Clinical Scorecard: Economic Strain, Healthcare Utilization at Life's End, and Expenses Among Cancer Patients
At a Glance
Category
Detail
Condition
Financial hardship (financial toxicity) in cancer patients
Key Mechanisms
High out-of-pocket medical and nonmedical spending, indirect costs from work/income loss, adverse financial events (AFEs) identified via credit data
Target Population
Insured adult patients with AJCC stage I-IV solid tumors diagnosed with cancer
Care Setting
End-of-life (EOL) care in hospital and outpatient settings
Key Highlights
Cancer patients are 2.65 times more likely to file for bankruptcy and 1.71 times more likely to experience major adverse financial events compared to matched non-cancer individuals.
Financial hardship is associated with higher-intensity care at EOL, including multiple emergency department or hospital visits and increased likelihood of dying in hospital.
Approximately one-quarter of Medicare spending occurs in the last year of life, driven largely by hospital-based care and high-cost therapeutics.
Guideline-Based Recommendations
Diagnosis
Use linked cancer registry, insurance claims, and consumer credit data to identify financial hardship via adverse financial events (AFEs).
Assess financial strain using objective credit data including collections, charge-offs, liens, foreclosures, and repossessions.
Management
Recognize financial toxicity as a factor influencing EOL care intensity and healthcare utilization.
Consider interventions to address financial hardship to potentially reduce fragmented or non–goal-concordant care at EOL.
Monitoring & Follow-up
Monitor frequency of emergency department visits and hospitalizations in the last 3 months of life as indicators of care intensity.
Track place of death (hospital vs outpatient) to assess care patterns related to financial strain.
Risks
Financial hardship increases risk of multiple ED/hospital visits and hospital death at EOL.
High-intensity EOL care driven by financial strain may contribute to increased healthcare spending and poorer patient outcomes.
Patient & Prescribing Data
Insured adult cancer patients with stage I-IV solid tumors, excluding Medicaid and dual Medicaid-Medicare enrollees
Patients experiencing new AFEs in the 3 to 24 months prior to death have higher healthcare utilization and costs at EOL, suggesting financial strain impacts treatment patterns and care intensity.
Clinical Best Practices
Incorporate financial hardship screening using objective credit data alongside clinical assessments in oncology care.
Address financial toxicity proactively to improve treatment adherence and quality of life.
Tailor EOL care planning to consider patients’ financial status to avoid unnecessary high-intensity interventions.
Use multidisciplinary approaches including social work and financial counseling to mitigate adverse financial events.
by Veena Shankaran, Li Li, Sara Khor, Kaiyue Yu, C. Natasha Kwendakwema, Catherine Fedorenko, Karma Kreizenbeck, Hiba M. Khan, Shannon Kestner, Winona Wright, Scott Ramsey
