EP122 - Early Onset Colorectal Cancer Is Associated With Objective Financial Toxicity

Purpose/Background: Patients diagnosed with colorectal cancer have long-lasting financial hardship, with the impact spanning years beyond other cancer types. Further, early-onset (before age 50) colorectal cancer is on the rise. Though there is a growing body of literature on financial toxicity after cancer diagnosis, many use patient-reported markers of financial hardship, and few use direct objective measures of financial health. Credit score is a composite score of payment history and credit balances, utilization & depth, and is a key indicator of financial wellbeing. Low credit score reflects significant financial strain, with Subprime Credit Score (SCS, ≤600 points) marking extreme difficulty in obtaining traditional loans. We aimed to identify factors associated with objective financial toxicity defined by SCS in patients with colorectal cancer.

Methods/Interventions: In this retrospective cohort study, patients age >=21 diagnosed with colorectal cancer between 2010-2019 who underwent partial or total colectomy were identified through the Massachusetts Cancer Registry and linked with credit reports. Patients with pre-diagnosis SCS, those who died during the study period, and those with missing data were excluded. 2,158 patients met inclusion criteria.

Using univariate analysis and multivariable logistic regression, we assessed associations with SCS 2 years post-diagnosis. Odds of SCS were adjusted for sociodemographic factors (age at diagnosis, race, marital status, sex, education, tobacco use history), financial factors (individual income, insurance status, pre-diagnosis bankruptcy), neighborhood characteristics (estimated median household income, poverty indicator, based on zip code), and cancer characteristics (extent of disease, treatment type).

Results/Outcomes: 63 patients (2.9%) of 2,158 developed SCS two years after diagnosis. Most patients were white (91%), married/partnered (62%), female (59%), non-smokers (53%), with a college education or more (54%), and public insurance (57%). Median individual income was $52,000 and median estimated household income was $86,570.

In a univariate analysis, SCS was associated with early-onset disease (24% vs 11%, p< 0.001), Black or Hispanic race (11% vs 3%, 16% vs 3% respectively, p< 0.001), lower income (71% vs 43%, p< 0.001), lack of insurance (3% vs 1%, p< 0.001), living in areas with lower median household income (16% vs 6%, p=0.003), living in areas of higher poverty (49% vs 29%, p=0.002), and pre-diagnosis bankruptcy (19% vs 3%, p< 0.001). Extent of disease and treatment type did not have an association with SCS. In a multivariable analysis, higher odds of SCS were associated with early-onset disease (aOR 2.96 [95% CI 1.47, 5.94]), Black or Hispanic race (aOR 3.45 [95% CI 1.29, 9.23] and 4.64 [95% CI 1.93, 11.13] vs White), and individual income below median (aOR 2.46 [95% CI 1.18, 5.11]).

Conclusion/Discussion: Credit score is an important financial indicator that affects borrowing ability, interest rates, and the ability to rent or purchase housing. Though studies exist examining financial toxicity in cancer care, few use reliable objective markers. Early-onset colorectal cancer is associated with poor financial outcomes, with those diagnosed before age 50 over twice as likely to develop subprime score compared to those diagnosed after age 50. Additionally, Black and Hispanic race is strongly associated with financial toxicity. This highlights the need for targeted interventions to mitigate disparities, as well as advocacy for health policy change.

Table
Characteristics by Post-Diagnosis Credit Score