Younger Age and Non-White Race Associated With an Increased Likelihood of Filing for Bankruptcy After a Breast Cancer Diagnosis

Non-White race and age below 64 years were associated with a higher risk of filing for bankruptcy after a breast cancer diagnosis among women with insurance who underwent surgery for their disease, according to study results published in Cancer.

“Technological advances and innovations in breast cancer care have resulted in increasing treatment costs,” the study authors wrote. “As insurance companies find ways to offset the cost of treatment, patients are increasingly facing higher out-of-pocket expenses in the form of cost-sharing strategies, such as deductibles, coinsurance, and copayments, in conjunction with high premiums.”

For younger patients, this is especially true, as they are most likely to be responsible for additional treatment-related costs such as fertility preservation and mental health resources, the authors explained. Moreover, missed workdays, reductions in work hours and loss of employment — and, therefore, loss of employer-based insurance — can result in further financial instability among younger patients.

READ MORE: Preserving Fertility in Adolescent and Young Adult Women with Cancer

Previous studies have demonstrated that patients with cancer are more than 2.5 times more likely to go bankrupt than those without cancer. Data have also shown that patients who file for bankruptcy have higher mortality rates, compared to those who are more financially stable.

As a result, the study authors aimed to examine the socioeconomic and clinical characteristics of insured patients in Indiana who underwent surgery for breast cancer.

“Indiana is consistently ranked among the top 10 states in the United States for personal bankruptcy,” they wrote. “This is significant because patients with cancer in Indiana have survival rates below the national average, and the majority of bankruptcy cases in the United States are secondary to health care costs.”

The authors reviewed the Indiana State Cancer Registry (ISCR) and the Public Access to Courts Electronic Records (PACER) database. They searched the PACER database for all individuals who filed for chapter 7 or chapter 13 bankruptcy from Jan. 1, 2008 to Dec. 31, 2014.Chapter 7 bankruptcy involves liquidation of assets to pay off debts, and chapter 13 filers pay their debts with a payment plan over a defined time period, the authors specified. Any findings excluded patients who did not undergo surgery.

The analysis included 23,321 women, aged 18 to 90 years, who were diagnosed with stage 0 through 4 breast cancer between Jan. 1, 2008 and Dec.31, 2014 in the ISCR. Of the patient population included in the analysis, 207 filed for bankruptcy after their diagnosis.

This is where the study authors discovered more details regarding who is more at risk to filing for bankruptcy. Factors most associated with filing for bankruptcy after diagnosis included women aged 40 years and under, women aged 41 to 64 years and non-White race.

“A higher percentage of patients who filed for bankruptcy after diagnosis underwent mastectomy compared with those who did not file for bankruptcy,” the authors wrote. After taking factors into consideration that could have influenced the study outcomes, the authors noted that there was not an association between insurance type at diagnosis or undergoing mastectomy and filing for bankruptcy.

“The findings from this study are important and timely because other studies have indicated that patients with breast cancer who are facing financial hardship have increased rates of treatment nonadherence and worse mortality,” they wrote. “Moreover, bankruptcy, which has been defined as an extreme form of financial hardship, is associated with a 48% increased relative risk of mortality compared with no bankruptcy in patients with breast cancer.”

For future studies, the authors encourage developing “approaches to explore the relation between surgery type and bankruptcy in larger, multistate bankruptcy cohorts,” and have deemed that additional research is needed.

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