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David S. Ettinger, MD, FACP, FCCP


ASCO Quality 2022: Are Mortgage Denial Rates Associated With Receipt of Guideline-Concordant Care in Lung Cancer?

By: Kayci Reyer
Posted: Tuesday, October 4, 2022

According to research presented at the 2022 American Society of Clinical Oncology (ASCO) Quality Care Symposium (Abstract 3), there may be an association between mortgage lending practices and receipt of care for patients with non–small cell lung cancer (NSCLC). Overall, patients who live in an area with higher mortgage denial rates may be less likely to receive guideline-adherent care.

“Our examination of institutional practices leading to barriers in access to resources highlights the critical need to understand the pathways through which area-level mortgage denials impact receipt of equitable cancer care,” concluded Qinjin Fan, PhD, of the American Cancer Society, and colleagues.

The study included 450,614 patients with newly diagnosed NSCLC who lived in 33,120 zip code tabulation areas. Mortgage denial rates for each zip code tabulation area were determined using data from 2014 through 2019 in the Home Mortgage Disclosure Act database, and patients were identified using data from 2014 through 2019 in the National Cancer Database. Patients who lived in zip code tabulation areas with higher proportions of denied home loans to total loans had lower likelihoods of receiving guideline-adherent care. Within these neighborhoods, patients were also more likely to experience prolonged time between diagnosis and the initiation of chemotherapy.

Zip code tabulation areas with high rates of mortgage denial were more likely to include residents who were non-Hispanic White men between the ages of 45 and 64 and had private health insurance as well as an annual income below $40,000. Overall, 69% of patients received care aligned with treatment guidelines. Examples of guideline-adherent care included surgery, chemotherapy, and chemoradiotherapy.

Disclosure: For full disclosures of the study authors, visit

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