Medical financial hardship between young adult cancer survivors and matched non-cancer individuals in the United States.

BACKGROUND: Young adult cancer survivors face medical financial hardships that may lead to delaying or forgoing medical care. This study describes the medical financial difficulties experienced by young adult cancer survivors in the United States in the post Affordable Care Act (ACA) period.

METHOD: We identified 1,009 cancer survivors aged 18-39 years from the National Health Interview Survey 2015-2022 and matched 963 (95%) cancer survivors to 2,733 controls using nearest neighbor matching. We used conditional logistic regression to examine the association between cancer history and medical financial hardship and assess whether this association varied by age, sex, race/ethnicity, and region of residence.

RESULTS: Compared to those without a cancer history, young adult cancer survivors were more likely to report material financial hardship (22.8% vs 15.2%; odds ratio (OR) 1.65, 95% confidence interval (CI):1.50-1.81) and behavioral medical financial hardship (34.3% vs 24.4%; OR 1.62, 95% CI: 1.49-1.76), but not psychological financial hardship (526% vs 50.9%; OR 1.07, 95% CI: 0.99-1.16). Young adult cancer survivors who were Hispanic, or lived in the Midwest and South were more likely to report psychological financial hardship than their counterparts.

CONCLUSIONS: We found that young adult cancer survivors were more likely to experience material and behavioral medical financial hardship than young adults without a cancer history. We also identified specific subgroups of young adult cancer survivors that may benefit from targeted policies and interventions to alleviate medical financial hardship.