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Background Young adult (YA) cancer survivors are at risk for financial toxicity during and after cancer treatment. Financial toxicity has been associated with medical‐related cost‐coping behaviors such as skipping or delaying treatment. The coronavirus disease 2019 (COVID‐19) pandemic has resulted in dire economic consequences that may worsen financial hardship among young survivors. Methods This was a cross‐sectional survey; data collection occurred online. A convenience sample was recruited through YA cancer advocacy groups and social media. Negative economic events associated with the COVID‐19 pandemic (eg, income loss, increased debt, and decreased job security) and medical‐related cost‐coping were documented. A validated measure assessed cancer‐related financial toxicity. Results Participants (N = 212) had a mean age of 35.3 years at survey completion and a mean age of 27.4 years at diagnosis. Financial toxicity (mean, 14.0; SD, 9.33) was high. Two‐thirds of the sample experienced at least 1 negative economic event during COVID‐19, and 71% engaged in at least 1 medical cost‐coping behavior. Cost‐coping and pandemic‐related negative economic events were significantly correlated with cancer‐related financial toxicity. In multivariable analyses, pandemic‐related negative economic events and financial toxicity were associated with cost‐coping. Conclusions Acute negative economic events associated with the COVID‐19 pandemic may exacerbate cancer‐related financial toxicity and overall financial hardship among YAs and lead to cost‐coping behaviors that can compromise survivorship care and health outcomes. Multilevel, systematic interventions are needed to address the financial needs of YA survivors after the global pandemic.

Background Cancer-related financial hardship can negatively impact financial well-being and may prevent adolescent and young adult (AYA) cancer survivors (ages 15–39) from gaining financial independence. This analysis explored the financial experiences following diagnosis with cancer among AYA survivors. Methods We conducted a cross-sectional, anonymous survey of a national sample of AYAs recruited online. The Comprehensive Score for Financial Toxicity (COST) and InCharge Financial Distress/Financial Well-Being Scale (IFDFW) assessed financial hardship (cancer-related and general, respectively), and respondents reported related financial consequences and financial coping behaviors (both medical and non-medical). Results Two hundred sixty-seven AYA survivors completed the survey (mean 8.3 years from diagnosis). Financial hardship was high: mean COST score was 13.7 (moderate-to-severe financial toxicity); mean IFDFW score was 4.3 (high financial stress). Financial consequences included post-cancer credit score decrease (44%), debt collection contact (39%), spending more than 10% of income on medical expenses (39%), and lacking money for basic necessities (23%). Financial coping behaviors included taking money from savings (55%), taking on credit card debt (45%), putting off major purchases (45%), and borrowing money (42%). In logistic regression models, general financial distress was associated with increased odds of experiencing financial consequences and engaging in both medical- and non-medical-related financial coping behaviors. Discussion AYA survivors face long-term financial hardship after cancer treatment, which impacts multiple domains, including their use of healthcare and their personal finances. Interventions are needed to provide AYAs with tools to navigate financial aspects of the healthcare system; connect them with resources; and create systems-level solutions to address healthcare affordability. Implications for Cancer Survivors Survivorship care providers, particularly those who interact with AYA survivors, must be attuned to the unique risk for financial hardships facing this population and make efforts to increase access available interventions.

