This year, an estimated 85,500 adolescents and young adults (AYAs) will be diagnosed with cancer in the United States, and about 9,380 AYAs will die from the disease. And while cancer survivorship is increasing for all age groups—there are now nearly 19 million cancer survivors in the United States—many of these young survivors face ongoing physical, emotional, and financial side effects from the cancer and its treatment.
An epidemiologic study investigating the social risks faced by cancer survivors in different age groups has found that AYA cancer survivors experience greater social risks—including food, housing, employment, and transportation insecurity—and psychosocial challenges compared to their healthy peers as well as older cancer survivors. The study’s findings highlight the need for targeted, age- and context-specific interventions to address the social risks and to support the survivorship care needs of AYA cancer survivors, concluded the study authors. The study was presented by Sedani et al during the 18th AACR Conference on The Science of Cancer Health Disparities (Abstract A019).
Study Methodology
Researchers conducted a cross-sectional analysis of the differences in individual-level social risk factors between cancer survivors in three age groups—18 to 39 years, 40 to 64 years, and 65 years and older—and compared the social risks experienced by these three groups to the general population without a cancer history. For young adults, the researchers also analyzed their racial and ethnic background, sex, and whether they lived in a state with Medicaid expansion.
The researchers used data from the 2022–2023 Behavioral Risk Factor Surveillance System to conduct their analysis. Their analytic sample included data from 472,531 adults who either did (8.7%) or did not have a self-reported cancer diagnosis. The social risk factors analyzed included insecurity related to food, housing, utilities, employment, and transportation; difficulty affording needed health care; and psychosocial challenges, such as life dissatisfaction, lack of social/emotional support, social isolation, and mental distress.
They estimated unadjusted weighted prevalence and absolute differences (ADs, in percentage points) by cancer history to preserve interpretability and to highlight meaningful population-level variation, consistent with descriptive epidemiology guidelines.
Results
The researchers found, overall, that 26.4% of cancer survivors and 34.9% of adults without a cancer history reported one or more social risks, although these differences varied substantially by age and demographic subgroups, justifying stratified analyses. In age-stratified analyses, AYA cancer survivors had a higher prevalence of social risks than peers without a cancer history, including mental distress (AD = 11.2%), housing insecurity (AD = 9.4%), and food insecurity (AD = 7.2%), despite higher food assistance (SNAP) use. Differences were minimal among adults aged 40 to 64 years and largely reversed among those aged over 65; however, mental distress, social isolation, and life dissatisfaction remained elevated among survivors across all age groups.
Among AYAs, the researchers found that ADs in food, housing, and utility insecurity between cancer survivors and those without a cancer history were larger in states without Medicaid expansion. Male AYA survivors had greater ADs in social risks compared to males without a cancer history, while female survivors exhibited higher absolute prevalence of most risks. Racial/ethnic minority AYA cancer survivors had the highest overall prevalence of social risks.
“Social risk burden among cancer survivors varies by age and demographic factors, with AYA cancer survivors experiencing a particularly high burden influenced by Medicaid expansion status, sex, and race/ethnicity. These findings highlight the need for targeted, age- and context-specific interventions to address social risks and support survivorship care,” concluded the study authors.
Considering Age as a Factor in Survivorship Disparities
“The results [of this study] highlight the importance of considering age when examining survivorship disparities and point to the potential value of policies and programs that strengthen social and economic support for young adult cancer survivors to promote more equitable health outcomes,” said presenting study author Ami E. Sendai, PhD, MPH, Assistant Professor of Epidemiology at UTHealth Houston School of Public Health in Dallas, in a statement.
Disclosures: Funding for this study was provided by North Carolina’s University Cancer Research Fund.
