DOES SUBSTANDARD CANCER CARE ADVERSELY IMPACT PATIENT FINANCIAL WELL BEING? AN ANALYSIS OF CANCER REGISTRY, CLAIMS, AND CREDIT REPORT SCORES
Author(s)
Scott Ramsey, PhD, MD1, Veena Shankaran, MD, MS2, Li Li, MA, MPA3, Catherine Fedorenko, MMSc3, Winona Wright, MS3, Joseph Unger, PhD3, Karma Kreizenbeck, BA3;
1Fred Hutchinson Cancer Research Center, Full Member & Co-Director, Lake Forest Park, WA, USA, 2University of Washington, Seattle, WA, USA, 3Fred Hutchinson Cancer Center, Seattle, WA, USA
1Fred Hutchinson Cancer Research Center, Full Member & Co-Director, Lake Forest Park, WA, USA, 2University of Washington, Seattle, WA, USA, 3Fred Hutchinson Cancer Center, Seattle, WA, USA
OBJECTIVES: Substandard cancer care harms patients and is costly to insurers, but the impact on patients' financial well-being is unknown. Using a unique linked database, we evaluated the hypothesis that patients experiencing substandard care are more likely to experience adverse financial outcomes.
METHODS: Among solid tumor cancer patients diagnosed between 2019-2023 in Washington state, we used insurance claims to determine whether patients received care consistent with one of four widely recognized quality measure: (M1) Receipt of recommended initial treatment (breast, lung, and colorectal cancer) (M2) Emergency department visit or unplanned hospitalization during chemotherapy (all cancers) (M3) Cancer tumor marker monitoring (breast cancer - not recommended) (M4) Germline susceptibility testing (breast or ovarian cancer - recommended). We used multivariate logistic regression (>=50-point decline in credit score 12+ months following the end of the quality metric measurement period, indicating significant adverse financial events), with nonadherence to the quality metric as the key indicator variable.
RESULTS: Among patients eligible for each metric, average (s.d.) credit score changes following the index date were as follows: M1 - 0.62 (46.8); M2 - -3.05 (47.6) M3 - 1.76 (42.3) M4 - 3.38 (53.2). Patients experiencing emergency department visits or hospitalizations during treatment were significantly more likely to have a 50 point(+) decline in credit scores (OR 1.54, 95% CI 1.36 - 1.75). Patients who did not receive germline susceptibility testing were less likely to experience declines (OR 0.69, 95% CI 0.50 - 0.94). Patients who did not receive recommended treatment or received tumor marker testing were not more likely to experience decline in credit scores.
CONCLUSIONS: Cancer patients experiencing emergency department or unplanned hospital stays later incurred adverse financial events manifested as a substantial decline in their credit scores. Overall, substandard care is variably impactful on patient finances but may represent an underappreciated consequence of low-quality care.
METHODS: Among solid tumor cancer patients diagnosed between 2019-2023 in Washington state, we used insurance claims to determine whether patients received care consistent with one of four widely recognized quality measure: (M1) Receipt of recommended initial treatment (breast, lung, and colorectal cancer) (M2) Emergency department visit or unplanned hospitalization during chemotherapy (all cancers) (M3) Cancer tumor marker monitoring (breast cancer - not recommended) (M4) Germline susceptibility testing (breast or ovarian cancer - recommended). We used multivariate logistic regression (>=50-point decline in credit score 12+ months following the end of the quality metric measurement period, indicating significant adverse financial events), with nonadherence to the quality metric as the key indicator variable.
RESULTS: Among patients eligible for each metric, average (s.d.) credit score changes following the index date were as follows: M1 - 0.62 (46.8); M2 - -3.05 (47.6) M3 - 1.76 (42.3) M4 - 3.38 (53.2). Patients experiencing emergency department visits or hospitalizations during treatment were significantly more likely to have a 50 point(+) decline in credit scores (OR 1.54, 95% CI 1.36 - 1.75). Patients who did not receive germline susceptibility testing were less likely to experience declines (OR 0.69, 95% CI 0.50 - 0.94). Patients who did not receive recommended treatment or received tumor marker testing were not more likely to experience decline in credit scores.
CONCLUSIONS: Cancer patients experiencing emergency department or unplanned hospital stays later incurred adverse financial events manifested as a substantial decline in their credit scores. Overall, substandard care is variably impactful on patient finances but may represent an underappreciated consequence of low-quality care.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
PCR19
Topic
Patient-Centered Research
Topic Subcategory
Adherence, Persistence, & Compliance
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Oncology