Young adult cancer survivors aged 18 to 39 face elevated social risks, including insecure access to living essentials and affordable health care, as well as psychological issues when compared to their peers who did not have cancer histories and survivors from older age cohorts.
This is the conclusion based on study results presented at the 18th AACR Conference on the Science of Cancer Health Disparities, held September 18-21, 2025, at the Hilton Baltimore Inner Harbor in Baltimore, Maryland.
The study authors recognize the fact that a cancer diagnosis may heighten vulnerability to social risks such as food, housing, and transportation insecurity; however, they note that nationally representative comparisons between adults diagnosed with cancer, cancer survivors, and adults without a history of cancer remain limited.
“There are now more than 18 million cancer survivors in the United States, many living a decade or more after diagnosis,” said Ami E. Sedani, Ph.D., MPH, assistant professor of epidemiology at UTHealth Houston School of Public Health in Dallas.
“While survivorship is a success story, a cancer diagnosis can heighten vulnerability to social risks such as food, housing, and transportation insecurity,” Sedani said, who is also the study presenter.
Cancer Survivors and Social Risk
Sedani wanted to understand how cancer survivors experience social risks, such as insecurity related to food, housing, utilities, employment, and transportation; difficulty affording health care; and psychosocial challenges, including life dissatisfaction, lack of social/emotional support, social isolation, and mental distress.
“To advance equal access to health care, we must systematically measure these social drivers of health,” she explained.
Study design
To understand the impact of social risks, Sedani and her team conducted a cross-sectional analysis using 2022–2023 Behavioral Risk Factor Surveillance System data.
The study, supported by North Carolina’s University Cancer Research Fund, investigated social risks in survivors of cancer from different age groups, which were then compared with the social risks from the general population of those not diagnosed with cancer.
Using data from the Behavioral Risk Factor Surveillance System (BRFSS) for the years 2022-2023, Sedani and her colleagues studied social risk factors in 472,531 U.S. adults (weighted n=265.6 million) who either did (8.7%) or did not have a self-reported cancer diagnosis and stratified them into three age cohorts: 18-39 (also referred to as adolescents and young adults or AYA), 40-64, and 65 and older.
For young adults, they also analyzed racial and ethnic background, sex, and whether participants in the BRFSS lived in a state with Medicaid expansion.
The study results showed that overall, 26.4% of cancer survivors and 34.9% of adults without a cancer history reported one or more social risks. However, these differences varied substantially by age and demographic subgroups, justifying the use of stratified analyses.
Study outcome
Sedani and colleagues found that social risk for cancer survivors impacted young adult cancer survivors the most.
“Because surviving cancer involves many stressors, one might expect that all cancer survivors, regardless of age, could experience greater social risks than people without cancer histories,” Sedani explained.
“Instead, we found that elevated social risks for cancer survivors clustered around young adults but disappeared in middle age. In fact, for the oldest age cohort, people without a cancer history were slightly more likely to experience social risks than cancer survivors in the same age group,” she added.
Ami E. Sedani, Ph.D., MPH, assistant professor of epidemiology at UTHealth Houston School of Public Health in Dallas. Photo courtesy © 2025 American Association for Cancer Research (AACR).More frequently
Among those aged 18 to 39 (adolescents and young adults; AYA), cancer survivors experienced social risks more frequently than those without a cancer history.
Compared to their apparently healthy peers, young adult survivors reported increased mental distress of 11.2% (absolute differences or AD in percentage points).
The prevalence of housing insecurity is 9.4 percentage points higher, and, despite higher food assistance (SNAP), the prevalence of food insecurity is 7.2 percentage points higher.
Sedani also noted that young adult cancer survivors who belonged to racial and ethnic minority groups had the highest prevalence of each social risk factor when compared with their non-Hispanic white peers.
Broader gap
Sedani explained that this age-associated distribution of social risks reflects broader gaps in social safety nets for younger adults across various states in the United States.
“Challenges such as financial strain from housing and childcare costs, precarious employment, limited health insurance, and difficulty navigating complex health care systems may contribute to these disparities,” she said, noting that Medicaid expansion status may play a role.
The researchers found that overall, male AYA survivors had greater absolute differences in social risks compared to males without a cancer history. In contrast, female survivors exhibited higher absolute prevalence of most risks. They also noted that racial/ethnic minority AYAs survivors had the highest overall prevalence of social risks.
Sedani pointed to the finding that young adult survivors in states without Medicaid expansion faced higher levels of food, housing, and utility insecurity relative to the general population.
Sedani and her team further observed that the social risk burden among cancer survivors varied by age and demographic factors, with AYA cancer survivors experiencing a particularly high burden. But the differences seen were minimal among adults aged 40–64 and reversed mainly among those 65 years of age. However, they also found that mental distress, social isolation, and life dissatisfaction remained elevated among survivors across all age groups.
Intervention
Based on the outcomes of the study, Sedani and her team concluded that there is an urgent need for targeted, age-and context-specific interventions to address social risks and support survivorship care.
And while currently available digital tools offer a potential solution to overcoming barriers to AYA cancer survivors’ unmet needs for psychosocial support, various (unrelated) studies found that these tools have not been tailored to the specific needs and preferences of this unique population.[1][2]
“The results highlight the importance of considering age when examining survivorship disparities and point to the potential value of policies and programs that strengthen social and economic support for young adult cancer survivors to promote more equitable health outcomes,” Sedani concluded.
Study limitation
The study’s limitations include the limited scope of data available in the Behavioral Risk Factor Surveillance System (BRFSS), which relies on self-reports and does not consistently capture all relevant contexts. Additionally, populations that may experience the highest social risk, like unhoused or institutionalized adults, are excluded from BRFSS data. Finally, the researchers acknowledged that the study data were limited to the 2022-2023 period and the U.S. population.
Reference
[1] Murphy KM, Glock R, Victorson D, Reddy M, Birken SA, Salsman JM. Co-Design of a Depression Self-Management Tool for Adolescent and Young Adult Cancer Survivors: User-Centered Design Approach. JMIR Form Res. 2025 Mar 24;9:e67175. doi: 10.2196/67175. PMID: 40126551; PMCID: PMC11976180.
[2] McGrady ME, Willard VW, Williams AM, Brinkman TM. Psychological Outcomes in Adolescent and Young Adult Cancer Survivors. J Clin Oncol. 2024 Feb 20;42(6):707-716. doi: 10.1200/JCO.23.01465. Epub 2023 Nov 15. PMID: 37967297.
Featured image licensed under the Unsplash+ License and used with permission.
DOI:10.14229/onco.2025.09.18.003
