Department of Paediatrics, University of Toronto, Toronto, ON, Canada.
Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA.
J Natl Cancer Inst. 2021 Aug 2;113(8):997-1004. doi: 10.1093/jnci/djab013.
Cancer and its treatment can result in lifelong medical financial hardship, which we aimed to describe among adult survivors of adolescent and young adult (AYA) cancers in the United States.
We identified adult (aged ≥18 years) survivors of AYA cancers (diagnosed ages 15-39 years) and adults without a cancer history from the 2010-2018 National Health Interview Surveys. Proportions of respondents reporting measures in different hardship domains (material [eg, problems paying bills], psychological [eg, distress], and behavioral [eg, forgoing care due to cost]) were compared between groups using multivariable logistic regression models and hardship intensity (cooccurrence of hardship domains) using ordinal logistic regression. Cost-related changes in prescription medication use were assessed separately.
A total of 2588 AYA cancer survivors (median = 31 [interquartile range = 26-35] years at diagnosis; 75.0% more than 6 years and 50.0% more than 16 years since diagnosis) and 256 964 adults without a cancer history were identified. Survivors were more likely to report at least 1 hardship measure in material (36.7% vs 27.7%, P < .001) and behavioral (28.4% vs 21.2%, P < .001) domains, hardship in all 3 domains (13.1% vs 8.7%, P < .001), and at least 1 cost-related prescription medication nonadherence (13.7% vs 10.3%, P = .001) behavior.
Adult survivors of AYA cancers are more likely to experience medical financial hardship across multiple domains compared with adults without a cancer history. Health-care providers must recognize this inequity and its impact on survivors' health, and multifaceted interventions are necessary to address underlying causes.
癌症及其治疗可能会导致终生的医疗经济困难，我们旨在描述美国青少年和青年期（AYA）癌症成年幸存者的这种情况。
我们从 2010-2018 年全国健康访谈调查中确定了 AYA 癌症（诊断年龄为 15-39 岁）的成年（年龄≥18 岁）幸存者和没有癌症病史的成年人。使用多变量逻辑回归模型比较两组之间不同困难领域（物质[例如，账单支付问题]、心理[例如，痛苦]和行为[例如，因费用而放弃治疗]）报告者的比例，并使用有序逻辑回归比较困难强度（困难领域的共同发生）。单独评估与成本相关的处方药使用变化。
共确定了 2588 名 AYA 癌症幸存者（诊断时中位数=31 [四分位距=26-35]岁；6 年以上者占 75.0%，16 年以上者占 50.0%）和 256964 名没有癌症病史的成年人。与没有癌症病史的成年人相比，幸存者更有可能报告至少有 1 项物质（36.7% vs 27.7%，P <.001）和行为（28.4% vs 21.2%，P <.001）领域、所有 3 个领域（13.1% vs 8.7%，P <.001）的困难以及至少 1 项与成本相关的处方药不依从（13.7% vs 10.3%，P =.001）行为。
与没有癌症病史的成年人相比，AYA 癌症的成年幸存者更有可能在多个领域经历医疗经济困难。医疗保健提供者必须认识到这种不平等及其对幸存者健康的影响，并且需要采取多方面的干预措施来解决根本原因。
