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.