Financial Toxicity in Adolescent and Young Adult Cancer Survivors: Proposed Directions for Future Research
Menée aux Etats-Unis par enquêtes auprès de 2 588 adolescents et jeunes adultes ayant survécu à un cancer (âge au diagnostic : 15-39 ans), cette étude analyse leurs difficultés financières liées à la maladie et à ses traitements
“I’m really surprised at how expensive health care is. But I knew it was expensive, having the background of nursing and stuff. But I didn’t realize how expensive it was until I was the actual patient.”
The costs of cancer treatment have increased dramatically over the past decade and are projected to rise in future years (1,2). Patients and families are bearing more of the economic burden of high-cost cancer treatments from growing out-of-pocket costs and inadequate health insurance. As a result, the financial effects of cancer are increasingly recognized as an adverse event and important outcome for cancer survivors. Financial toxicity refers to negative effects on one’s finances directly from the cancer, whereas financial burden or hardship more generally refers to negative economic effects both from health-care costs and paying for basic needs (3). Financial hardship is linked to worse quality of life and earlier mortality in people with cancer (4,5). National studies suggest that more than one-third of cancer patients experience medical financial hardship (6-9).
In this issue of the Journal, Lu et al. (10) report on findings regarding medical financial hardship from a national sample of adolescent and young adult (AYA) cancer survivors diagnosed between the ages of 15 and 39 years. The authors grouped medical financial hardship into 3 domains: material (ie, debt, out-of-pocket costs, problems paying for care), psychological (ie, distress and worry about current or future financial situation), and behavioral (ie, difficulty paying for care or cost-related treatment nonadherence). Compared with adults without a cancer history, AYA cancer survivors were more likely to experience material and behavioral financial hardship within the past 12 months, and many experienced all 3 domains of hardship. More than 75% of the sample was more than 6 years from diagnosis, a time when most survivors would be done with major cancer treatments such as surgery and chemotherapy. Their findings highlight how pernicious financial hardship and financial toxicity can be, particularly for AYA survivors. The financial health of AYA survivors may never recover after cancer diagnosis without appropriate clinical and policy intervention.(...)
Journal of the National Cancer Institute , éditorial en libre accès, 2020