Extreme financial distress appeared to influence survival after cancer diagnosis and may be taking a greater toll on patients than previously recognized, Seattle researchers have found.1

“Oncologists need to be mindful that their patients may have a tenuous financial situation that could prevent them from completing planned therapies,” said study investigator Scott Ramsey, MD, PhD, director of the Hutchinson Institute for Cancer Outcomes Research at the Fred Hutchinson Cancer Center in Seattle, WA, in an interview with Cancer Therapy Advisor.

“They should give their patients permission to bring up the issue and help them find less expensive alternatives if the patient voices concern. We cannot ignore the patient cost burden of cancer care any longer.”

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Their study linked Western Washington Surveillance, Epidemiology, and End Results (SEER) Program records with federal bankruptcy records in the same region. They found an adjusted hazard ratio (HR) of 1.79 for mortality among patients with cancer who filed for bankruptcy compared with those who did not file.

The investigators used propensity score matching to account for differences in several demographic and clinical factors between patients who did or did not file for bankruptcy. They examined the relationship between bankruptcy filing  and survival among patients with cancer using Cox proportional hazards models.

The idea for the study arose after Dr Ramsey analyzed the results of a previous study, which found that patients with cancer go bankrupt at 2.5 times the rate of the general population.2

Dr Ramsey and colleagues found that between 1995 and 2009, 231 596 individuals were diagnosed with cancer and that 4728 patients with cancer filed for bankruptcy. HRs varied by cancer type, with the highest HR for patients with colorectal, prostate, and thyroid cancers. When they excluded patients with distant-stage disease from the models, researchers found no significant differences.

“We don’t know if it is getting worse or better,” Ramsey said. On the one hand, the Affordable Care Act has given millions of people access to health insurance, which presumably will reduce their likelihood of going bankrupt in the event of a severe illness like cancer. On the other, the cost of cancer care is rising so fast.”

RELATED: Financial Toxicity More Likely in Younger, Nonwhite Women Cancer Survivors

Oncologists are seeing a growing number of patients who are undergoing “financial toxicity,” in which patients are under such severe financial distress from cancer care that they refuse treatment or do not comply with recommended therapies.