Financial Toxicity in Adolescents and Young Adults With Cancer

Abstract

Background A cancer diagnosis as an adolescent and young adult (AYA) poses exceptional challenges, including potential greater financial toxicity than older survivors experience who have had more time for career establishment and to build financial assets. Costs to patients have increased more than the past decade; prospects for AYA long-term survival have also increased. A better understanding of what financial toxicity is, how it presents, and the immediate and longer-term implications for AYAs is needed. Objective The aim of this study was to analyze the concept financial toxicity in AYAs diagnosed with cancer. Methods We used Rodgers’ evolutionary method and articles published between January 2013 and December 2020. Results We identified key antecedents, attributes, and consequences of financial toxicity in AYAs and review its related terms that have often been used as surrogate terms. Attributes were financial burden, financial distress, and competing financial pressures. Consequences were mostly adverse and persistent and included engaging in various financial problem-solving behaviors, material hardship and poor financial well-being, and deteriorated quality of life. Conclusions Results of this analysis clarify financial toxicity and provide guidance for a conceptual framework in the context of AYA cancer survivorship. Its consequences in AYAs with cancer are profound and will continue to evolve over time with changes in health systems and the economy. Implications for Practice Oncology nurses should understand the attributes and consequences of financial toxicity for AYAs throughout the cancer trajectory. Future research on financial toxicity should extend across AYAs living with other chronic illnesses and cancer survivors in other age groups.

Determinants of telemedicine adoption among financially distressed patients with cancer during the COVID-19 pandemic: insights from a nationwide study

“…Accordingly, 45-73% of cancer survivors report some manifestation of financial toxicity according to subjective and material conditions measures [16,17]. The thoughtful deployment of virtual encounters might engender reductions in patient medical and nonmedical out-of-pocket costs, avoidance of unnecessary hospital visits, and minimization of employment disruption [18,19].…”

The long-term financial experiences of adolescent and young adult cancer survivors

“…Despite a recent emergence of commentaries and reviews addressing financial hardship among AYA survivors, the issue—and, more importantly, interventions to address it—remain understudied, particularly among historically and systematically excluded populations [ 6 , 11 , 28 – 30 ]. Promising efforts have been made toward disease- and treatment-focused research and among specific populations, including YA survivors in the military and YA women in the workforce; these studies demonstrate a need for tailored interventions to address the unique concerns experienced within disparate populations [ 31 , 32 ].…”

“…The high costs of cancer care, coupled with the disruptions to employment and earnings caused by cancer, its treatment, and the late effects of treatment, often result in financial hardship for cancer survivors [ 1 , 2 ]. This hardship, which includes medical debt, difficulty paying out-of-pocket expenses, and associated psychosocial distress, can negatively impact financial well-being and may prevent adolescent and young adult (AYA) cancer survivors from gaining financial independence [ 3 – 6 ]. Survivors of AYA cancers are more likely to experience medical financial hardship than adults with no cancer history, and AYA survivors are more likely than older survivors to face financial hardship after treatment [ 4 , 7 – 9 ].…”

“Now Everybody Is Thinking About Things Like That.” Young Adult Cancer Survivors Reimagining Work During the COVID-19 Pandemic

“…Specifically, significant events in the exosystem and macrosystem resulted in many participants modifying their work environment and changing relationships with their supervisors and colleagues. For individuals in the YACS population, pandemic-related financial pressures worsened preexisting or onset of new financial problems, worries about money, difficulties paying for basics, and meeting existing financial obligations (Baddour et al, 2020; Ghazal, Gormley, et al, 2021). Across and within the multiple levels, factors operate dynamically to affect QOL for cancer populations (Santacroce & Kneipp, 2021).…”