Major Financial Toxicity Confers Later-Stage Cancer Diagnosis Risk


Findings from a study raise concerns for the outcomes of individuals who experience an adverse financial event prior to a cancer diagnosis.

Major Financial Toxicity Confers Later-Stage Cancer Diagnosis Risk  | Image Credit: © VanHope -

"Our findings raise substantial concerns for the outcomes for people with an AFE before cancer diagnosis who are among the most vulnerable of all patients with cancer," according to the study authors.

Approximately one third of patients who are newly diagnosed with cancer experienced a major adverse financial event (AFE) before their diagnosis and AFEs were found to confer a higher risk of a later-stage diagnosis, according to findings from a study published in the Journal of Clinical Oncology.

Of 101,649 patients with cancer who had available LexisNexis data, 36,791 (36.2%) experienced a major AFE prior to their cancer diagnosis. Additionally, patients who were non-Hispanic Black had the highest rate of major AFEs before a diagnosis, including 45.2% of those in the Louisiana registry, 55.3% in the Seattle registry, and 59.7% in the Georgia registry. The rates of pre-diagnosis major AFEs for patients who were non-Hispanic Asian ranged from 16.6% in Seattle to 21.0% in Georgia. Investigators reported that 39.2% and 22.9% of unmarried and married patients, respectively, experienced an AFE.

A major AFE correlated with a later-stage cancer diagnosis for both male (adjusted OR, 1.09; 95% CI, 1.03-1.14) and female patients (adjusted OR, 1.18; 95% CI, 1.13-1.24) based on adjusted analyses. Investigators also reported a significantly higher likelihood of Black women having a later-stage diagnosis compared with White women, and Black men had a significantly lower probability compared with White men. A higher later-stage diagnosis risk was also highlighted in unmarried patients, those who were part of the 2 lowest income groups, and those who were 50 to 64 or 65 to 69 years old.

“We found that one-third of patients newly diagnosed with cancer in this cohort had 1 or more major AFEs before their cancer diagnosis,” the study authors wrote.

“Having an AFE was associated with a later-stage diagnosis. Patients with a previous AFE not only face a greater likelihood of more advanced cancer but also may encounter barriers to receiving recommended care for their newly diagnosed cancer because of their pre-existing AFE. Our findings raise substantial concerns for the outcomes for people with an AFE before cancer diagnosis who are among the most vulnerable of all patients with cancer.”

Investigators collected patient data from the Seattle (Seattle-Puget Sound), Georgia, and Louisiana population-based Surveillance, Epidemiology, and End Results (SEER) registries. These registries contained patient’s date of birth, sex, marital status, race and ethnicity, disease type and stage at diagnosis, and number of primary tumors.

LexisNexis, a data aggregation company, provided information about estimated income levels and AFEs. Information related to AFEs pertained to 1 of 3 major types: a court record for bankruptcy, a lien, or eviction. Investigators assessed the relationship between major AFEs and stage III or IV cancer diagnoses using separate sex-specific multivariate logistic regression models.

Patients age 20 to 69 years old with a cancer diagnosis in 2014 or 2015 and residents in one of the 3 registries were included in the analysis. The study did not include data on patients who made up small demographic groups, such as those who were neither male nor female and American Indian or Alaska Native individuals.

Across the registries, 82.1% of patients were non-Hispanic White, 6.2% were non-Hispanic Asian, and 2.0% were non-Hispanic Pacific Islander individuals in Seattle. Additionally, non-Hispanic Black patients made up 29.4% and 31.0% of the Georgia and Louisiana populations, respectively.

The rates of major AFEs prior to a diagnosis for patients in the 2 lowest-income groups were 40% in Seattle and Louisiana and 50% in Georgia. Additionally, anywhere from 18.2% to 31.7% of those in the highest-income group had a major AFE before a diagnosis.

Among those with breast cancer, 17.1% of patients with a prior AFE had late-stage disease compared with 12.0% of those who had no prior AFE. The corresponding rates with respect to melanoma were 9.2% vs 5.3% among male patients and 5.9% vs 3.4% among female patients.


Warren JL, Mariotto AB, Stevens J, et al. Association of major adverse financial events and later-stage cancer diagnosis in the United States. J Clin Oncol. Published online February 6, 2024. doi:10.1200/JCO.23.01067

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