Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA.
Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA.
J Adolesc Young Adult Oncol. 2023 Oct;12(5):744-751. doi: 10.1089/jayao.2022.0099. Epub 2023 Mar 23.
Financial burden is a major concern for survivors of adolescent and young adult (AYA) cancers. We identified if employment disruptions during the COVID-19 pandemic affected AYA survivors' financial burden. AYAs who were enrolled in a cancer patient navigation program were e-mailed a survey in fall 2020. Survey items included sociodemographics, employment disruption, and two measures of financial burden: COmprehensive Score for Financial Toxicity (COST) and material and behavioral financial hardship items (for any reason, COVID-19 induced, cancer induced). Financial burden outcomes were dichotomized at the median (COST = 21; financial hardship = 3). The association of employment disruptions and sociodemographics with financial burden was assessed using multivariable logistic regression models. Reduced hours/job loss was reported by 24.0% of 341 participants. Survivors with a high school education or less (odds ratio [OR]: 2.70; 95% confidence interval [CI]: 1.21-6.03) or who had decreased hours or job loss (OR: 3.97; 95% CI: 2.01-7.84) had greater odds for high financial toxicity. Reduced hours/job loss was the only factor associated with high material and behavioral financial hardship for both any reason (OR: 2.75; 95% CI: 1.41-5.33) and owing to COVID-19 (OR: 4.98; 95% CI: 2.28-10.92). Cancer treatment since March 2020 was associated with cancer-induced high material and behavioral financial hardship (OR: 3.31; 95% CI: 1.96-5.58). Employment disruptions owing to the COVID-19 pandemic, lower education levels, and cancer treatment were associated with high financial burden among AYA cancer survivors. Our findings suggest the need for multilevel interventions to identify and address financial burden among vulnerable cancer survivors.
经济负担是青少年和年轻成人（AYA）癌症幸存者的主要关注点。我们确定了 COVID-19 大流行期间的就业中断是否会影响 AYA 幸存者的经济负担。参加癌症患者导航计划的 AYAs 在 2020 年秋季通过电子邮件收到了一份调查。调查项目包括社会人口统计学、就业中断以及两个经济负担衡量标准：全面财务毒性评分（COST）和物质及行为财务困难项目（因任何原因、COVID-19 引起、癌症引起）。经济负担结果以中位数（COST=21；经济困难=3）进行二分法。使用多变量逻辑回归模型评估就业中断和社会人口统计学与经济负担的关联。341 名参与者中有 24.0%报告减少工作时间/失业。高中及以下学历的幸存者（比值比[OR]：2.70；95%置信区间[CI]：1.21-6.03）或减少工作时间或失业的幸存者（OR：3.97；95% CI：2.01-7.84）具有更高的高财务毒性可能性。减少工作时间/失业是与高物质和行为财务困难相关的唯一因素，无论是因任何原因（OR：2.75；95% CI：1.41-5.33）还是由于 COVID-19（OR：4.98；95% CI：2.28-10.92）。自 2020 年 3 月以来的癌症治疗与癌症引起的高物质和行为财务困难相关（OR：3.31；95% CI：1.96-5.58）。COVID-19 大流行导致的就业中断、较低的教育水平和癌症治疗与 AYA 癌症幸存者的高经济负担有关。我们的研究结果表明，需要采取多层次的干预措施来识别和解决弱势癌症幸存者的经济负担问题。
