New research from the American Cancer Society published by Zheng et al in JNCCN–Journal of the National Comprehensive Cancer Network found that younger cancer survivors are more likely to experience significant financial strain for daily living necessities—such as food, housing, and monthly bills—even years after diagnosis.

“This could be because younger cancer survivors are not able to maintain their jobs due to health conditions, and therefore lose their health insurance coverage,” explained lead author Zhiyuan Zheng, PhD, of the American Cancer Society, who also worked with researchers from the University of California, Los Angeles, and The Center for Health Research at Kaiser Permanente on this study.

“At the same time,” he continued, “they may have substantial other financial obligations, such as student loans, mortgage obligations, and child-rearing responsibilities. Younger cancer survivors may have had fewer opportunities to accumulate wealth, and for millennials specifically, I think they are living in an economic environment with low interest rates and low saving rates, combined with the rapidly increasing costs of cancer care, they face significant challenges in paying large out-of-pocket costs.”

Dr. Zheng added: “For survivorship planning, we should address the needs of patients with younger age, lower family income, and a higher number of comorbid conditions, and develop both clinical and health policy interventions to reduce the impact of cancer on nonmedical financial burden and food insecurity in the United States.”

Survey Details

For this study, the researchers used the 2013–2017 National Health Interview Survey (NHIS), a cross-sectional household survey from the National Center for Health Statistics within the Centers for Disease Control and Prevention. Their sample included 12,141 cancer survivors (771 aged 18–39; 4,269 aged 40–64; and 7,101 aged 65 and older) and 143,664 individuals without a cancer history (53,262 aged 18–29; 60,141 aged 40–64; and 30,261 aged 65 and older).

They sorted financial concerns into categories related to retirement, standard of living, monthly bills, and housing costs. They also assigned a point system to the responses: “very worried,” “moderately worried,” “not too worried,” and “not worried at all.” They similarly scored food insecurity based on “worry about food running out,” “food not lasting,” and “unable to afford balanced meals.”

Results

Among survivors between ages 18 and 39, 20.4% expressed high levels of worry about paying monthly bills, compared to 12.9% of individuals in that age range without a history of cancer. Likewise, 6.3% of cancer survivors in that age group reported being unable to afford balanced meals vs 3.4% of those without a cancer history. The findings were less consistent for survivors in the 40–64 age group, and there were no disparities for those aged 65 and older who did and did not have a history of cancer.

The adjusted analyses found that 26.4% of cancer survivors aged 18 to 39 reported severe financial worry and 12.6% reported severe food insecurity. For those aged 40 to 64, 22.2% reported severe financial worry and 6.8% reported severe food insecurity. Among those 65 and older, 6.9% reported severe financial worry and 2.3% had severe food insecurity.

Commentary

“Young adult survivors are more vulnerable to financial instability for many reasons related to the tasks of young adult development, such as early career disruptions, the need for increased child care, costs of fertility treatment, or unexpected costs of medical care,” commented Karen M. Fasciano, PsyD, of Dana-Farber Cancer Institute, an expert on cancer survivorship and young adults who was not involved in this research.

“In addition, the psychological impact of being a cancer survivor as a young adult is greater than for older adults and includes being exposed to uncertainty at an age earlier than most peers. When a negative event has happened one time, it follows that a young person is primed to worry about future uncertainty in life domains, including financial and food security,” she said.

The researchers call for additional study evaluating the relative impact of different financial hardships on long-term outcomes for cancer survivors. They also highlighted some policies they consider promising steps toward addressing these concerns.

“Congress passed the Deferment for Active Cancer Treatment Act of 2018, which allows patients with cancer to postpone payments on public student loans while they are actively receiving cancer treatment,” said Dr. Zheng. “In addition, the Centers for Medicare & Medicaid Services has also expanded Medicare Advantage coverage to allow insurers to include healthy groceries, rides to medical appointments, and home-delivered meals in their new benefits for qualified younger people with disabilities. These efforts, plus some state-level Medicaid policies, may provide much-needed help for cancer survivors.”

Disclosure: For full disclosures of the study authors, visit jnccn.org.