Financial Hardship Among Adult Survivors of Childhood Cancer After Implementation of the Affordable Care Act

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In an analysis from the Childhood Cancer Survivor Study reported in the Journal of Clinical Oncology, Nathan et al found that adult survivors of childhood cancer were more likely to report financial hardship than siblings without cancer in the era following implementation of the Affordable Care Act.

Study Details

The study included 3,555 ≥ 5-year survivors of childhood cancer and 956 of their siblings who completed a survey administered from 2017 to 2019. Financial hardship was measured by 21 survey items. Survivors had a median age at diagnosis of 8.5 years and median age at survey of 40.5 years; siblings had a median age of 46.7 years at survey.

Key Findings

A total of 19 survey items were grouped into three hardship domains in a principal component analysis: behavioral hardship (8 items), material hardship/financial sacrifices (8 items), and psychological hardship (3 items). A higher proportion of survivors vs siblings endorsed at least one item in each of the domains (all P < .001) and survivors had higher mean standardized domain scores in each domain (all P < .001). Within each domain, survivors were significantly more likely (all P < .001) to report financial hardship vs siblings: behavioral hardship (32.2% vs 23.3%), material hardship/financial sacrifices (43.9% vs 35.4%), and psychological hardship (39.9% vs 27.4%).  

Survivors were significantly more likely than siblings (all P < .001) to report:

  • Hardship in at least one item (63.4% vs 53.7%)
  • Being sent to debt collection (29.9% vs 22.3%)
  • Problems paying medical bills (20.7% vs 12.8%)
  • Foregoing needed medical care (14.1% vs 7.8%)
  • Worry/stress about paying rent/mortgage (33.6% vs 23.2%) or having enough money to buy nutritious meals (26.8% vs 15.5%).

Sociodemographic factors (eg, college education, no private insurance) and treatment factors (eg, receipt of cumulative anthracycline dose ≥ 250 mg/m2 or chest radiation therapy) were significantly associated with increased hardship in the three domains.

The investigators concluded, “Survivors of childhood cancer were more likely to experience financial hardship than siblings. Correlates of hardship can inform survivorship care guidelines and intervention strategies.”

Paul C. Nathan, MD, MSc, of the Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, is the corresponding author for the Journal of Clinical Oncology article.

Disclosure: The study was supported by the National Cancer Institute, American Lebanese-Syrian Associated Charities, Leukemia and Lymphoma Society, and American Cancer Society. For full disclosures of the study authors, visit

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.