Amy D Lu1, Zhiyuan Zheng2, Xuesong Han2, Ruowen Qi3, Jingxuan Zhao2, K Robin Yabroff2, Paul C Nathan1,4. 1. Department of Paediatrics, University of Toronto, Toronto, ON, Canada. 2. Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA. 3. Rollins School of Public Health, Emory University, Atlanta, GA, USA. 4. Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada.
Abstract
BACKGROUND: Cancer and its treatment can result in lifelong medical financial hardship, which we aimed to describe among adult survivors of adolescent and young adult (AYA) cancers in the United States. METHODS: We identified adult (aged ≥18 years) survivors of AYA cancers (diagnosed ages 15-39 years) and adults without a cancer history from the 2010-2018 National Health Interview Surveys. Proportions of respondents reporting measures in different hardship domains (material [eg, problems paying bills], psychological [eg, distress], and behavioral [eg, forgoing care due to cost]) were compared between groups using multivariable logistic regression models and hardship intensity (cooccurrence of hardship domains) using ordinal logistic regression. Cost-related changes in prescription medication use were assessed separately. RESULTS: A total of 2588 AYA cancer survivors (median = 31 [interquartile range = 26-35] years at diagnosis; 75.0% more than 6 years and 50.0% more than 16 years since diagnosis) and 256 964 adults without a cancer history were identified. Survivors were more likely to report at least 1 hardship measure in material (36.7% vs 27.7%, P < .001) and behavioral (28.4% vs 21.2%, P < .001) domains, hardship in all 3 domains (13.1% vs 8.7%, P < .001), and at least 1 cost-related prescription medication nonadherence (13.7% vs 10.3%, P = .001) behavior. CONCLUSIONS: Adult survivors of AYA cancers are more likely to experience medical financial hardship across multiple domains compared with adults without a cancer history. Health-care providers must recognize this inequity and its impact on survivors' health, and multifaceted interventions are necessary to address underlying causes.
BACKGROUND: Cancer and its treatment can result in lifelong medical financial hardship, which we aimed to describe among adult survivors of adolescent and young adult (AYA) cancers in the United States. METHODS: We identified adult (aged ≥18 years) survivors of AYA cancers (diagnosed ages 15-39 years) and adults without a cancer history from the 2010-2018 National Health Interview Surveys. Proportions of respondents reporting measures in different hardship domains (material [eg, problems paying bills], psychological [eg, distress], and behavioral [eg, forgoing care due to cost]) were compared between groups using multivariable logistic regression models and hardship intensity (cooccurrence of hardship domains) using ordinal logistic regression. Cost-related changes in prescription medication use were assessed separately. RESULTS: A total of 2588 AYA cancer survivors (median = 31 [interquartile range = 26-35] years at diagnosis; 75.0% more than 6 years and 50.0% more than 16 years since diagnosis) and 256 964 adults without a cancer history were identified. Survivors were more likely to report at least 1 hardship measure in material (36.7% vs 27.7%, P < .001) and behavioral (28.4% vs 21.2%, P < .001) domains, hardship in all 3 domains (13.1% vs 8.7%, P < .001), and at least 1 cost-related prescription medication nonadherence (13.7% vs 10.3%, P = .001) behavior. CONCLUSIONS: Adult survivors of AYA cancers are more likely to experience medical financial hardship across multiple domains compared with adults without a cancer history. Health-care providers must recognize this inequity and its impact on survivors' health, and multifaceted interventions are necessary to address underlying causes.
Authors: I-Chan Huang; Tara M Brinkman; Kelly Kenzik; James G Gurney; Kirsten K Ness; Jennifer Lanctot; Elizabeth Shenkman; Leslie L Robison; Melissa M Hudson; Kevin R Krull Journal: J Clin Oncol Date: 2013-10-14 Impact factor: 44.544
Authors: Clare Meernik; Anne C Kirchhoff; Chelsea Anderson; Teresa P Edwards; Allison M Deal; Christopher D Baggett; Lawrence H Kushi; Chun R Chao; Hazel B Nichols Journal: Cancer Date: 2020-10-12 Impact factor: 6.860
Authors: I-Chan Huang; Nickhill Bhakta; Tara M Brinkman; James L Klosky; Kevin R Krull; DeoKumar Srivastava; Melissa M Hudson; Leslie L Robison Journal: J Natl Cancer Inst Date: 2019-02-01 Impact factor: 13.506
Authors: Ashley Wilder Smith; Nita L Seibel; Denise R Lewis; Karen H Albritton; Donald F Blair; Charles D Blanke; W Archie Bleyer; David R Freyer; Ann M Geiger; Brandon Hayes-Lattin; James V Tricoli; Lynne I Wagner; Bradley J Zebrack Journal: Cancer Date: 2016-02-05 Impact factor: 6.860
Authors: Olga Husson; Bryce B Reeve; Anne-Sophie Darlington; Christabel K Cheung; Samantha Sodergren; Winette T A van der Graaf; John M Salsman Journal: J Natl Cancer Inst Date: 2022-04-11 Impact factor: 13.506
Authors: Renata Abrahão; Julianne J P Cooley; Frances B Maguire; Arti Parikh-Patel; Cyllene R Morris; Eleonor Bimla Schwarz; Ted Wun; Theresa H M Keegan Journal: Int J Cancer Date: 2021-12-08 Impact factor: 7.396
Authors: Clare Meernik; Jennifer E Mersereau; Christopher D Baggett; Stephanie M Engel; Lisa M Moy; Nancy T Cannizzaro; Mary Peavey; Lawrence H Kushi; Chun R Chao; Hazel B Nichols Journal: Cancer Epidemiol Biomarkers Prev Date: 2022-05-04 Impact factor: 4.090
Authors: Michelle Ann B Eala; Edward Christopher Dee; Katherine Donatela Manlongat; Enrico D Tangco Journal: J Natl Cancer Inst Date: 2022-07-11 Impact factor: 11.816
Authors: Kelsey L Corrigan; Shuangshuang Fu; Ying-Shiuan Chen; Kelsey Kaiser; Michael Roth; Susan K Peterson; Ya-Chen T Shih; Reshma Jagsi; Sharon H Giordano; Robert J Volk; K Robin Yabroff; Mathew P Banegas; Chiara Acquati; Rena M Conti; Hilary Y Ma; Kimberly Ku; Y Nancy You; Grace L Smith Journal: Cancer Date: 2022-04-13 Impact factor: 6.921