Prediagnosis Financial Hardship Linked to Higher Cancer Mortality

Patients with a court-documented major adverse financial event (AFE)—bankruptcy, lien, eviction, or a combination—before their cancer diagnosis had higher mortality risk for several common cancers, according to a cohort study published as a research letter in JAMA Network Open.

Investigators linked data from 3 Surveillance, Epidemiology, and End Results (SEER) cancer registries—Seattle-Puget Sound, Georgia, and Louisiana—with LexisNexis consumer data. They identified adults aged 20 to 69 years diagnosed with 1 of 8 common cancers during 2014 to 2015 and followed deaths through December 31, 2022, using cancer site–specific Cox models adjusted for demographic characteristics.

Of 56,892 patients, 20,789 (36.5%) had a prediagnosis AFE. Those with AFEs were more likely to be non-Hispanic Black, unmarried, in a lower income group, and diagnosed at a later stage. There were 16,132 deaths, 11,697 (72.5%) of them from cancer. Prediagnosis AFEs were associated with significantly higher cancer-specific mortality risk in melanoma (hazard ratio [HR], 1.99; 95% CI, 1.58-2.50), prostate (HR, 1.34; 95% CI, 1.16-1.54), female breast (HR, 1.30; 95% CI, 1.19-1.43), colorectal (HR, 1.10; 95% CI, 1.01-1.19), and non–small cell lung (HR, 1.07; 95% CI, 1.00-1.13) cancers.

AFEs were also associated with higher all-cause mortality risk in those 5 cancers and in oral cavity and pharynx cancer. Stage-stratified analyses were consistent with the main results, and HRs varied little by AFE timing or sex, the authors reported. In kidney cancer, AFEs were associated with lower cancer-specific mortality risk (HR, 0.84; 95% CI, 0.71-0.99) but not with all-cause mortality.

The authors noted that findings from 3 registries may not generalize to the entire US, that comorbidity data were unavailable and may have contributed to the observed associations, and that cancer treatments were not examined because SEER provides limited systemic therapy information. They said further research with detailed comorbidity and treatment information is warranted.

Source: Yabroff KR, Noone AM, Mariotto A, et al. Court-documented adverse financial events before cancer diagnosis and mortality risk. JAMA Netw Open. 2026;9(10):e2637677. doi:10.1001/jamanetworkopen.2026.37677