Cancer diagnosis as a risk factor for personal bankruptcy.

6007 Background: The risk of bankruptcy for cancer patients is not well characterized and may vary by cancer type, treatment, and personal factors. Linking the Washington State SEER registry with Western District of Washington bankruptcy court records, we measured the rate of bankruptcy after cancer and identified factors that increased risk among common cancers. METHODS We included adults age >20 with newly diagnosed first primary cancers between 1995-2009, excluding cancers in situ or diagnosed at death. We calculated the conditional probability of personal bankruptcy (chapters 7 and 13), i.e., probability conditional on survival to the time point. For cancers with the highest risk, we used competing risks regression to identify patient- and treatment-related factors associated with bankruptcy. RESULTS There were N=231,799 cancer cases; after a mean follow-up of 4.3(sd=4.1) years, N=4,805 (2.1%) filed for bankruptcy. Median time to bankruptcy was 2.5 years. Lung, thyroid, and leukemia/lymphoma cancers had the highest conditional probabilities at 1 year (1.5%, 0.9%, and 0.6%, respectively), 2 years (3.1%, 2.0%, and 1.4%, respectively), and 5 years (7.7%, 4.8%, and 3.6%, respectively) from diagnosis. In regression analysis (Table), age ≥65 at diagnosis was associated with a decreased risk of bankruptcy for all cancers (Hazard Ratio [HR] 0.3-0.5). Bankruptcy risk was higher for lung, colorectal and breast cancer cases receiving surgery (HR 2.0-4.1) and chemotherapy (HR 1.4-1.5). CONCLUSIONS Bankruptcy risk is highest for lung, thyroid, and leukemia/lymphoma cancer patients. Patients over age 65, who are typically on Medicare, have a much lower risk of bankruptcy than younger patients. Certain cancers face additional risks due to surgery and chemotherapy. [Table: see text].