Financial insolvency as a risk factor for mortality among patients with cancer.

6509 Background: Patients with cancer are more likely to file for bankruptcy than the general population, but the impact of severe financial distress on health outcomes among cancer patients is not known. Methods: We linked Surveillance, Epidemiology and End Results (SEER) cancer registry records and federal bankruptcy records for Western Washington and identified patients who were diagnosed with cancer from 1995 to 2009. We used propensity score matching to account for differences between patients who filed for bankruptcy and those who did not, with respect to age, gender, race, marital status, residence type, income, stage at diagnosis, and treatment (s) received. In the propensity score matched sample, we used Cox proportional hazards models to compare overall survival between patients who filed and those who did not. Results: Compared to patients who did not file for bankruptcy (n = 226, 868), those who filed (n = 4, 728) were more likely to be younger, female, non-white, have local or regional (vs. distant) stage disease at diagnosis and have received treatment. After propensity score matching, 7, 682 patients remained in the analysis, 3, 841 subjects in each group. Both groups had a mean age of 53 (SD 14. 7), more men than women (54%), a mean income of 49, 000 (SD 12, 000), and majorities of white (86%), married (60%) and urban (91%) patients. Most patients in both groups were diagnosed with local or regional stage cancer (84%) and both groups received similar first courses of treatment. Compared to cancer patients who did not file for bankruptcy, the adjusted hazard rate for mortality among patients who filed was 75% higher HR 1. 75, 95% CI (1. 61, 1. 91). Excess mortality risk following bankruptcy varied by cancer type, with colorectal, prostate, lung and thyroid cancers having the highest risk. Excluding patients who were distant stage at cancer diagnosis from the analysis had little impact on the mortality risk. Conclusions: Severe financial distress requiring bankruptcy protection following cancer diagnosis appears to be a risk factor for mortality. Further research is needed to understand the process by which extreme financial distress influences survival after cancer diagnosis, and to find factors that could mitigate this risk.