12117 Background: Due to disruptions in education, workforce entry, and career development caused by cancer and its treatment, young adult (YA) cancer survivors face financial toxicity (i.e., cancer-related financial distress) at rates higher than older survivors. Financial toxicity in YA survivors is associated with avoiding care and diminished psychosocial well-being, but enduring effects on employment, personal finances, and healthcare use and the association with YA’s financial capability are not well studied. Methods: This was a cross-sectional survey of a national sample of YAs with cancer (n = 214) recruited online and via mailing lists. It included the Comprehensive Score for Financial Toxicity (COST), demographic/clinical self-report, and questions on medical cost-coping and healthcare use. Financial capability questions considered respondents’ knowledge about finances, self-efficacy for managing health expenses, and attitudes and behaviors regarding tracking expenses, budgeting, saving, investing, and bill paying. Multiple linear regression assessed associations among financial toxicity, financial capability, and cost-coping. Results: Mean respondent age was 35.4 years ( sd= 5.40) at survey and 27.5 years ( sd= 7.23) at diagnosis. Breast cancer (28%) and lymphoma (17%) were the most common diagnoses; most respondents were white (79%) women (87%) with college degrees (74%). Financial toxicity, as measured by COST, was high (mean = 13.9, sd= 9.3; possible range 0-44, scores < 26 indicate severe financial toxicity). Nearly all of the sample (96%) had health insurance, but 30% said their insurance does not meet their needs. One-half of the sample lacked confidence to manage health expenses. Cost-coping strategies included skipping/delaying: treatment (23%), survivorship care (35%), or medications (39%); 65% relied on a family member to pay for some/all medical bills. Negative events related to medical expenses included using money from savings (58%), taking on credit card debt (45%), post-cancer credit score decrease (44%), borrowing money to pay bills (42%), debt collection contact (37%), lacking money to pay for basic necessities (23%), loan denial (20%), and thoughts about and/or filing for bankruptcy (15%). In multivariate analyses, greater financial toxicity was associated with lower self-efficacy for managing health expenses (β = -0.88, p =.01), poorer financial behaviors (β = -0.54, p =.001), lower income (β = -5.27, p =.001), and skipping/delaying: treatment (eβ= 1.16, p <.001), survivorship care (eβ= 1.13, p <.001), or prescribed medication (eβ= 1.10, p =.001). Conclusions: Our findings illustrate the profound enduring impact of financial toxicity among YAs after cancer treatment. Multilevel interventions are needed to provide YAs the tools to navigate financial aspects of the healthcare system and connect them with resources toward gaining financial independence.

Lead impairs cognition in children and occupationally exposed adults. Chronic low-level exposure to lead is associated with accelerated decline in cognition in older men, an association that has not been studied in women. We examined biomarkers of lead exposure in relation to performance on 8 tests of cognition in 578 female nurses. When they were 47-74 years old, we measured their patella and tibia bone lead, indices of exposures over years and decades, and blood lead, an index of more recent exposures. We evaluated women's cognition 5 years later via validated telephone interview. Mean (standard deviation) lead levels in tibia, patella and blood were 11.0 ug/g bone (9.9), 13.3 ug/g bone (12.1), and 3.0 ug/dL (1.9), reflecting very low lead exposure. In adjusted analyses, bone lead levels were generally associated with worse performance on the cognition tests, but none of the associations was statistically significant. Tibia lead level was associated with worse performance on 6 of the 8 tests. For example, a 12-ug/g increment in tibia lead (interquartile range [IQR]) was associated with a 0.20-point lower score on a test of working memory (95% CI: ÿ0.45 to 0.05). Similarly, patella lead level was associated with worse performance on 5 of the 8 tests, most strongly on a delayed verbal recall test, where a 13-ug/g increment in patella lead (IQR) was associated with a 0.16-point lower score (95% CI: ÿ0.37 to 0.05). In our data, this corresponded to the difference in delayed verbal recall observed between women who were 4 years apart in age. Results were similar using the analyzed averaged z scores of the two bone lead measures. Blood lead was not associated with test scores in any consistent pattern. In these older women with non-occupational exposure to lead, bone lead was adversely but not significantly associated with performance on several tests of cognition. We conducted a randomized controlled trial of three approaches to screening women aged 15-24 years for intimate partner violence (IPV). Our prior work found that young women a) did not mind being screened for partner violence. b) felt the health care provider was the most appropriate person to screen. c) wanted to begin with the positive not negative aspects of a relationship, and d) often reported participating in violent aspects of a relationship. 700 young women seeking reproductive care were consented and randomized to one of three IPV screens. Screen A included three questions on current physical and sexual violence and controlling behavior and two questions on lifetime experience. Screen B built on Screen A but began with two questions asking about positive aspects of the relationship (trust and respect); Screen C added three reciprocal questions about her violent behavior. Using an audio-CASI program the screens were incorporated into the clinical information forms women completed prior to seeing a provider who used the screen results in assessing and referring the woman appropriately. While no differences were found in prevalence of partner violen...