Introduction
Adolescents and young adult cancer survivors (AYAs, age 15-39 years) face devastating financial toxicity.1 Defined as the negative personal financial impact of healthcare costs,2-4 financial toxicity results from the costs of cancer care, as well as from interrupted education, exclusion from the workforce, and developmental disruption in achieving or maintaining independence.5,6 Compared to older cancer survivors, AYAs experience disproportionately higher rates of financial toxicity and unemployment, associated with poorer overall survival and bankruptcy.5,7-11 Among AYA survivors in the United States (U.S.), those with public insurance, who live in areas of high deprivation, or who are Black or Hispanic/Latinx (hereafter Hispanic) have lower rates of 5- and 10-year survival,12-20 likely due in part to adverse social determinants of health (SDOH) and unmet health-related social needs (HRSN: financial strain, food insecurity, un/underinsurance, unstable housing, and suboptimal education).20-22 Thus,financial toxicity and HRSN are key contributors to health outcome disparities among AYA survivors .23
For adolescents and emerging adults (hereafter younger AYAsbetween age 15 and 26 years),24 less is known about the risk for, development of, and modifiable factors on which to focus efforts to address financial toxicity. Younger AYAs are distinct from the pediatric population because they are developing greater social and financial autonomy;24 yet they are more likely than older AYAs and adults to have parental or caregiver involvement in their care decision making.21,25 The experience of financial toxicity and effective interventions to mitigate it, therefore, may differ from adult and pediatric populations with cancer.
To improve our understanding of the unique needs and preferences of younger AYAs and their caregivers for financial screening and support, we conducted a qualitative descriptive study26,27 to explore the financial experiences of an ethnically and socioeconomically diverse group of younger AYAs with cancer and their caregivers.