Death or debt? National estimates of financial toxicity in persons with newly-diagnosed cancer

PURPOSE: To evaluate the impact of cancer upon a patient's depletion of net worth and incursion of debt in the U.S.

METHODS: This longitudinal study used the Health and Retirement Study (HRS) from 1998-2014. Persons ≥50 years with newly-diagnosed malignancies were included, excluding minor skin cancers. Multivariable generalized linear models were employed to assess changes in net worth and debt (consumer, mortgage, home equity) at two-and four-years following diagnosis (Year, Year) after controlling for demographic and clinically-related variables, cancer-specific attributes, economic factors, and mortality. A two-year period prior to cancer diagnosis served as an historical control.

RESULTS: Across 9.5 million total estimated new diagnoses of cancer from 2000-2012, individuals averaged 68.6±9.4 years with slight majorities being married (54.7%), not retired (51.1%), and Medicare beneficiaries (56.6%). At Year, 42.4% depleted their entire life's assets, with higher adjusted odds associated with worsening cancer, requirement of continued treatment, socio-economic factors (i.e., increasing age/income/household size, female sex), clinical characteristics (i.e., current smoker, worse self-reported health, hypertension, diabetes, lung disease), Medicaid, and uninsured (p<0.05); average losses were -$92,098. At Year, financial insolvency extended to 38.2%, with several consistent socio-economic, cancer-related, and clinical characteristics remaining significant predictors of complete asset depletion.

CONCLUSION: Using nationally-representative data, this investigation of an estimated 9.5 million newly-diagnosed persons with cancer ≥50 years of age found a substantial proportion incurring financial toxicity. As large financial burdens have been found to adversely affect access to care and outcomes among cancer patients, the active development of approaches to mitigate these effects among already vulnerable groups remain of key importance.

http://www.ncbi.nlm.nih.gov/pubmed/29906429?dopt=Abstract