Association of major adverse financial events and later stage cancer diagnosis in the US.

Abstract

6545 Background: Studies have documented an increased risk of bankruptcy and other financial hardships for individuals following a cancer diagnosis in the US. Few studies, however, have examined how patients’ financial situation prior to cancer diagnosis is associated with cancer stage at diagnosis. This study assessed the prevalence of the specific major adverse financial events (AFEs) of bankruptcies, liens, and evictions prior to cancer diagnosis and their association with later stage diagnosis. Methods: Individuals aged 21 to 69 years diagnosed with cancer during 2014-2015 were identified from the SEER population-based registries for Seattle, Louisiana and Georgia. Registry data were linked with LexisNexis consumer data to identify patients with a history of court-documented AFEs. All AFEs occurring at any time prior to cancer diagnosis were identified. The association of AFEs and later stage cancer diagnoses (Stages III/IV) was assessed with sex-specific multivariable logistic regression. Results: Among 101,649 individuals diagnosed with cancer linked to LexisNexis data, 36,791 (36.2%) had a major AFE reported prior to diagnosis. The most recent event occurred a mean of 7.8 years prior to diagnosis. For individuals with an AFE, one-third experienced multiple events. Within each registry, AFEs were most common among non-Hispanic Black, unmarried, and low-income individuals. However, even in the highest income group, 27% had a prior AFE. Individuals with prior AFEs were more likely to be diagnosed with later stage cancer than individuals with no prior AFE (males-odds ratio (OR) 1.09; 95% CI, 1.03 to 1.14; P < .001 and females-OR 1.11; 95% CI, 1.06 to 1.17; P < .0001), after adjusting for age, race and ethnicity, marital status, income prior to diagnosis, registry, and type of cancer. The association between a major AFE and later stage diagnosis was observed regardless of when the event occurred relative to cancer diagnosis. Conclusions: In this novel cancer registry, LexisNexis consumer data linkage, we found that one-third of individuals newly diagnosed with cancer had a pre-diagnosis bankruptcy, lien, or eviction. Individuals with these AFEs were more likely to have later stage diagnosis, even after accounting for traditional measures of socioeconomic status, such as income. The prevalence of pre-diagnosis AFEs underscores patient financial vulnerability at the time of their cancer diagnosis, even before experiencing any subsequent financial burden associated with cancer treatment. Our findings are especially timely, with growing efforts by health care providers to screen and address patient social needs as part of oncology care.