EP279 - Financial Hardship After Colorectal Cancer Diagnosis in the U.S.: Insights From a Nationally Representative Sample

Purpose/Background: In the U.S., colorectal cancer (CRC) is the third most commonly diagnosed cancer and the third leading cause of cancer-related death in both men and women. Advances in diagnosis and treatment have improved survival and clinical outcomes; however, these gains are accompanied by substantial financial burdens from treatment and surveillance. Financial hardship-the detrimental financial impact of illness, healthcare utilization, and resulting personal financial concerns-is increasingly recognized as a critical outcome of cancer care but is infrequently prioritized in CRC interventions. Although smaller studies have documented post-treatment financial hardship among CRC patients, national estimates remain unknown.

Methods/Interventions: We conducted a retrospective, cross-sectional observational study using data from the National Health Interview Survey from 2011-2023. The CRC cohort included U.S. adults ages 18 and older diagnosed with CRC within the five years preceding survey participation. A matched cohort of respondents without a cancer diagnosis was identified using coarsened exact matching (1:4) based on age, sex, insurance, marital/partnered status, race/ethnicity, income, and census region. Financial hardship domains-concern for future finances, delayed/forgone care due to cost, medical debt, inability to cover nonmedical expenses, and work loss-were compared between CRC patients and matched controls. Logistic regression was used to calculate odds ratios (OR) for experiencing financial hardship, defined as the presence of ≥2 of the above financial hardship domains. All analyses were conducted using STATA 18.0.

Results/Outcomes: A total of 1,219 patients with CRC were identified, representing a weighted annual sample size of 441,985. Compared to matched controls, CRC patients were more likely to report poor health (37.4% vs 20.3%, OR 2.29, 95% CI: 1.73-3.03), to experience medical debt (17.3% vs 10.8%, OR 1.74, 95% CI: 1.26-2.39), and to have difficulty managing nonmedical expenses (13.8% vs 8.1%, OR 1.81, 95% CI: 1.19-2.73). Overall, CRC patients were more likely to experience financial hardship (15.5% vs 9.1%, OR 1.72, 95% CI: 1.18-2.53). Among all CRC patients, those reporting financial hardship were also more likely to report poor overall health (66.6% vs 32.6%, OR 3.11, 95% CI: 1.39-7.00).

Conclusion/Discussion: Nearly 1 in 6 adults with a recent colorectal cancer diagnosis in the U.S. experience financial hardship, with 1 in 6 reporting medical debt and nearly 1 in 7 struggling with nonmedical expenses. When controlling for differences using a quasi-experimental approach, we found that CRC patients had 72% higher odds of financial hardship than matched controls. Finally, financial hardship among CRC patients is both a harm in itself and strongly associated with poorer overall health, emphasizing the importance of clinician awareness and the development of targeted interventions to mitigate financial hardship in this population.

Financial and health outcomes among US adults with colorectal cancer vs matched controls
Health outcomes among colorectal cancer patients with and without financial hardship