Risk of Adverse Financial Events in Patients With Cancer: Evidence From a Novel Linkage Between Cancer Registry and Credit Records

Abstract

PURPOSE 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 versus individuals without cancer. We conducted a population-based retrospective matched cohort study using credit reports to investigate the impact of a cancer diagnosis on the risk of adverse financial events (AFEs). METHODS Western Washington SEER cancer registry (cases) and voter registry (controls) records from 2013 to 2018 were linked to quarterly credit records from TransUnion. Controls were age-, sex-, and zip code–matched to cancer cases and assigned an index date corresponding to the case's diagnosis date. Cases and controls experiencing past-due credit card payments and any of the following AFEs at 24 months from diagnosis or index were compared, using two-sample z tests: third-party collections, charge-offs, tax liens, delinquent mortgage payments, foreclosures, and repossessions. Multivariate logistic regression models were used to evaluate the association of cancer diagnosis with AFEs and past-due credit payments. RESULTS A total of 190,722 individuals (63,574 cases and 127,148 controls, mean age 66 years) were included. AFEs (4.3% v 2.4%, P < .0001) and past-due credit payments (2.6% v 1.9%, P < .0001) were more common in cases than in controls. After adjusting for age, sex, average baseline credit line, area deprivation index, and index/diagnosis year, patients with cancer had a higher risk of AFEs (odds ratio 1.71; 95% CI, 1.61 to 1.81; P < .0001) and past-due credit payments (odds ratio 1.28; 95% CI, 1.19 to 1.37; P < .0001) than controls. CONCLUSION Patients with cancer were at significantly increased risk of experiencing AFEs 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.

Financial toxicities of cancer in low‐ and middle‐income countries: Perspectives from Southeast Asia

“…

Patients with cancer in the United States are 71% more likely to experience a severe adverse financial event and 28% more likely to have past-due credit card payments than patients without cancer. 1 We write from Southeast Asia (SEA), a region of 660 million people with immense diversity in cancer epidemiology, health care systems, socioeconomic status, and culture, where cancer is a leading cause of death. The region is composed of 11 nations:

…”

“…1 Patients flagged for a high risk of financial toxicity should be referred proactively to social workers. 1 Patient navigators may provide practical assistance, informational support, and emotional empowerment to mitigate financial toxicity. 2 To this end, there is a need to invest in the training of these professionals, as they are a scarce resource in LMICs.…”

“…At the hospital level, financial navigators, counselors, and billing specialists must be integrated into cancer clinics 1 . Patients flagged for a high risk of financial toxicity should be referred proactively to social workers 1 .…”

“…At the hospital level, financial navigators, counselors, and billing specialists must be integrated into cancer clinics 1 . Patients flagged for a high risk of financial toxicity should be referred proactively to social workers 1 . Patient navigators may provide practical assistance, informational support, and emotional empowerment to mitigate financial toxicity 2 .…”

Reexamining Social Determinants of Health Data Collection in the COVID-19 Era

“…4 Second, these data sources have their own built-in delay between collection and reporting, with even further delays to link given the data use agreements, anonymization, and institutional review board approvals that need to be put into place before linkages can occur. One recent novel study 5 that linked cancer registry data with credit reports to study the association between a cancer diagnosis and risk of adverse financial events shared that the database linkage process took nearly 2 years to complete-time largely spent on establishing data use agreements between the cancer center and the credit agency. Even outside the context of a pandemic, such time delays dilute the effect of research findings, particularly in disparities research wherein the findings should ideally influence subsequent equity-oriented interventions such as referrals to community-based organizations.…”