Impact of financial fragility on emergency department (ED) and inpatient (IP) visits among cancer patients in Washington state.

210 Background: Recent studies have shown that cancer patients with precarious personal finances (i.e. financially fragile (FF)) are diagnosed at later stages and have worse survival. Little is known, however, about the impact of FF on healthcare utilization. We sought to evaluate whether baseline FF is associated with a higher likelihood of ED or IP care among cancer patients who received systemic therapy. Methods: We conducted a retrospective analysis of newly diagnosed adult patients with solid tumor or lymphoma in Washington (WA) state diagnosed in 2013-2018. Patients were identified from a unique database linking Western Washington Surveillance Epidemiology and End Results (WA SEER), insurance claims from Medicare, Medicaid, and commercial payers, and deidentified credit reports from TransUnion. Baseline FF was defined as evidence of at least one of the following in the 90 days before diagnosis: charge-offs, collections, liens, foreclosures, repossessions, and bankruptcy. Race/ethnicity data were obtained via WA SEER. In the subset of patients who received any outpatient chemotherapy within 6 months from diagnosis, we used a multivariate logistic regression analysis to evaluate whether baseline FF was associated with higher likelihood of having 1 or more claims for ED or IP care within 6 months of their first chemotherapy dose, adjusting for payer type, race, ethnicity, and urban/rural status. ED encounters were defined as a claim for ED care only without associated admission; ED visits resulting in IP hospitalization were counted as IP visits only. Results: A total of 38,612 adult cancer patients were identified of whom 7,798 (20.2%) were FF. Baseline FF was most frequent among patients who were age ≤65, identified as Black, American Indian/Alaska Native, Pacific Islander, multiracial, or Hispanic, were diagnosed with colorectal, lung, and “other” cancers (non-breast/prostate), diagnosed at stage III/IV, insured by Medicaid, and living in metropolitan areas. Of the 10,745 patients who received chemotherapy, 3,258 (30.3%) experienced ED visits and 3,855 (36%) were hospitalized. FF was associated with an increased likelihood of ED visits (OR 1.44, 95% CI 1.30-1.60, p < 0.0001) and IP hospitalization (OR 1.39, 95% CI 1.25-1.54, p < 0.0001). Conclusions: Patients with baseline FF are more likely to receive ED and IP care during chemotherapy. These findings suggest that patients with decreased financial resources may have more intense hospital-based care, which could potentially have impacts on quality of life and overall healthcare costs.