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% filed for bankruptcy protection after being diagnosed. Of those who
were not diagnosed with cancer, 1% 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% 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 May 15 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
US 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
- 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%, it
went up to 1.7% 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
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, DC.
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,"
Learn more about the cost of cancer treatment from the American