Research reveals the financial problems of cancer survivors

A cancer diagnosis can affect more than just a person’s health. Researchers have found that financial consequences can follow cancer patients and their families into bankruptcy, lower credit scores and other forms of financial problems years after diagnosis.

Benjamin C. Benjamin C. James, MD, Chief of the Division of General Surgery at Beth Israel Deaconess Medical Center and Associate Professor of Surgery at Harvard Medical School, led studies that tracked the credit scores and other financial performance of patients enrolled in the Massachusetts Cancer Patient Registry. The results of these studies are being presented at the American College of Surgeons (ACS) Clinical Congress 2024 in San Francisco, Calif.

These are the first studies to present figures on the “financial toxicity” of oncology for cancer survivors. Previous data on this topic were mostly based only on subjective surveys.

The first study included 99,175 people diagnosed with cancer between 2010 and 2019 and 188,875 cancer-free patients as controls. The researchers matched patient registry data with credit bureau data to assess objective markers of financial toxicity.

Patients with cancer had higher rates of debt collections, medical collections, and bankruptcies. Cancer patients were nearly 5 times more likely to experience bankruptcy.

The second study used a population sample of 7,227 patients with colorectal cancer and found a number of factors that correlated with lower credit scores in cancer patients.

Both studies found that the decline in financial scores was greater in people with bladder, liver, lung, and colorectal cancer and persisted up to 9.5 years after diagnosis. However, Dr. James noted that the researchers were not looking for a direct link between cancer prognosis and financial toxicity, but that some more aggressive cancers actually have less financial toxicity than tumors with a good prognosis.

There are certain factors that are associated with worse financial problems:

• people under the age of 62,
• of Negroid or Hispanic race,
• unmarried,
• with a regional disadvantage index below average,
• homelessness, and
• below average income.

The use of objective numerical data to assess financial toxicity makes this research unique. Obtaining financial data was a challenge, the principal investigator noted. Credit bureaus are not allowed to share personally identifying information, and their data does not meet the privacy standards that healthcare providers must meet under the Health Insurance Privacy and Accountability Act (HIPAA). For the study, the researchers provided identifying data to a financial analytics company, which then merged it with their credit data and removed all personal identifiers before returning it to the researchers. This complex and thorough process took nearly five years.

“We look at years after diagnosis and see that credit scores drop and don’t go up again, and this is the first example of its kind,” Dr. James said.

He also noted that the results of the latest study are striking because Massachusetts has universal health care coverage. “This persistence of financial problems, even in a state with fairly high levels of insurance coverage, calls for broader policy changes and reforms, including an overhaul of debt collection practices,” the doctor said.

Further research is needed, but it is already clear that financial security must be a priority in cancer treatment.