Risk of early mortality in patients with cancer experiencing adverse financial events.

Abstract

6503 Background: Patients with cancer are at higher risk for experiencing severe adverse financial events (AFEs) compared to similar individuals without cancer. Among persons with cancer, those experiencing bankruptcy have poorer survival. In this study, we sought to determine whether AFEs less severe than bankruptcy have an increased risk of death among patients with cancer. Methods: Records for all patients diagnosed with a solid tumor between 2013 and 2018 were identified through the Western Washington State SEER cancer registry and were linked to quarterly credit reports from TransUnion. Patients who survived at least 2 years from date of diagnosis were included. Cancer patients experiencing any AFE, 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. After adjusting for age, sex, race, area deprivation index, rural/urban status, marital status, AFE at diagnosis, cancer type, and stage of cancer, we fit a Cox proportional hazards model to examine the relationship between AFEs and overall survival, and also fit a separate model for each cancer type. Results: A total of 64,637 patients were diagnosed with cancer between 2013 and 2018, and survived 2 years post-diagnosis. The overall population was 84% white, 53% female, and had a median age of 64. 12,698 patients experienced any severe financial event. The adjusted hazard ratio for mortality among patients who did versus did not experience an AFE was 1.22 (95% CI, 1.145-1.299, p <0.001), with age >65, Asian/Pacific Islander race, greater area deprivation index, and higher stage of cancer associated with increased risk for mortality. Among differing cancer types, patients with prostate cancer who experienced an AFE had the highest risk of death compared with patients with prostate cancer who did not experience an AFE (HR 1.703,95% CI, 1.395 to 2.08, p <0.001). Conclusions: Patients with cancer who experience severe AFEs within 2 years of diagnosis are at higher risk for mortality after adjusting for sociodemographic and clinical factors. When comparing within separate cancer groups, this association is strongest among patients with prostate cancer. Current analysis is limited by restricting population to those who survived at least 2 years after diagnosis; future work will expand population to include patients who died at any time point. Further research should investigate mechanisms for this increased mortality risk, to inform potential interventions and policy solutions, especially among the prostate cancer population. [Table: see text]