Adolescents/Young Adults With Cancer Experience Increased Financial Toxicity, Unmet Social Needs

Kaitlyn Lapen, MD

Decreased quality of life (QOL) and treatment adherence were strongly associated with financial toxicity among adolescent and young adult patients with cancer, according to results from a financial toxicity and social needs screening quality improvement project presented during the 2024 ASCO Quality Care Symposium.¹

The mean Comprehensive Score for Financial Toxicity (COST) score was 23.2, with 54% of patients having COST less than 26 suggesting financial toxicity. Additionally, the regression analysis showed that patients who were of racial/ethnic minorities and those who had recent treatment had worse financial toxicity (β –4.37, P <.001; β –3.21, P <.001).

Overall, 24% of patients reported using their savings to pay for treatment, and 25% had borrowed money or took on loans. Of the 25%, 58% borrowed from friends and family. The regression analysis highlighted that a greater financial toxicity was associated with a reduced quality of life (β –0.10; P <.001), using more savings to pay for treatment (β 0.52; P <.001), and taking less medications due to cost (β 0.01; P <.001).

“Screening for financial toxicity and ability to meet social needs is feasible in a diverse cohort of adolescents and young adults with cancer,” Kaitlyn Lapen, MD, a third-year radiation oncology resident at the Memorial Sloan Kettering Cancer Center, and colleagues wrote in the poster.

The authors stated that the incidence of cancer was rising in young adults between the ages of 18 and 39. Currently, the standards for financial toxicity and social needs screening are unknown despite adolescent and young adult cancer survivors having unique risks for poor outcomes associated with financial toxicity. The authors defined social needs as elements that influence a person’s health and well-being, such as access to housing, food, and transportation. They noted that there have been few studies exploring the relationship between financial toxicity and social needs in adolescents and young adults with cancer.

“We sought to evaluate and describe best practices in screening for financial toxicity and assessment of unmet social needs among adolescents and young adults with cancer,” the authors wrote.

Between June 2022 and August 2023, the screening assessments on financial toxicities and social needs were administered at urban comprehensive cancer centers. Additionally, multivariate linear and logistic regression tested for associations with financial toxicity and unmet social needs while also adjusting for demographic and clinical characteristics.

A total of 2519 patients completed the survey, with a median age of 33.7 years, and 65% were non-Hispanic White. Of note, the most common disease sites were breast (41%), gastrointestinal (20%), and gynecologic (19%). Active cancer treatment including chemotherapy, radiation therapy, or surgery was reported in 54% of patients within 120 days of participating in the survey.

Of the patients who screened for financial toxicity, 44% accepted a referral for financial assistance. Unmet social needs in the population included clothing (1%), repairs (5%), medicine (10%), food (13%), transportation (14%), and housing (16%).

Investigators also conducted a multivariate logistic regression of factors associated with unmet social needs. Variables included male gender (adjusted OR [aOR], 0.86; 0.59-1.24; P = .422), being of a non-White minority (aOR, 2.98; 95% CI, 2.35-3.79; P <.001), and having stage IV disease (aOR, 2.45; 95% CI, 1.10-5.45; P = .028).

Site of disease in this model included gastrointestinal (aOR, 0.91; 95% CI, 0.63-1.34; P = .647), gynecologic (aOR, 0.77; 95% CI, 0.53-1.13; P = .181), thoracic (aOR, 0.39; 95% CI, 0.16-0.96; P = .040), hematologic (aOR, 1.96; 95% CI, 0.89-4.31; P = .094), and other (aOR, 2.45; 95% CI, 1.10-5.45; P = .028). Additionally, recent treatment was also a factor (aOR, 1.14; 95% CI, 0.88-1.46; P = .319).

Reference

Lapen K, Dee EC, Ghazal LV, et al. Financial toxicity and unmet social needs in adolescents and young adults (AYA) with cancer. JCO Oncol Pract. 2024;20(10):13. doi:10.1200/OP.2024.20.10_suppl.13