January 28, 2016
2 min read

Bankruptcy increases risk for cancer mortality

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Filing for bankruptcy protection after a cancer diagnosis appeared associated with an increased risk for death, according to the results of a registry study.

Patients diagnosed with colorectal, prostate and lung cancer who filed for bankruptcy appeared to have the highest mortality risks, results showed.

“Doctors and health systems that care for patients with cancer have to start considering patients’ financial situations when they initiate conversations about cancer care,” Scott D. Ramsey, MD, PhD, professor of medicine at University of Washington and director of the Hutchinson Institute for Cancer Outcomes Research at Fred Hutchinson Cancer Research Center, told HemOnc Today. “If it is true that patients experiencing extreme financial distress have a significantly higher mortality risk, that wipes out the potential gains of certain therapies.”

Scott Ramsey

Scott D. Ramsey, MD, PhD

In a prior study, Ramsey and colleagues linked cancer diagnoses with a 2.5-fold increase in the risk for bankruptcy. However, the impact of a severe financial burden on health outcomes among patients with cancer remained unknown.

Thus, the researchers sought to determine the relationship between bankruptcy and survival. They linked the Western Washington SEER Cancer Registry with federal bankruptcy records for the region.

The researchers identified 231,596 individuals diagnosed with cancer between 1995 and 2009. Of this cohort, 4,728 filed for bankruptcy (Chapter 7, n = 3,909; Chapter 13, n = 819).

Characteristics associated with filing for bankruptcy included younger age, female sex, nonwhite race, local or regional disease at diagnosis, and treatment receipt.

Ramsey and colleagues performed propensity score matching to account for differences in demographic and clinical factors between patients who filed for bankruptcy and those who did not. After adjustments, 3,841 patients remained in each group (mean age, 53 years; 54% men; 86% white).

The mean income of the cohort was $49,000 per year. Sixty percent of patients were married, 91% lived in urban areas, and 84% presented with local or regional disease at diagnosis.

Mortality rates appeared higher among patients with cancer who filed for bankruptcy than among those who did not (HR = 1.79; 95% CI, 1.64-1.96).

The association between severe financial burdens and mortality varied across cancer subtypes. Patients with prostate cancer who filed for bankruptcy appeared twice as likely to die as patients who did not (HR = 2.07; 95% CI, 1.56-2.74).

For patients with colorectal cancer, the increase in mortality associated with bankruptcy was nearly 2.5-fold (HR = 2.47; 95% CI, 1.85-3.31).

Other subtypes with significant bankruptcy-associated risks included breast cancer (HR = 1.48; 95% CI, 1.15-1.91) and lung cancer (HR = 1.55; 95% CI, 1.22-1.98).

Of these four subtypes, patients with lung cancer showed the highest cumulative risk for bankruptcy (47%) and the poorest OS (38%) at 5 years from diagnosis.

Researchers also observed an increased risk for mortality associated with bankruptcy among patients with melanoma (HR = 1.5; 95% CI, 0.83-2.72), thyroid cancer (HR = 1.71; 95% CI, 0.69-4.27), leukemia or lymphoma (HR = 1.22; 95% CI, 0.93-1.61), and uterine cancer (HR = 1.09; 95% CI, 0.55-2.16), but these associations did not reach statistical significance.

The exclusion of patients with distant-stage disease did not appear to affect the results, according to the researchers.

“Getting patients into financial counseling services if they are deemed at risk for bankruptcy may be helpful,” Ramsey said. “We should also try to make the care plan to have as little out-of-pocket burden as possible, which might allow more patients to complete their therapy as planned, without having to cease care due to financial problems.” – by Cameron Kelsall

For more information:

Scott D. Ramsey, MD, PhD, can be reached at sramsey@fredhutch.org.

Disclosure: The researchers report no relevant financial disclosures.