Patients Often Go Bankrupt, Even With Insurance

The perils of cancer are more than just physical. New research shows that cancer patients in the U.S. often pay a heavy and lasting financial toll following their treatment, which can then lead to lower credit scores and bankruptcy.

The U.S. is known for having some of the best cancer-related outcomes in the world, including a lower mortality rate than many other high-income nations. But the typical costs of cancer treatment (and health care in general) are also far higher in the U.S. than its peers, and many studies have found that cancer patients will commonly experience money troubles as a result of their diagnosis. But two new studies, presented this week at the American College of Surgeons (ACS) Clinical Congress 2024, appear to be the first to empirically demonstrate the financial fallout often suffered by cancer patients.

In the first study, the researchers analyzed the Experian credit bureau data of patients who were enrolled in the Massachusetts Cancer Registry and first diagnosed with cancer between 2010 to 2019. They compared the financial outcomes of these patients to similarly matched people without cancer, who acted as controls. Compared to non-patients, those who experienced cancer had higher rates of total debt collections and medical-related collections, the researchers found. Cancer patients were also almost five times more likely to declare bankruptcy, and their average credit score was roughly 80 points lower than those without cancer.  In the second study, the researchers focused on a subset of patients who were diagnosed with colorectal cancer, looking for potential risk factors that affected their chances of hardship. Compared to patients who only got surgery (the team’s “standard” for comparison), for instance, patients who only got radiation had credit scores 62 points lower. Those who got surgery and chemoradiation seemed to fare the best, with credit scores a bit higher than the baseline of people who got surgery alone.

The researchers additionally found that people with bladder, liver, lung, and colorectal cancers tended to have worse declines in their credit score than others. People’s loss of good credit also often followed them for a long time, with declines in their credit score lasting up to 9.5 years. Other risk factors associated with worse financial toxicity included being under the age of 62, not owning a home, not being married, making less than $52,000 a year, and being Black or Hispanic.

The team’s research was no easy task to get done, especially since credit bureaus aren’t allowed to share potentially identifiable data with others. To work around this limitation, according to the researchers, the MCR first securely provided its patient registry data to Experian, which then matched and combined it with their credit data. Experian then stripped the combined data of any personal identifying information before finally sending it off to the researchers for analysis. All in all, the effort took five years, but it allowed the scientists to objectively track the financial path of cancer patients compared to non-patients—something that past studies on the topic really haven’t been able to do.

“These are the first studies to provide numerical evidence of financial toxicity among cancer survivors,” said lead study researcher Benjamin James, chief of general surgery at Beth Israel Deaconess Medical Center and associate professor of surgery at Harvard Medical School, in a statement from the ACS. “Previous data on this topic largely relies on subjective survey reviews.”

The researchers point out that their data comes from Massachusetts, a state where universal health coverage is mandated. So it’s certainly possible that Americans who get cancer living elsewhere will have an even rougher time money-wise. That said, there have been important changes lately in how medical bills generally can affect our finances. In recent years, the major bureau companies have begun removing paid and small amounts of unpaid medical debt from their reports—changes that do appear to have had a positive impact on Americans’ credit already. This summer, the Consumer Financial Protection Bureau also proposed a new rule that would prevent medical bills altogether from appearing on most credit reports, which might remove up to $49 billion worth of medical debt that has lowered the credit scores of 15 million Americans. But the researchers still argue that much more needs to be done to protect patients from the debilitating costs of cancer treatment.

“This persistence of financial challenges, even in a state with relatively high insurance coverage, calls for broader policy changes and reforms, including reconsidering debt collection practices,” James said. “Further research is needed, but I think financial security should be a priority in cancer care.”