Capturing the financial hardship of cancer in military adolescent and young adult patients: A conceptual framework.

Abstract

163 Background: Cancer can be a setback for young active-duty military patients, with potential implications for their financial well-being, early career paths, and young families. Despite the assumption of sufficient material support for military patients, cancer and its treatments still result in substantial out-of-pocket expenses and lost-opportunity costs that can lead to financial hardship. Although prior cancer survivorship studies have put forth a material, psychosocial, and behavioral conceptual framework for describing financial hardship following a cancer diagnosis, it is unknown whether this framework adequately depicts the experience of financial hardship among military adolescent and young adult (AYA) patients. The primary aim of the current study was to extend this conceptual model of financial hardship following a cancer diagnosis for application among military AYA patients. Methods: Using Gale and colleagues’ Framework Method for qualitative multi-disciplinary health research, the investigator team conducted focus groups and key informant interviews (n=24) with active-duty AYA cancer patients, cancer care providers, and commanding officers at both a military medical center and a military post in Hawaii. Subsequently, content analysis and thematic abstraction produced results that were sorted to characterize the material, psychosocial, and behavioral domains of financial hardship. Finally, investigators employed health behavioral change theories to construct a conceptual framework. Results: Data analysis revealed that young active-duty military patients’ experiences of financial hardship following a cancer diagnosis occur within material, psychosocial, and behavioral domains that are uniquely situated within the environments of AYA development and military culture. Hence, we elaborated upon an existing conceptual framework of the financial hardship of cancer, by extending it to capture two meso-level contexts that emerged from our findings: (1) life course development and (2) occupational culture. Conclusions: Differentiating individual experiences of financial hardship within the contexts of life course development and occupational culture, may enable the development of interventions that are informed by the aspect of financial hardship most impacted by cancer care for this special population. Future research should further explicate the meso-level contexts in our study, and investigate the associations among and between factors within these social and environmental contexts.

Stakeholder‐informed conceptual framework for financial burden among adolescents and young adults with cancer

“…Theories of human development suggest that all cancer patients experience a similar set of life disruptions, 6 however, how those disruptions are managed and influence subsequent outcomes depends on when in the life course they occur and the resources one has to manage them. The themes in our study highlight the important developmental issues that can impact the financial burden of AYA survivors and should be explicitly recognized in future AYA cancer research studies such as when in the life course cancer survivorship is being managed, circumstances prior to diagnosis, and the enduring influence or “ripple effect” that managing a cancer diagnosis can have on longer‐term financial resources 27 . Our themes demonstrated that the effects of financial burden certainly impact patients and family members; at the same time, the effects reach out further and impact oncology providers/care teams, health care systems, and ultimately state and federal health policy environments.…”