People diagnosed with cancer are more than two-and-a-half times more likely to declare bankruptcy than those without cancer, according to a new study. Also, younger patients had two- to fivefold higher bankruptcy rates compared to older patients. Overall bankruptcy filings increased as time passed after diagnosis.

“This study found strong evidence of a link between cancer diagnosis and increased risk of bankruptcy,” the authors wrote. “Although the risk of bankruptcy for cancer patients is relatively low in absolute terms, bankruptcy represents an extreme manifestation of what is probably a larger picture of economic hardship for cancer patients. Our study thus raises important questions about the factors underlying the relationship between cancer and financial hardship.”

For this study, researchers from the Fred Hutchinson Cancer Center in Seattle, Washington, analyzed data from a population-wide registry of individuals over age 21 who lived in western Washington state and who were diagnosed with cancer between Jan. 1, 1995 and Dec. 31, 2009. They were compared to a randomly sampled age-, sex-, and ZIP code–matched population of people without cancer. Cancer cases were identified using the Cancer Surveillance System of Western Washington, a population-based cancer registry based at the Fred Hutchinson Cancer Center that is part of the National Cancer Institute’s Surveillance Epidemiology and End Results Program (SEER).

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The cancer and control cohorts were both linked with the records of the US Bankruptcy Court for the Western District of Washington. The court serves 19 counties in western Washington, including all 13 counties represented in the Cancer Surveillance System of Western Washington. Researchers included Chapter 7 or Chapter 13 bankruptcy filings only.

“This is the strongest evidence we have between a disease and risk for severe financial distress,” said corresponding author Scott Ramsey, MD, PhD, of Fred Hutchinson Cancer Center. “I’ve not seen other studies that linked databases of this quality.”

Among the cancer patients in the study, 2.2% files for bankruptcy, which was half the rate (1.1%) of the matched controls who did not have cancer. Bankruptcy was more common among patients who were younger, female, and nonwhite.

Cancer is generally a sudden and unexpected event, and the risk of bankruptcy is affected by such factors as debt load before diagnosis, presence and terms of health and disability insurance, number of dependent children, and incomes of others in the household at the time of cancer diagnosis.

Patients age 65 years and older generally have Medicare insure and Social Security benefits, along with more assets and possibly more income than working-age people. The researchers suggested that having stable insurance that was not tied to employment has a major role in mitigating the risk of bankruptcy in those over 65 years old. The study was published in Health Affairs (2013; doi: 10.1377/hlthaff.2012.1263).