Financial Difficulty Over Time in Young Adults With Breast Cancer.

Area of Science:

• Oncology
• Health Economics
• Psycho-oncology

Background:

• Young adults (18-39 years) diagnosed with breast cancer are a vulnerable population susceptible to financial hardship.
• Factors contributing to sustained financial difficulty in this demographic remain largely unknown.

Purpose of the Study:

• To identify distinct patterns (trajectories) of financial hardship over time in young adult breast cancer survivors.
• To characterize demographic, clinical, and treatment-related factors associated with these financial trajectories.
• To test the hypothesis that treatment-related arm morbidity is linked to long-term financial difficulty.

Main Methods:

• A cohort study of 1008 young adults (≤40 years) diagnosed with stage 0-III breast cancer between 2006-2016.
• Financial difficulty patterns were modeled using the Cancer Rehabilitation Evaluation System (CARES) scale from baseline to 10 years post-diagnosis.
• Multinomial regression analyzed associations between patient characteristics (including arm symptoms) and financial trajectories.

Main Results:

• Three financial difficulty trajectories were identified: low (54.7%), mild with improvement (29.1%), and moderate-to-severe with delayed improvement (16.3%).
• Hispanic ethnicity, unemployment, and arm symptoms were associated with increased odds of persistent moderate-to-severe financial difficulty.
• A college degree and being partnered were associated with a lower likelihood of experiencing significant financial hardship.

Conclusions:

• A significant subset of young adult breast cancer survivors experiences persistent financial hardship into survivorship.
• Interventions targeting modifiable factors like employability support and return-to-work assistance for those with arm symptoms are needed to reduce financial toxicity.