When someone is diagnosed with cancer, the clinical questions come quickly. What treatment should begin? How soon? With what intensity? Far less visible, but often just as consequential, is another question: can the patient afford what comes next? In oncology, this problem is often discussed under the umbrella of “financial toxicity,” a term meant to capture the economic strain that accompanies cancer care. But a new study suggests that for many patients, financial hardship does not begin with treatment; it is already there.
In a new study published in Clinical Lymphoma, Myeloma and Leukemia, Drs. Veena Shankaran and Christopher Su at Fred Hutch Cancer Center, along with their collogues, examined whether personal credit report data could be used to identify financial hardship among patients with multiple myeloma and whether that information could predict treatment disruptions and long-term financial strain. Rather than relying on patient questionnaires, which are the current standard, the team explored whether objective indicators embedded in credit data might reveal financial vulnerability earlier and more consistently.
“We explored — in a retrospective fashion — using credit report data to identify financial hardship among patients with cancer, rather than relying solely on patient questionnaires,” Dr. Su explained. “Traditional survey-based measures can miss vulnerable patients due to nonresponse, limited literacy, or barriers to technology.”
For people living with multiple myeloma, care often unfolds over years and can involve substantial out-of-pocket costs, making financial stress a significant part of the illness experience. Treatment may include prolonged courses of high-cost medications and, for some patients, autologous stem cell transplantation. Previous studies have shown that when patients face financial hardship, they are more likely to delay care, interrupt treatment, or forgo recommended therapies. What has been harder to establish is when that hardship begins, and whether it can be identified early, before it starts to shape care itself.
To investigate this, the researchers conducted a retrospective cohort study of 396 insured adults diagnosed with multiple myeloma between 2012 and 2020 in Western Washington State. Using a linked data resource, they combined cancer registry information, insurance claims, and de-identified credit data obtained with patient consent. Credit reports were examined near the time of diagnosis and again roughly two years later.
The team classified financial status into four tiers using common credit indicators: no hardship, mild hardship reflected by high credit utilization, moderate hardship marked by delinquent debt, and severe hardship defined by third-party actions such as collections or bankruptcy. Financial status at diagnosis was described as “financial fragility,” while credit data at two years were used to characterize longer-term financial hardship.
The researchers then asked two main questions. First, was financial fragility at diagnosis associated with suboptimal treatment patterns, such as delays in starting therapy or interruptions during early care. Second, among patients who survived at least two years, did financial fragility predict persistent or worsening hardship during survivorship.
The answers were striking. One quarter of patients had moderate or severe financial fragility at the time of diagnosis, despite being insured. Patients in this group were more likely to experience delays in treatment initiation or interruptions during the first six months of therapy. While some associations did not meet conventional thresholds for statistical significance, the direction and magnitude of the effects were consistent and clinically meaningful.
The most powerful findings emerged in the longitudinal analysis. Financial fragility at diagnosis strongly predicted financial hardship two years later. Patients who entered treatment with delinquent debt or more severe credit issues were far more likely to experience ongoing hardship during survivorship. In fact, among the 71 patients who had moderate to severe financial vulnerability at diagnosis, 62% showed no improvement or experienced persistent or worsening financial hardship.
“Our findings raise the possibility that what is often labeled as ‘financial toxicity’ during cancer treatment may, in part, reflect pre-existing financial vulnerability,” Dr. Su said. “This underscores the importance of earlier and more objective screening for social and financial risk at the time of cancer diagnosis, as substantial out-of-pocket costs are anticipated as treatment gets underway.”
The study also revealed that patients who received an autologous stem cell transplant within the first year had lower odds of long-term financial hardship. This finding may reflect both greater baseline financial stability and changes in care intensity following transplant, but it also highlights how financial resources can shape access to aggressive, potentially life-extending therapies.
Beyond its specific findings, the study raises broader questions about how health systems identify patients at risk. Patient-reported surveys remain essential, but they are not neutral tools. They require time, literacy, trust, and access to technology. Those who are most economically precarious may be the least likely to complete them. Credit data, while imperfect and ethically sensitive, offer a different kind of signal. They are already collected, standardized, and longitudinal. Used carefully, they may help identify patients who would otherwise remain invisible until financial strain has already disrupted care.
Looking ahead, the authors emphasize that this approach is not meant to replace patient voices. Instead, future work will focus on prospectively validating how credit-based measures align with patient-reported hardship and examining whether credit screening can be integrated into clinical intake in a way that is transparent, consensual, and supportive. “Can credit screening be feasibly integrated into patient financial intake?” Dr. Su asked. “While this would represent a radical paradigm shift in current workflow, informal patient feedback from related projects suggests high acceptability when the rationale for our approach is clearly explained.”
At a time when cancer care is becoming more effective and more expensive, the study challenges clinicians and institutions to rethink when and how financial risk is assessed. If hardship can be detected at diagnosis, waiting until patients fall behind may no longer be an acceptable default.
This research was supported by the National Cancer Institute and the FHCC K12 career development grant administered by Drs. Davison and Meshinchi.
Fred Hutch/University of Washington/Seattle Children’s Cancer Consortium Members Drs. Veena Shankaran and Christopher Su contributed to this research.
Su, C. T., Banerjee, R., Li, L., Fedorenko, C., Cowan, A., Ramsey, S. D., & Shankaran, V. (2025). Association of Personal Credit Data With Financial Hardship and Treatment Outcomes in Patients With Multiple Myeloma. Clinical lymphoma, myeloma & leukemia, S2152-2650(25)04292-2. Advance online publication.
Science Spotlight writer Darya Moosavi is a postdoctoral research fellow within Johanna Lampe's research group at Fred Hutch. Darya studies the nuanced connections between diet, gut epithelium, and gut microbiome in relation to colorectal cancer using high-dimensional approaches.
For the Media