Longitudinal changes in credit status for newly diagnosed metastatic colorectal cancer patients (SWOG S1417).
Authors: C. Natasha Kwendakwema, Amy Darke, Joseph M. Unger, Dawn L. Hershman, Scott David Ramsey, Veena Shankaran
Journal: Journal of Clinical Oncology (2025)

11076 Background: We previously reported that 71% of insured patients with newly diagnosed metastatic colorectal cancer (mCRC) self-reported major financial hardship (MFH), defined as one or more of increased debt, new loans from family and/or friends, selling or refinancing a home, or 20% or more income decline, within 12 months of diagnosis. In this secondary analysis using credit data, we examined if enrolled patients experienced changes in credit status over time. Methods: Depersonalized credit data were obtained from TransUnion, one of the largest credit agencies in the United States, at enrollment, 6, and 12 months. Patients with a baseline and at least one follow-up credit record were analyzed. Demographic data were obtained from questionnaires at enrollment. We determined the mean number or proportion of patients with adverse credit events (defined as past due or delinquent credit cards or mortgage payments, third-party collections, tax liens, charge-offs, bankruptcies, foreclosures, or repossessions) and the mean past due credit card amount, if applicable, at baseline and follow-up. We used paired t-tests to compare credit characteristics between baseline and follow-up in the entire cohort and in subgroups with and without MFH. Multivariate logistic regression was used to identify factors associated with adverse credit events. Results: 318 patients were analyzed (median age 59.1, 41% female, 80% white, 59% married, 42% with private health insurance). Approximately 3.4% of patients experienced a new adverse credit event during the study period, 143 (45.0%) patients at baseline and 154 (48.4%) at follow-up (p=0.07). Overall, new adverse credit events were uncommon and only third-party collections significantly worsened over time (mean 3.20 (SD 3.17) at baseline and mean 4.11 (SD 3.85) at follow-up; p &lt; 0.001). Charge-offs numerically increased over time, but the value did not reach significance. On average, past due amounts on open credit cards increased over time ($100.60 at baseline and $291.33 at follow-up), with the increase largely seen among patients self-reporting MFH. Adverse credit events were more likely to worsen in patients who were younger (OR 2.51, CI 1.08-5.84), had lower household income (OR 3.09, CI 1.07-8.92), lower educational status (OR 2.07, CI 1.10-3.88), and fewer assets, defined as less than $100,000 (OR 4.15, CI 1.58-10.91). Conclusions: Despite high levels of self-reported MFH in this cohort, credit data showed no significant increase in adverse credit events between baseline and follow-up, except for increased third-party collections and total past due credit card balances. This may be due to credit reports capturing only more severe financial impacts or because the impacts of financial hardship take longer to be reflected in credit reports. A future study will examine how patients leverage credit, such as applying for new credit cards or reaching credit limits.