People diagnosed with cancer are almost three times more likely to declare bankruptcy than are those without the disease, a large new study suggests.
And younger people with cancer have up to five times higher bankruptcy rates compared to older patients with the disease, the researchers found.
Of almost 200,000 people with cancer in the study based in Washington state, about 2 percent filed for bankruptcy protection after being diagnosed. Of those who were not diagnosed with cancer, 1 percent filed.
Although the risk of bankruptcy for those with cancer is still relatively low, researchers said it is significant.
"Bankruptcy is such an extreme measure of financial distress, and we didn't include the other forms of financial difficulties people encounter," said Catherine Fedorenko, a study co-author and technical project coordinator at the Fred Hutchinson Cancer Research Center, in Seattle.
Whether people suffer substantial debt or have to go so far as to declare bankruptcy, their financial problems are likely to be stressful, said Karma Kreizenbeck, a study co-author and project director at the Hutchinson Institute for Cancer Outcomes Research.
"This paper shows how medical debt associated with a cancer diagnosis could be more likely to lead to a bankruptcy," Kreizenbeck said. "But it could also mean people have to take second jobs, end up with lower credit scores or have to make other decisions."
Celeste Smith, 63, was diagnosed five years ago with breast cancer. A Seattle realtor who was just starting to do well in a new job, she found she had to stop working when she was faced with months of radiation and chemotherapy. Despite the fact that she had health insurance, her mortgage and car payment bills began to mount. "It's a horrible circle trying to get over cancer and deal with all the financial stress," she said. Smith ended up filing for bankruptcy and moving from her foreclosed house to affordable living for seniors.
Researchers have noted before that the financial burden on people with cancer can be substantial. Data from the Medical Expenditure Panel Survey in 2004 showed that 6.5 percent of the $20.1 billion spent on cancer care by those not yet on Medicare each year comes directly from the patients themselves, according to study background information.
A small study presented last year at an American Society of Clinical Oncology meeting showed that four of every five cancer patients and their spouses or caregivers said they had concerns about meeting medical costs and suffered associated financial and mental stress.
The new research, published online and in the June print issue of Health Affairs, is based on data taken from a registry of people 21 and older who lived in Washington and were diagnosed with cancer from 1995 through 2009. They were compared to a randomly sampled population of people without cancer, matched by age, gender and ZIP code.
Cancer cases were identified using a cancer registry based at the Fred Hutchinson Cancer Research Center, part of a U.S. National Cancer Institute epidemiology database.
Key findings of the new study include the following:
- Cancer patients were 2.65 times more likely than people without cancer to go bankrupt.
- Those cancer patients who filed for bankruptcy were more likely to be younger, female and nonwhite than were cancer patients who didn't file. The youngest age groups had up to 10 times the bankruptcy rate compared to the older age groups. The youngest groups in the study were diagnosed at a time when their debt was typically high and their income was not, the study noted.
- Bankruptcy filings went up as time went by. While the proportion of cancer patients who filed for bankruptcy within one year of diagnosis was 0.52 percent, it went up to 1.7 percent after five years.
- Bankruptcy rates were highest for people with the diagnosis of thyroid and lung cancer, and lowest for melanoma, breast and prostate cancer. The authors suggested that the higher rate of bankruptcy associated with thyroid cancer was likely due to the fact that it affects younger women more often than do other cancers.
The study, based on data from 1995 to 2009, did not take into account the potential impact of the implementation of the Affordable Care Act (ACA) in 2010, an expert pointed out.
"The problem of bankruptcy was one thing the ACA was designed to address," said Peter Cunningham, a senior fellow and director of quantitative research at the Center for Studying Health System Change, in Washington, D.C.
Cunningham expressed concern that the researchers didn't note whether the cancer patients or the control participants had health insurance. "So we don't know how much of a difference having health insurance makes in terms of avoiding bankruptcy," he said. "It would have been nice to see what the impact of health insurance coverage is in being able to prevent bankruptcy and how many people lost their health insurance coverage because of their cancer diagnosis."
What should people do to avoid the stress of money troubles when faced with a serious disease? "The study points to the value of having health insurance," Cunningham said.