expensive, more and more of these costs are being shifted towards patients through cost-sharing in the form of co-insurances and co-payments," Khan said. "Clinicians who treat patients with cancer should know that [these] patients can have significant financial toxicity in the form of adverse financial events that we now know increases their risk for mortality."
Sarah DiGiulio is a contributing writer.