Warren Joan L, Mariotto Angela B, Stevens Jennifer, Davidoff Amy J, Shankaran Veena, Ward Kevin C, Wu Xiao-Cheng, Schwartz Stephen M, Penberthy Lynne, Yabroff K Robin
Division of Cancer Control and Population Science, National Cancer Institute, Bethesda, MD.
Information Management Services, Calverton, MD.
J Clin Oncol. 2024 Mar 20;42(9):1001-1010. doi: 10.1200/JCO.23.01067. Epub 2024 Feb 6.
This study assessed the prevalence of specific major adverse financial events (AFEs)-bankruptcies, liens, and evictions-before a cancer diagnosis and their association with later-stage cancer at diagnosis.
Patients age 20-69 years diagnosed with cancer during 2014-2015 were identified from the Seattle, Louisiana, and Georgia SEER population-based cancer registries. Registry data were linked with LexisNexis consumer data to identify patients with a history of court-documented AFEs before cancer diagnosis. The association of AFEs and later-stage cancer diagnoses (stages III/IV) was assessed using separate sex-specific multivariable logistic regression.
Among 101,649 patients with cancer linked to LexisNexis data, 36,791 (36.2%) had a major AFE reported before diagnosis. The mean and median timing of the AFE closest to diagnosis were 93 and 77 months, respectively. AFEs were most common among non-Hispanic Black, unmarried, and low-income patients. Individuals with previous AFEs were more likely to be diagnosed with later-stage cancer than individuals with no AFE (males-odds ratio [OR], 1.09 [95% CI, 1.03 to 1.14]; < .001; females-OR, 1.18 [95% CI, 1.13 to 1.24]; < .0001) after adjusting for age, race, marital status, income, registry, and cancer type. Associations between AFEs prediagnosis and later-stage disease did not vary by AFE timing.
One third of newly diagnosed patients with cancer had a major AFE before their diagnosis. Patients with AFEs were more likely to have later-stage diagnosis, even accounting for traditional measures of socioeconomic status that influence the stage at diagnosis. The prevalence of prediagnosis AFEs underscores financial vulnerability of patients with cancer before their diagnosis, before any subsequent financial burden associated with cancer treatment.
本研究评估了在癌症诊断之前特定重大不良财务事件（AFE）——破产、留置权和驱逐——的发生率及其与诊断时晚期癌症的关联。
从西雅图、路易斯安那州和佐治亚州基于人群的监测、流行病学和最终结果（SEER）癌症登记处识别出2014 - 2015年期间诊断为癌症的20 - 69岁患者。登记处数据与LexisNexis消费者数据相链接，以识别在癌症诊断之前有法庭记录的AFE病史的患者。使用单独的性别特异性多变量逻辑回归评估AFE与晚期癌症诊断（III/IV期）之间的关联。
在与LexisNexis数据相关联的101,649例癌症患者中，36,791例（36.2%）在诊断前有重大AFE报告。最接近诊断的AFE的平均和中位时间分别为93个月和77个月。AFE在非西班牙裔黑人、未婚和低收入患者中最为常见。在调整年龄、种族、婚姻状况、收入、登记处和癌症类型后，有既往AFE的个体比没有AFE的个体更有可能被诊断为晚期癌症（男性——优势比[OR]，1.09[95%置信区间，1.03至1.14]；P <.001；女性——OR，1.18[95%置信区间，1.13至1.24]；P <.0001）。诊断前AFE与晚期疾病之间的关联不因AFE时间而有所不同。
三分之一的新诊断癌症患者在诊断前有重大AFE。有AFE的患者更有可能被诊断为晚期，即使考虑到影响诊断阶段的社会经济地位的传统衡量指标。诊断前AFE的发生率凸显了癌症患者在诊断前的财务脆弱性，在与癌症治疗相关的任何后续财务负担之前。
