Medical financial hardship between young adult cancer survivors and matched individuals without cancer in the United States

Background: Young adult cancer survivors face medical financial hardships that may lead to delaying or forgoing medical care. This study describes the medical financial difficulties young adult cancer survivors in the United States experience in the post–Patient Protection and Affordable Care Act period. Method: We identified 1009 cancer survivors aged 18 to 39 years from the National Health Interview Survey (2015-2022) and matched 963 (95%) cancer survivors to 2733 control individuals using nearest-neighbor matching. We used conditional logistic regression to examine the association between cancer history and medical financial hardship and to assess whether this association varied by age, sex, race and ethnicity, and region of residence. Results: Compared with those who did not have a history of cancer, young adult cancer survivors were more likely to report material financial hardship (22.8% vs 15.2%; odds ratio ¼ 1.65, 95% confidence interval ¼ 1.50 to 1.81) and behavior-related financial hardship (34.3% vs 24.4%; odds ratio ¼ 1.62, 95% confidence interval ¼ 1.49 to 1.76) but not psychological financial hardship (52.6% vs 50.9%; odds ratio ¼ 1.07, 95% confidence interval ¼ 0.99 to 1.16). Young adult cancer survivors who were Hispanic or lived in the Midwest and South were more likely to report psychological financial hardship than their counterparts. Conclusions: We found that young adult cancer survivors were more likely to experience material and behavior-related financial hardship than young adults without a history of cancer. We also identified specific subgroups of young adult cancer survivors that may benefit from targeted policies and interventions to alleviate medical financial hardship.