LUGPA Policy Brief - Addressing the Long-Term Financial Toxicity of Medical Debt for Cancer Survivors

October 2025

A recent JAMA Oncology study shows that cancer survivors face persistent medical debt, even in Massachusetts, where nearly all residents have insurance. Among 74,000 patients diagnosed between 2010 and 2019, medical debt in collections remained on credit records for over six years, increasing by an average of $15.45 compared with controls.

While most debt measures remained stable, patients with bladder cancer, a core urological malignancy, experienced the steepest rise, with total debt in collections increasing by $375.77. These findings show that insurance alone does not protect patients from long-term financial harm.

LUGPA recommends reforms to remove medical debt from credit reports, strengthen insurance protections, and expand financial support programs to safeguard cancer survivors and ensure the sustainability of independent practices.

Background

Financial toxicity—the economic toll of cancer treatment—can persist for years, limiting survivors’ access to housing, employment, and financial stability. The Massachusetts study followed cancer patients and matched controls over a decade, tracking debt, credit scores, and bankruptcies.

Even in a state with near-universal insurance coverage, cancer survivors carried significantly more medical debt. For urologists, the disproportionate impact on bladder cancer patients is especially concerning.

Key Findings

• Medical debt in collections rose by 123% for cancer patients. Survivors carried an additional $15.45 at six years; those with any debt faced an added $160.
• Bladder cancer patients saw the largest increase in total debt in collections—$375.77 at 5.5 years.
• Other cancers, including colorectal, showed moderate increases; most others were stable.

Why it Matters: Implications for Urology Practices

For LUGPA members, these findings highlight the heightened vulnerability of bladder cancer patients. Financial toxicity can delay care, reduce treatment adherence, and strain practice resources. In states with lower insurance coverage than Massachusetts, these challenges are likely even more severe.

Policy Recommendations

LUGPA urges reforms to address the financial toxicity of cancer care:

1. Remove medical debt from credit reports to prevent long-term barriers to jobs, housing, and financial recovery.
2. Strengthen insurance protections, including caps on out-of-pocket costs and safeguards against surprise billing.
3. Expand targeted financial support programs for high-burden cancers such as bladder and colorectal.
4. Integrate financial navigation into care, equipping practices to help patients manage costs and debt.

Medical debt lingers long after treatment, undermining recovery for cancer survivors. For bladder cancer patients, the burden is especially severe. By advocating for reforms that reduce financial toxicity, LUGPA can protect patients, support independent practices, and promote equitable access to care.