Economic Strain and End-of-Life Healthcare Utilization in Cancer Patients

Overview

This study links cancer registry, insurance claims, and consumer credit data to examine how financial hardship, measured by adverse financial events (AFEs), relates to healthcare use and costs at the end of life (EOL) among insured cancer patients. Findings indicate that new AFEs in the last 2 years of life are associated with increased emergency department visits, hospitalizations, in-hospital death, and higher healthcare spending during the final 3 months.

Background

Financial toxicity is a recognized consequence of cancer diagnosis, stemming from high out-of-pocket medical and nonmedical expenses and income loss. Prior research has shown that cancer patients have a higher risk of bankruptcy and adverse financial events compared to non-cancer individuals. End-of-life care represents a period of intense medical, financial, and emotional challenges, with substantial healthcare spending largely driven by hospital-based care. However, the relationship between financial strain and EOL care intensity and costs remains underexplored, particularly using objective financial data.

Data Highlights

Key Findings

• Patients experiencing new AFEs in the 3-24 months before death had higher rates of multiple ED visits and hospitalizations in the last 3 months of life.
• New AFEs were associated with increased likelihood of dying in a hospital setting rather than outpatient settings.
• Financial hardship measured via credit data provides an objective marker linked to more intense and costly EOL care.
• Patients with cancer are 2.65 times more likely to file for bankruptcy and 1.71 times more likely to have major AFEs compared to matched controls without cancer.
• Approximately one-quarter of Medicare spending occurs in the last year of life, driven by hospital-based care, which is exacerbated by high-cost therapeutics in oncology.

Clinical Implications

Clinicians should recognize that financial strain is not only a socioeconomic issue but also correlates with more intensive and costly EOL care. Identifying patients with financial hardship through objective measures like credit data could help target supportive interventions to reduce fragmented care and improve goal-concordant treatment. Integrating financial counseling and palliative care earlier may mitigate adverse outcomes associated with economic strain.

Conclusion

This study demonstrates a significant association between financial hardship, as objectively measured by adverse financial events, and increased healthcare utilization and costs at the end of life among cancer patients. Addressing financial toxicity may be critical to optimizing EOL care quality and resource use.

References

1. Ramsey et al. 2016 -- Financial Insolvency as a Risk Factor for Early Mortality Among Patients With Cancer
2. Zafar et al. 2013 -- The Financial Toxicity of Cancer Treatment: A Pilot Study Assessing Out-of-Pocket Expenses and the Insured Cancer Patient’s Experience
3. Hsu et al. 2019 -- Association of Financial Strain With End-of-Life Care Intensity Among Patients With Cancer