Medical Debt Persists for Years After Cancer Diagnosis

TOPLINE:

A population-based cohort study in Massachusetts found that medical debt in collections increased modestly for up to 6 years post-diagnosis, despite “high insurance coverage,” and patients with colorectal or bladder cancer experienced persistent increases in total debt in collections. In the overall population, however, total debt in collections, bankruptcy rates, or credit scores did not differ after diagnosis.

METHODOLOGY:

• Cancer diagnoses affect nearly 40% of individuals in the US and are associated with increased out-of-pocket expenses and financial difficulties for patients. However, comprehensive data on debt, bankruptcy, and credit scores after diagnosis are lacking.
• Researchers conducted a retrospective study of 74,146 patients with a first-time diagnosis of bladder, breast, cervical, colorectal, liver, lung, ovarian, thyroid, or uterine cancer in Massachusetts from 2010 to 2019, matched 1:1 with individuals without cancer based on baseline demographic and socioeconomic factors (mean age, 57.2 years; 81.2% women).
• Using comprehensive financial data and a difference-in-differences design, researchers examined longitudinal changes in total debt, total debt in collections, medical debt in collections, credit scores, and bankruptcy rates. Data were collected at 6-month intervals throughout the study period.
• Total debt was defined as the total balance in US dollars on all open installment trades. Credit scores were defined using VantageScore, a widely used model developed jointly by US credit reporting bureaus, with scores ranging from 300 (very poor) to 850 (excellent).
• Breast cancer was the most common diagnosis (38.6%) followed by lung cancer (18.6%) and colorectal cancer (14%).

TAKEAWAY:

• In a matched difference-in-differences analysis, cancer diagnosis increased medical debt in collections up to $15.45 at 6 years post-diagnosis. Among patients who had any medical debt in collections after diagnosis, the increase was $160.01 at 6 years. No significant changes were observed in mean total debt, mean total debt in collections, bankruptcy rates, or credit scores.
• Patients with liver cancer experienced a significant decrease in total debt of $12,608 at 8.5 years post-diagnosis.
• Mean total debt in collections increased by $155.55 among patients with colorectal cancer at 6 years post-diagnosis and by $375.77 at 5.5 years among patients with bladder cancer.
• Mean medical debt in collections increased post-diagnosis by $11.02 for breast cancer (up to 4 years), by $33.91 for cervical cancer (up to 1 year), by $38.99 for colorectal cancer (up to 6 years), by $26.68 for lung cancer (up to 5.5 years), and by $9.77 for uterine cancer (up to 1 year).

IN PRACTICE:

This study found that “a cancer diagnosis was associated with increases in medical debt in collections compared with a control population, that certain cancer subpopulations experience persistent increases in total debt in collections, and that these differences persist for years after diagnosis” the authors wrote, noting that this occurred despite “relatively high rates of insurance coverage in Massachusetts.” They added “these results demonstrate the importance of considering financial factors at the time of cancer diagnosis and highlight the need for financial assistance programs that prevent medical debt, which has been associated with diminished access to care and is a focus of public and private debt forgiveness programs.”

SOURCE:

This study, led by Nishant Uppal, MD, MBA, Massachusetts General Hospital, Boston, was published online in JAMA Oncology.

LIMITATIONS:

Limitations included retrospective design and possibility of inaccurate credit reports. This study did not assess the effects of cancer stage and treatment, or caregiver financial information. Additionally, certain cancer subpopulations were not included due to funding and privacy restrictions, which could limit generalizability.

DISCLOSURES:

This study was supported by the American Association of Endocrine Surgeons ThyCa Award and Martin & Diane Trust Career Development Endowed Chair position. Uppal reported receiving support from BrightEdge, outside the submitted work. No other disclosures were reported.