Debt, Bankruptcy, and Credit Scores After Cancer Diagnosis

Importance A cancer diagnosis is a major driver of financial burden for US households, yet longitudinal data on debt, bankruptcy, and credit scores after diagnosis are lacking. Objective To examine longitudinal changes in adverse financial outcomes for nearly all individuals diagnosed with cancer in Massachusetts over a 10-year period (2010-2019) compared with a Massachusetts control population. Design, Setting, and Participants This retrospective, population-based cohort study included individuals diagnosed with different cancers in Massachusetts over a 10-year period (2010-2019). Analysis was conducted between April 2024 and February 2025. Individuals with cancer were matched 1:1 with control individuals based on baseline demographic and socioeconomic factors. Using comprehensive financial data, a difference-in-differences design was then used to study debt, bankruptcy, and credit scores over time. Subanalyses across 9 major cancer types were performed to assess heterogeneity in adverse financial outcomes. Exposures Cancer diagnosis during the study period (2010-2019) was used as the primary exposure. Covariates included age, sex, marital status, education, occupation status, and income. In subgroup analyses, exposures were defined based on the cancer subpopulation (ie, bladder, breast, cervical, colorectal, liver, lung, ovarian, thyroid, and uterine cancer) over the same time period. Main Outcomes and Measures Financial outcomes included total debt, total debt in collections, medical debt in collections, credit scores, and bankruptcy rates. Results In a matched difference-in-differences analysis of 74 146 individuals with a cancer diagnosis and 74 146 control individuals (mean [SD] age, 57.2 [14.1] years; 81.2% female), increases in mean medical debt in collections of $15.45 (95% CI, $2.19-$28.71) at 6 years postdiagnosis were observed. There were no changes in mean total debt, total debt in collections, number of bankruptcies, or credit scores after diagnosis. In subgroup analysis, patients with colorectal cancer experienced an increase in mean total debt in collections of $155.55 (95% CI, $0.34-$310.76) at 6 years postdiagnosis, and patients with bladder cancer experienced an increase in mean total debt in collections of $375.77 (95% CI, $5.89-$745.65) at 5.5 years postdiagnosis. Conclusions and Relevance In this retrospective cohort study, modest amounts of medical debt in collections persisted for years after cancer diagnosis. Total debt in collections was present at higher amounts for certain cancer subpopulations. The persistence of adverse financial outcomes after cancer diagnosis, despite high rates of insurance coverage in Massachusetts, warrants further research and consideration of broader systemic reforms.