Association of court-documented major adverse financial events before cancer diagnosis and mortality risk in the US.

Abstract

1519 Background: Cancer diagnosis is associated with increased risk of financial hardship in the US. This study examined the associations of court-documented major adverse financial events (AFEs) of bankruptcies, liens, and evictions prior to cancer diagnosis and risks of all-cause and cancer-specific mortality. Methods: Individuals aged 21 to 69 years diagnosed with common cancer types, including bladder, female breast, colorectal, kidney, lung and bronchus, oral cavity/pharynx, or prostate cancers or melanoma during 2014-2015 were identified from the SEER population-based registries for Seattle, Louisiana, and Georgia. Registry data were linked with LexisNexis consumer data to identify history of court-documented AFEs of bankruptcies, liens, and evictions. Vital status and cause of death were examined through December 31, 2021. The association of pre-diagnosis AFEs and risk all-cause and cancer-specific mortality was assessed with separate multivariable Cox proportional hazards models for each survival outcome, stratified by cancer site. Models were adjusted for stage, age, race and ethnicity, marital status, registry, registry-specific income categories, and the interaction between income and registry. Results: Of 58,796 individuals diagnosed with one of the 8 selected cancers, 21,694 (36.9%) had a pre-diagnosis AFE and there were 16,714 deaths (28.4%) during the study period between 2014 and 2021. Pre-diagnosis AFEs were associated with higher risk of all-cause mortality for individuals diagnosed with female breast (hazard ratio (HR): 1.18; 95% confidence interval (CI): 1.09-1.28), colorectal (HR: 1.14; 95% CI: 1.06-1.23), oral cavity/pharynx (HR: 1.14; 95% CI: 1.06-1.23 ) and prostate (HR: 1.33; 95%CI: 1.20-1.47) cancer and early- and late-stage melanoma (HR: 2.23; 95% CI: 1.89-2.99 and HR:1.34; 95% CI:1.01-1.80, respectively), in adjusted models. Pre-diagnosis AFEs were also associated with significantly higher risk of cancer-specific mortality for these five cancers. Conclusions: Court-documented AFEs of pre-diagnosis bankruptcy, lien, or eviction was associated with increased risk of all-cause and cancer-specific mortality for multiple cancer types in this study using a novel SEER cancer registry-LexisNexis consumer data linkage. The association of pre-diagnosis AFEs and mortality risk underscores lasting adverse consequences of patient financial vulnerability prior to incurring high out-of-pocket costs of cancer treatment. Our findings are especially timely, with growing efforts by health care providers to screen and address patient health-related social needs as part of comprehensive oncology care.