Abstract A051: Inequities in financial burden, quality of life, and physical functioning among cancer survivors: A nationally-representative Medical Expenditures Panel Survey (MEPS) study
Authors: Mobley Erin M. , Garvan Gerard , Norez Daniel , Mitchell Halle , Salloum Ramzi , Gutter Michael S. , Awad Ziad T. , Braithwaite Dejana , Anton Stephen , Gurka Matthew , Parker Alexander S. 
Published: January 2023

Abstract
Introduction: We examined the relationship between financial burden, quality of life (QOL), and physical functioning for young adult (YA) cancer survivors under 40 years of age in comparison to their healthy peers and older cancer survivors ages 40-64 while adjusting for demographic factors, utilization, and access to care. Methods: Data from the Medical Expenditures Panel Survey (MEPS) from 2011 to 2018 household component survey were used. We examined differences in 1) out-of-pocket expenditures (first modeled as a binary outcome of any expenditures; then modeled as the sum of office/outpatient visits, emergency department use, inpatient stays, and prescriptions expenditures with log base 10 adjusted to 2018 dollars), 2) quality of life (measured with the VR-12 mental component score or MCS), and 3) physical functioning (measured with the VR-12 physical component score or PCS). Outcomes were compared among 1) YA cancer survivors to YAs without a cancer history (&lt;40) and 2) YA survivors (&lt;40) to older adult cancer survivors (40-64). Multivariable generalized linear models with a log link function were adjusted for demographics (sex, annual household income), utilization (any prescriptions and any outpatient, inpatient, and emergency department visits), and access to care (delayed medical care because of cost and insurance). MEPS sampling weights, stratum, and clusters were used. Results: YA cancer survivors were not more likely to have any expenditures in comparison to their non-cancer peers. However, if YA survivors did have expenditures, their total out-of-pocket expenditures in the multivariable model were 1.3 times more than their non-cancer peers annually. YA survivors were 2.7 times less likely to have expenditures in comparison to older adult cancer survivors. If YA survivors did have expenditures, they were 1.6 times less than older survivors annually. YA survivors experienced an annual decrease in MCS when compared to their healthy peers by 2.3 points and by 1.2 points when compared to older adult survivors. YA survivors experienced an annual decrease in PCS in comparison to their healthy peers by 3.2 points. YA survivors experienced an annual increase in PCS in comparison to older adult survivors by 4.8 points. Conclusion: If YA cancer survivors did have expenditures, they were significantly more than their non-cancer peers. In comparison to older adult survivors, YA survivors were less likely to have any expenditures and if they did have expenditures, they were less. MCS scores were lower among YA cancer survivors, indicating lower QOL in comparison to both healthy peers and older adult survivors. PCS scores were lower among YA survivors in comparison to their healthy peers, indicating decreased physical functioning, and higher than older adult survivors. The findings underscore the need for appropriate access to high-quality care for cancer survivors and interventions associated with improving MCS and PCS, particularly among those most vulnerable.
Citation Format: Erin M. Mobley, Gerard Garvan, Daniel Norez, Halle Mitchell, Ramzi Salloum, Michael S. Gutter, Ziad T. Awad, Dejana Braithwaite, Stephen Anton, Matthew Gurka, Alexander S. Parker. Inequities in financial burden, quality of life, and physical functioning among cancer survivors: A nationally-representative Medical Expenditures Panel Survey (MEPS) study [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A051.