Financial hardships and chronic medical conditions in adolescent and young adult cancer survivors

Adolescents and young adult (AYA) cancer survivors face a higher risk of chronic medical conditions and are more likely to delay or forgo health care due to costs compared to same-age individuals without cancer. They also experience greater financial hardship than older adult survivors. However, gaps remain in our understanding of the financial hardships associated with cancer or the lasting health effects of treatment in AYA cancer survivors. In the Valuing Opinions and Insights from Cancer Experiences (VOICE) Study, participants diagnosed during 2016-2022 with 10 common AYA cancers between ages 15-39 years in California completed a survey in 2023-2024. Financial hardship was measured by financial debt due to cancer and 8 questions on the impact of medical expenses in the past year, categorized into trouble meeting needs (e.g., put off major purchases, unable to pay for basic necessities), asset depletion (e.g., took money from savings/retirement, credit card debt) and major financial changes (e.g., needed mortgage against home, thought about bankruptcy). In addition, we assessed whether AYAs were diagnosed after cancer diagnosis with 10 chronic medical conditions (asthma/lung problems, blood clots, bladder dysfunction, diabetes, heart conditions, hypertension, kidney dysfunction, liver problems, osteoporosis, thyroid problems). We examined the association of each financial hardship with 1 or ≥2 (vs 0) medical conditions using multinomial logistic regression, adjusting for age, sex, race/ethnicity, current health insurance and cancer type. Among 3,685 AYAs, most were age 30-39 years at diagnosis (70.6%), of non-Hispanic (NH) White (34.6%) or Hispanic (32.4%) race or ethnicity and had employer-sponsored insurance (66.6%). Breast (25.3%), thyroid (22.4%) melanoma (10.0%), and testicular (10.3%) were the most common cancers. Overall, 18.9% and 7.8% of AYAs developed 1 or ≥2 of the 10 chronic medical conditions, respectively. Nearly one-fifth (18.8%) of AYAs experienced financial debt since their cancer diagnosis. In the past year, approximately one-third of AYAs experienced trouble meeting needs (27.5%) and asset depletion (31.7%), while 6.1% experienced major financial changes. In multivariable models, AYAs with ≥2 conditions were more likely to have financial debt (odds ratio (OR)=1.99, 95% confidence interval (CI) 1.50-2.64 vs. no medical conditions), trouble meeting needs (OR=2.05, CI 1.58-2.67), asset depletion (OR=1.83, CI 1.42-2.37) and major financial changes (OR=2.24, CI 1.49-3.36). Financial hardship impacts one-third of AYA cancer survivors, and those with chronic medical conditions have a substantially greater likelihood of experiencing financial hardship. Our findings highlight the long-term economic impact of cancer in this population and the need to evaluate the effectiveness of targeted interventions, such as financial navigation, to address financial burden.