mCRC Treatment May Result in Major Financial Hardships Regardless of Health Insurance

Patients with metastatic colorectal cancer who were below a certain income level appear to be more susceptible to major financial hardship.

Major financial hardships occurred in 3 of 4 patients with metastatic colorectal cancer regardless of health insurance status, according results from a multicenter cooperative group–led study published in the Journal of the National Cancer Institute.

At 12 months, the cumulative incidence of major financial hardships was 71.3% (95% CI, 65.7%-76.1%). Patient characteristics such as age, race, marital status, and income split at $50,000 per year were not significantly associated with major financial hardships. However, those who had an income of and or total assets of less than $100,000 were associated with greater major financial hardships.

A total of 368 patients were eligible, 73% of whom were alive after 1 year of follow-up. Overall, 82.1% of patients reached the primary end point or had a 12-month evaluation available. The median age was 60.2 years, and 62.8% of patients were younger than 65 years. Moreover, 61.9% of patients were male and 13.0% were Black. In total, 30.9% of patients had a total household income of $0 to $25,000, 25.5% earned $25,001 to $50,000, 14.7% earned $50,001 to $75,000, 8.4% earned $75,001 to $100,000, and 17.7% earned over $100,000. Most patients had private insurance (46.5%) while others had Medicare (38.9%), Medicaid (11.9%), another type (0.82%), or were uninsured (1.9%). Patients were geographically distributed in either the Midwest (47.3%), South (23.1%), West (20.4%), and Northeast (9.2%). In the study, 19.8% of patients were from rural areas.

The cumulative incidence of new debt at 12 months was 57.6% (95% CI, 51.7%-63.0%), 26.6% (95% CI, 21.3%-32.0%) for a 20% or more decline in income, 26.0% (95% CI, 21.5%-30.7%) for new loans from family and/or friends, 3.4% (95% CI, 1.7%-5.9%) for home refinance, and 2.6% (95% CI, 1.3%-4.7%) for selling a home. Major financial hardship was typically reported early on, with 24.9% (95% CI, 20.9%-29.5%) experiencing hardship at 3 months, 53.8% (95% CI, 48.5%-58.8%) at 6 months, and 63.0% (95% CI, 57.8%-67.8%) at 9 months.

Patients who were unemployed had a statistically significant lower likelihood of major financial hardship, however, this was thought to be confounded by age, with older patients being more likely to have greater assets and savings. Age younger than 65 years was associated a statistically significantly increased risk of major financial hardship (HR, 1.71; 95% CI, 1.06-2.75). Lower total assets were also notably associated with a greater likelihood of major financial hardship at all total assets cut points.

At 3 months, patients with major financial hardships were more likely to have lower European Organisation for Research and Treatment of Cancer (EORTC) scores at 6 months. The analysis adjusted for quality of life at 3 months, although only social functioning score and the global health status score were statistically significant.

A sensitivity analysis indicated that the cumulative incidence of major financial hardship ay 1-year was 43.0% (95% CI, 37.3%-48.6%) after omitting new debt measure. A total of 32.7% (95% CI, 27.8%-37.7%) of patients had accrued new debt by 1 year, and the overall estimate of major financial hardships at 1 year was 58.2% (95% CI, 52.5%-63.6%).

A post hoc analysis indicated that for every increase risk factors such as income of less than 100,000 that increased from 0 to 1 and 1 to 2 had a 49% increase in risk of major financial hardships (HR, 1.49; 95% CI, 1.21-1.85; P <.001). At 12 months, the cumulative incidence of major financial hardship was similar between homeowners at 69.9% (95% CI, 62.8%-76.0%) and nonhomeowners at 71.8% (95% CI, 62.3%-79.2%).


Shankaran V, Unger JM, Darke AK, et al. S1417CD: a prospective multicenter cooperative group-led study of financial hardship in metastatic colorectal cancer patients. J Natl Cancer Inst. 2022;114(3):372-380. doi:10.1093/jnci/djab210