Patients with cancer have a significantly higher risk of adverse financial events (AFEs), such as past-due credit card payments, than do similar people without cancer, according to a study published in the Journal of Clinical Oncology.

The population-based, retrospective study is the first to “establish the feasibility of linking credit data to the cancer registry and using these data to further our understanding of financial toxicity in oncology,” the researchers wrote.

The researchers compared cancer patients from the Western Washington SEER cancer registry and control individuals from the Washington state voter registry, linking people from both groups to their TransUnion credit records.

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Cancer patients and control individuals were matched by age, sex, and zip code. Control individuals received an index date corresponding to their matched cancer patient’s diagnosis date.

The study was designed to compare rates of AFEs between the 2 groups, and the primary outcome was evidence of an AFE closest to 24 months from cancer diagnosis or the index date.

AFEs were categorized as “severe,” “more severe,” and “most severe.” A severe AFE was defined as the inability to pay bills, translating to collections or charge-offs. More severe AFEs put people at risk of creditor action against the owners’ property, which included tax liens and delinquent mortgage payments. The most severe AFEs were cases in which creditors assumed people’s property, including foreclosures and repossessions.

The study included 190,722 people in total — 63,574 cancer patients and 127,148 control individuals. Both cohorts were split 52.9% female to 47.1% male, and the mean age was 65.8 years.

The cancer patients were 18 years or older at the time of diagnosis, and those diagnoses fell between January 1, 2013, and December 31, 2018. The cohort included patients with hematologic malignancies and solid tumors, stages I-IV. 

The cancer patients were 71% more likely than control individuals to experience an AFE. The proportion of people with AFEs at 24 months was 4.3% in the cancer cohort and 2.4% in the control cohort (odds ratio, 1.71; 95% CI, 1.61-1.81; P <.0001).

Cancer patients were more likely than control individuals to have:

  • A severe AFE — 3.8% vs 1.9% (P <.0001)
  • A more severe AFE — 0.68% vs 0.55% (P =.0005)
  • A most severe AFE — 0.13% vs 0.08% (P =.0005)
  • Past-due credit payments — 2.6% vs. 1.9% (P <.0001)
  • Third-party collections — 3.0% vs 1.2% (P <.05)
  • Charge-offs — 1.41% vs 0.91% (P <.05)
  • Delinquent mortgage payments — 0.92% vs 0.76% (P <.05)
  • Repossessions — 0.10% vs 0.06% (P <.05).

Foreclosures and tax liens were the only AFEs that were not significantly more common in the cancer cohort (P =.08 and .53, respectively). Both AFEs were uncommon in both cohorts.

Based on these results, the researchers concluded that credit data could be “an efficient way to screen newly diagnosed cancer patients and families for financial risk and align resources and interventions to patients with the greatest need.”

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Shankaran V, Li L, Fedorenko C, et al. Risk of adverse financial events in patients with cancer: Evidence from a novel linkage between cancer registry and credit records. J Clin Oncol. Published online January 7, 2022. doi:10.1200/JCO.21.01636