Abstract PO-207: Cancer diagnosis in young adulthood as a risk factor for financial hardship among African American cancer survivors
Authors: Hastert Theresa A. , Ruterbusch Julie J. , Nair Mrudula , Wenzlaff Angie S. , Beebe-Dimmer Jennifer L. , Pandolfi Stephanie S. , Schwartz Ann G. 
Published: December 2020

Abstract
Background: Financial hardship is common among cancer survivors, particularly those with fewer financial resources at the time of diagnosis. Previous work suggests that working age adults (usually &lt;65 at diagnosis) have worse financial outcomes than older adults (ages 65+); however, little is known about the financial outcomes of young adult (ages 20-39) relative to middle aged and older cancer survivors, despite their often-limited financial resources. The purpose of this study is to estimate associations between young adult age at diagnosis and material, behavioral, and psychological financial hardship among African American cancer survivors. Methods: We utilized data from 3,348 participants in the Detroit Research on Cancer Survivors (ROCS) cohort. African American adults were invited to participate if they were between the ages of 20-79 at diagnosis with breast, colorectal, lung, or prostate cancer since January 1, 2013; or diagnosed with endometrial cancer (ages 20-79) or any other cancer diagnosed at age 20-49 since January 1, 2016 and identified through the Metropolitan Detroit Cancer Surveillance System. Participants self-reported several forms of material and behavioral financial hardship (MFH and BFH, respectively). Psychological financial hardship was measured using the COST score. Modified Poisson models estimated prevalence ratios (PR), and 95% confidence intervals (CI) for financial hardship outcomes and age at diagnosis (20-39, 40-54, 55-64, 65+) controlling for demographic, socioeconomic, and cancer-related factors. Results: Overall, 44% of ROCS participants reported MFH, and prevalence was inversely associated with age at diagnosis such that 72% of young adults (ages 20-39) reported MFH compared with 31% of adults ages 65+ (PRadjusted: 1.97, 95% CI: 1.62-2.39; ptrend&lt;0.001). Results were similar for individual forms of MFH, including decreased income, using assets to pay for care, current cancer debt, and borrowing from friends or family to pay for cancer care (all PRs &gt;2.0 with 95% CIs excluding 1.0). BFH was reported by 24% of survivors and was also more common among young adults than those 65+ (29% vs. 21%; PRadjusted: 1.66, 95% CI: 1.14-2.43; ptrend=0.015); however, younger age was not associated with prevalence of specific forms of BFH. COST scores (calculated so that lower scores reflect greater financial distress) were also inversely related to age. Mean COST score was 24.3 overall and ranged from 19.3 (95% CI: 17.4, 21.1) among young adults to 26.8 (95% CI: 26.2, 27.4) among adults 65+ at diagnosis (ptrend&lt;0.001). Conclusions: MFH is much more common, and psychological financial hardship is much more severe, in African American cancer survivors diagnosed between the ages of 20-39 compared with those diagnosed as older adults. Young age at diagnosis should be considered a risk factor for cancer-related financial hardship and addressed in work designed to reduce the adverse financial impacts of cancer.
Citation Format: Theresa A. Hastert, Julie J. Ruterbusch, Mrudula Nair, Angie S. Wenzlaff, Jennifer L. Beebe-Dimmer, Stephanie S. Pandolfi, Ann G. Schwartz. Cancer diagnosis in young adulthood as a risk factor for financial hardship among African American cancer survivors [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-207.