Financial Strain & Delayed Treatment in Blood Cancers | Christopher Su, MD

So, my name is Doctor Christopher Su from the Fred Hutch Cancer Center in Seattle.

At ASH this year, we're presenting on a study that looks at adverse financial events and its association with treatment initiation in patients with DLBCL, a type of lymphoma, CML, a type of leukemia, and multiple myeloma.

So just to kind of break down those terms a little bit, what we did was we used a very large database that has patients’ credit information linked to their cancer treatment, linked to their insurance claims. Everything is de-identified.

And what we're trying to do is we're trying to use credit data and looking for things that might indicate to us that patients have financial difficulty, and then looking at the patients who have these indicators and how long it took them to get treated for their blood cancer.

So these adverse financial events, as we call them, include basically past due debt. So if your debt goes beyond the due date and that becomes delinquent. And also some of the downstream effects on that. So basically going into foreclosure, getting a lien placed on your property, or having collections companies come and try to collect upon your past due debt.

So we looked at this in the credit reports, and we identified patients with the blood cancers that I mentioned that have these things that we call AFEs. And we looked at how long it took them to get treatment for their cancer.

And we actually found that in patients with these AFEs, when they come into diagnosis, so for all these credit data we obtained within 50 days of that initial diagnosis, if a patient has any of these things, they had significantly delayed time to initiating their treatment for their blood cancers.

And this effect was very strong. So after we controlled for other things that might be at play, including their age, their race, and what type of disease they had, we saw that this relationship persisted.

So I think the biggest takeaways from our study is we were really interested in finding out that actually 24% of the 1000 plus patients that we included in this research had these AFEs when they came into their blood cancer diagnosis. So this is a lot of patients. This is a quarter of our patient population.

And it shows that if we were to just go into a cancer center, hypothetically, a quarter of the patients who are trying to get care for their blood cancer would be struggling with issues of unresolved debt and also a lot of downstream financial hardship.

And we know from our analysis that these patients are then likely to get treatment delay and probably likely to have worse outcomes from their disease treatment because they had delayed time to treatment.

So I think it really speaks to the importance of improving our screening and also improving the questions that we ask when patients come into care about whether they're struggling with financial issues, because if we can pick these things up very early as they're coming into care, we may be able to send patients to financial navigation or to offer support services a lot earlier on in the cancer care survivorship trajectory, rather than waiting until we develop all these financial problems down the road once they start on the treatment and then referring them.

So I think the most important takeaway of our research is that there is a lot of patients that are struggling out there with issues with debt and also the downstream side effects of that. And the earlier we can catch these people and we can offer them support and ways to potentially maybe even mitigate their debt, I think there will be better access to treatment and also better treatment outcomes.

Thank you.

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