Financial Hardship in Adolescent and Young Adult Oncology: The Need for Multidimensional and Multilevel Approaches

Abstract

The cost of cancer care is substantial, steadily increasing, and significantly disruptive for patients and their families. The magnitude and impact of these costs, known as financial hardship or toxicity, comprise material (monetary resources), psychosocial (distress and worry about costs), and behavioral (coping strategies to manage costs) dimensions. [1][2][3] In the article that accompanies this editorial, Kishimoto et al 4 examined the material costs of cancer among children, and adolescents and young adults (AYAs) in Japan from the perspective of the public payer. To our knowledge, this is the first population-based study to leverage an administrative claims database to examine payer costs among children and AYAs with cancer in Japan, a country with universal health care. Their findings revealed median 1year postdiagnosis costs per patient of 2,832,840 in Japanese Yen ($28,047 in US dollars), costs for pediatric and AYA patients that are disproportionately greater than previous reports of Japanese adults with cancer. 5,6 These results are broadly consistent with studies from Canada, Chile, India, and the United States, underscoring the greater financial burden on the health care system for treating younger patients with cancer. [7][8][9][10][11] ASSOCIATED CONTENT See accompanying article on page 238Author affiliations and support information (if applicable) appear at the end of this article.

Identifying health-related quality of life cut-off scores that indicate the need for supportive care in young adults with cancer

“…If a respondent felt the healthcare team would be unable to provide support, they may not report that they have ‘need’ even if they have financial issues. Financial toxicity is high amongst YAs compared to older adults and about a third of patients had need for financial concerns in this study [ 23 ]. Future research should prioritise developing appropriate methods to identify and address financial toxicity amongst YAs.…”

Adolescent and young adult cancers: unmet needs and closing the gaps

“…Measures that are valid, reliable, multidimensional, age-appropriate, and psychometrically robust are needed to study and address financial toxicity in the AYA population [12 && ,32]. Some suggested interventions to bridge this gap focus on patient navigation in order to: provide education about cost-saving financial methods and decision making; improve and expand referrals to financial assistance programs and community resources; and enhance coping and adaptation strategies to manage financial stress [33][34][35].…”

Who Should Be Responsible for Relief of Financial Toxicity?

“…Financial toxicity is a growing threat to the security and long-term well-being of all patients, particularly those who receive costly therapies that require laboratory monitoring. 1,3 Lack of insurance, underinsurance, and job loss suffered as a consequence of cancer diagnosis and treatment 4 and the burden of cost shifting to patients through rising deductibles, copays, and oral antineoplastics are a few factors that contribute to financial toxicity. Worry about the financial impact of cancer adds to the survivorship burden of patients and may adversely affect outcomes/survival.…”