Financial toxicity among adolescent and young adult cancer survivors: A systematic review of educational attainment, employment, and income

Giuseppe, Giancarlo Di; Pagalan, Lief; Jetha, Arif; Pechlivanoglou, Petros; Pole, Jason D.

doi:10.1016/j.critrevonc.2023.103914

Cited by 16 publications

(9 citation statements)

References 84 publications

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“…32 Thus, there remains a critical need to capture the unique effects that a cancer diagnosis among AYAs could have on both individual and contextual AYA SDOH and subsequent survival. 31 3. Clinical trial enrollment remains poor, but access may be improving.…”

Section: Discussionmentioning

confidence: 99%

“…The intersection of insurance coverage and SES with health outcomes represents a complex but important relationship 30 that likely has a substantial, but underinvestigated, impact on AYAs with cancer. Multiple aspects of SES are linked to social determinants of health (SDOH) that can affect financial stability, employment, and educational status, among other factors, 31 and play a role in access to care, treatment adherence, and subsequent health outcomes. 32 In numerous studies of AYAs with cancer, SES and insurance coverage are associated with both disease stage at presentation and survival.…”

Section: Ses and Insurancementioning

confidence: 99%

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Access to Care for Adolescents and Young Adults With Cancer in the United States: State of the Literature

Kirchhoff,

Waters,

Chevrier

et al. 2024

JCO

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Access to care remains a persistent challenge for adolescents and young adults (AYAs) with cancer. We review key findings in the science to date. (1) Location of care matters. There is survival benefit for AYAs treated either at a pediatric center or site with special status (eg, Children's Oncology Group, National Cancer Institute [NCI]–designated Comprehensive Cancer Center). (2) Socioeconomic status and insurance require further investigation. Medicaid expansion has had a moderate effect on AYA outcomes. The dependent care expansion benefit has come largely from improvements in coverage for younger populations whose parents have insurance, while some subgroups likely still face insurance gaps. (3) Clinical trial enrollment remains poor, but access may be improving. Numerous barriers and facilitators of clinical trial enrollment include those that are system level and patient level. NCI has established several initiatives over the past decade to improve enrollment, and newer collaboratives have recently brought together multidisciplinary US teams to increase clinical trial enrollment. (4) Effective AYA programs require provider and system flexibility and program reflection. With flexibility comes a need for metrics to assess program effectiveness in the context of the program model. Centers treating AYAs with cancer could submit a subset of metrics (appropriate to their program and/or services) to maintain their status; persistence would require an entity with staying power committed to overseeing the metrics and the system. Substantial clinical and biological advances are anticipated over the next 20 years that will benefit all patients with cancer. In parallel, it is crucial to prioritize research regarding access to health care and cancer care delivery; only with equitable access to care for AYAs can they, too, benefit from these advances.

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Section: Discussionmentioning

confidence: 99%

Section: Ses and Insurancementioning

confidence: 99%

Access to Care for Adolescents and Young Adults With Cancer in the United States: State of the Literature

Kirchhoff,

Waters,

Chevrier

et al. 2024

JCO

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“…Furthermore, interruption of school or work may have negative consequences for long-term career opportunities and lifetime earning potential. 47 Standardized collection of the prevalence and impact of financial toxicity is warranted to guide interventions such as financial navigation programs to reduce out-of-pocket payment and structured support for education and workforce re-entry.…”

Section: Unique Considerations For Aya Allmentioning

confidence: 99%

Future of Treatment of Adolescents and Young Adults With ALL: A Vision for Collaboration and Equity

Newman,

Hunger

2024

JCO

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Over the past several decades, survival of children with ALL has improved dramatically with treatment regimens refined through cooperative group trials. Despite aggressive treatment and iterative therapy changes for adolescents and young adults (AYAs), improvement has not been as promising. Comparisons between pediatric and adult clinical trials have consistently demonstrated superior outcomes for AYAs treated on pediatric ALL protocols, leading to the implementation of pediatric-inspired ALL protocols by several groups worldwide and/or expansion of the age limit of pediatric trials to include the full spectrum of the AYA population. Despite these efforts, AYAs in both pediatric and adult settings continue to have inferior survival compared with younger children with ALL. Real-world data suggest that uptake of pediatric-style treatment is variable, and even with identical pediatric-style treatment, AYAs still fare worse than younger children. As we enter an era of immunotherapy and precision medicine for newly diagnosed ALL, now is an opportune time to consider how best to approach future therapy for AYA patients. Comparisons of pediatric and adult treatment approaches and subanalyses of AYA patients will help guide harmonization of treatment. The focus of the next stage of ALL therapy for AYA should not only involve novel treatment approaches but also standardization and optimization of supportive care measures, psychosocial support, adherence interventions, oncofertility treatment, and survivorship care. All these efforts should simultaneously work to address health disparities to ensure that a future of improved outcomes is experienced equitably for all AYA patients.

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“…With regards to engagement in age-appropriate social roles, there has been significant work describing the impact of an AYA cancer diagnosis on work, education, and financial outcomes. [26][27][28][29] A recent systematic review indicated that, compared with the general population, AYA survivors are more likely to be unemployed, earn less, and use government benefits. 26 Female sex, diagnosis of a brain tumor or lymphoma, advanced disease, and/or report of cognitive impairment predicted poorer vocational and financial outcomes.…”

Section: Social Functioningmentioning

confidence: 99%

Psychological Outcomes in Adolescent and Young Adult Cancer Survivors

McGrady,

Willard,

Williams

et al. 2024

JCO

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The diagnosis of cancer during adolescent and young adulthood (AYA) may alter the development and psychological trajectory of survivors across their lifespan. The current review focuses broadly on emotional health, social functioning, health behaviors, and cancer-related cognitive impairment (CRCI) among AYA survivors. Overall, AYA survivors appear to be at elevated risk of emotional distress symptoms, mood and anxiety disorders, suicide, and mental health care service utilization compared with individuals without a cancer history. Difficulties with social relationships and reduced achievement of expected social outcomes including educational attainment and employment have been reported. Despite risk for health-related morbidities, including subsequent neoplasms, many AYA survivors do not engage in health behaviors at the recommended levels for physical activity, diet, or tobacco and alcohol use. Although CRCI has not been comprehensively characterized in this population, subgroups of AYA survivors appear to be at risk for experiencing CRCI, including survivors of central nervous system tumors, Hodgkin lymphoma, testicular, and breast cancer. Across each considered domain of psychological functioning, intervention efforts have largely focused on acceptability and feasibility with an increasing focus on e/mHealth approaches. Future research should include multiphase studies, including randomized controlled trials designed to evaluate intervention efficacy and effectiveness. It is imperative that psychological interventions consider the unique needs of AYA survivors by developmental stage and across multiple levels of influence (patient, support system, institution, and health care system).

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Financial toxicity among adolescent and young adult cancer survivors: A systematic review of educational attainment, employment, and income

Cited by 16 publications

References 84 publications

Access to Care for Adolescents and Young Adults With Cancer in the United States: State of the Literature

Access to Care for Adolescents and Young Adults With Cancer in the United States: State of the Literature

Future of Treatment of Adolescents and Young Adults With ALL: A Vision for Collaboration and Equity

Psychological Outcomes in Adolescent and Young Adult Cancer Survivors

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