SAN FRANCISCO — A diagnosis of cancer can take a toll on more than a person’s health. Researchers at Beth Israel Deaconess Medical Center and Harvard Medical School in Boston found that financial fallout can follow patients with cancer and their families in the form of bankruptcy, lower credit scores, and other forms of financial challenges years after a cancer diagnosis.
Benjamin C. James, MD, FACS, chief of general surgery at Beth Israel Deaconess Medical Center and associate professor of surgery at Harvard Medical School, led research that followed the credit scores and other financial metrics of patients enrolled in the Massachusetts Cancer Registry (MCR). The results of these studies are being presented at the American College of Surgeons (ACS) Clinical Congress 2024 in San Francisco, California.
“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.”
Key Findings
The first study included 99,175 people who had a cancer diagnosis from 2010 through 2019 and 188,875 non-cancer patients to serve as a control. Researchers matched patient registry data with Experian credit bureau data to evaluate objective financial markers of financial toxicity.
Patients with cancer had higher rates in total debt collections, medical collections, and bankruptcies. Cancer patients are nearly 5 times more likely to experience bankruptcy. The cancer patients also had average credit scores nearly 80 points lower.
The second study used a sample of 7,227 patients with colorectal cancer and identified a number of factors that correlated with lower credit scores. For example, patients who had only radiation as treatment had credit scores 62 points lower than those who had only surgery, which was used as the “standard” group to compare to. Those who had chemotherapy had credit scores 14 points lower than those with 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.
The study also found that declines in credit scores are larger for people with bladder, liver, lung, and colorectal cancers, and persist for up to 9.5 years after diagnosis. However, Dr. James noted that the researchers did not directly correlate cancer prognosis with financial toxicity, but that some more aggressive cancers actually have less financial toxicity than cancers with a good 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 added.
Crunching the Numbers on Cancer’s Financial Fallout
The use of objective, numerical data to evaluate financial toxicity makes these studies unique, Dr. James said. Obtaining the financial data was daunting, he noted. 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 (HIPAA). To accomplish this study, the MCR 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 five years to complete, Dr. James noted.
“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 said.
The studies followed up on findings from the 2015 North American Thyroid Cancer Survivorship Study, which showed that 50% of thyroid cancer survivors encountered financial toxicity due to their diagnosis. Dr. James also contributed to that study.
Dr. James noted the latest study findings were striking because Massachusetts mandates universal health care coverage. “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,” Dr. James said. “Further research is needed, but I think financial security should be a priority in cancer care.”
Co-authors of the larger study are Jorge L. Gomez-Mayorga, MD; Nishant Uppal, MD, MBA; Anastasia Bogdanovski, MD; Ashley L. O’Donoghue, PhD; Aaron Fleishman, MPH; Rafael R. H. Martin, MD; Iman Abedin, MBBS; Qing L. Hu-Bianco, MD, MS; and Katharine M. Esselen, MD, MBA.
Co-authors of the colorectal cancer subanalysis are Anastasia Bogdanovski, MD; Ashley L. O’Donoghue, PhD; Jorge L. Gomez-Mayorga, MD; Rafael R.H. Martin, MD; Iman Abedin, MBBS; Nishant Uppal, MD, MBA; Aaron Fleishman, MPH; Qing L. Hu-Bianco, MD, MS; and Kristen Crowell, MD, FACS.
Authors of both studies have nothing to disclose.
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