The impact of financial toxicity on adolescent/young adult cancer survivors (AYACS): A mixed methods study

Purpose: Financial toxicity (the financial burden that accompanies a cancer diagnosis) uniquely affects adolescent/young adult cancer survivors (AYACS). The objective of this study was to use a mixed-method approach to understand AYACS’ perspectives on financial consequences of cancer treatment, to complement quantitative measures of financial toxicity. Methods: In this convergent mixed methods study, data from AYACS participants (n = 35) were collected. Financial toxicity was measured quantitatively using the Comprehensive Score for Financial Toxicity (COST) and a sociodemographic survey. Qualitative measures included semistructured interviews. Results: The mean COST score was 30.4 (SD 7.26), ranging from 16 to 43. Mixed methods analysis revealed: 1) financial situations related to cancer treatment led to varying levels of support and conversation within families; 2) financial strain was significant for participants of all ages and impacted future planning; 3) participants experienced gratitude for philanthropic funding, while experiences with insurance were mixed; and 4) due to financial strain, some participants experienced stressful emotions, while others did not. No statistically significant differences were found in COST scores across demographic variables. Conclusions: AYACS experienced financial challenges. While quantitative data did not reveal statistically significant differences in financial toxicity by sex, diagnosis age, or treatment phase, qualitative data uncovered important differences in experiences of younger versus older AYACS, particularly social support’s role in protecting against financial toxicity. This study revealed the importance of improving services to ensure AYACS (especially older AYACS) have resources to decrease financial toxicity and designing sensitive quantitative instruments to assess financial toxicity among AYACS with additional focus on assessing social aspects of financial support.