Adolescent and young adult cancer survivors, who were diagnosed with cancer when they were aged between 15 and 39 years old, are generally more likely to have multiple chronic conditions compared to adolescent and young adult without history of cancer. In addition, the financial burden of chronic conditions directly related to their history of cancer can substantially impact cancer survivors.
In addition, results from a new study by researchers of the University of California, Davis, demonstrates that psychological distress from cancer and cancer treatment may cause many adolescent and young adult cancer survivors to seek additional care. In turn, this may burden them with considerable medical expenses.
These findings were published online in CANCER, a peer-reviewed journal of the American Cancer Society.
Compared with individuals without a history of cancer, adolescent and young adult cancer survivors are more likely to experience psychological distress, which can be expressed as depression, anxiety, panic attacks, posttraumatic stress disorder, cancer worry, or anger.
To examine the health care use and medical costs associated with psychological distress in adolescent and young adult cancer survivors, Ola A. Abdelhadi, MBBCh, MPH, Ph.D, of the University of California, Davis, and her colleagues examined data from the 2001–2016 Medical Expenditure Panel Survey for 1,757 adolescent and young adult cancer survivors and 5,227 adults with no history of cancer.
The prevalence of psychological distress in adolescent and young adult cancer survivors was two times higher than that observed in adults with no history of cancer (11.5% versus 5.8%). Also, 11.2% of cancer survivors reported distress 20 or more years after being diagnosed.
Survivors with psychological distress were more likely to smoke and have chronic medical conditions, and they were less likely to exercise regularly compared with survivors with no history of psychological distress. Also, females, those with lower income, and unmarried cancer survivors were more likely to have psychological distress than males, those with higher income, and those who were married.
Costs of psychological distress
Psychological distress was associated with an additional US $4,415 in annual medical expenses in adolescent and young adult cancer survivors, compared with $1,802 in adults without a history of cancer.
Results from an earlier study, published in April 2021 in Nature, also showed considerable additional healthcare cost for adolescent and young adult cancer survivors, compared to adolescent and young adult without history of cancer.
Using data from the Medical Expenditure Panel Survey (MEPS) from 2011 – 2016, the researchers identifies the prevalence of chronic conditions, health risk behaviors, and health care access in 2,326 adolescent and young adult cancer survivors.
MEPS includes a set of large-scale surveys of families and individuals, their medical providers, and employers across the United States and the results of their study, confirmed a clear association between health risk behaviors, health care access factors, and chronic conditions with medical expenditures was assessed using multivariable regression with gamma distribution and log link. Analyses were adjusted for age, sex, race/ethnicity, education, and marital status.
In this study, most adolescent and young adult cancer survivors cancer survivors had ≥1 chronic condition (74%) and were diagnosed with cancer ≥10 years prior to the survey (76%).
Adolescent and young adult cancer survivors with chronic conditions spent an additional US $ 2,777 (95% CI, US $ 480 to US $ 5,958) annually compared to survivors with no chronic conditions. Additional annual expenses also were associated with physical inactivity (US $ 3,558; 95% CI, US $ 2,200 to US $ 4,606) and being unable to get care when needed (US $ 1,291; 95% CI, US $ 198 to $ 3,335). Expenses were adjusted for inflation to 2016 dollars.
More healthcare needs
In adolescent and young adult cancer survivors cancer survivors, those with psychological distress had an average of 2.8 more annual office visits and used an average of 11.58 additional prescription medications or medication refills each year.
“Our study is the first to estimate the additional medical expenses and health care utilization associated with psychological distress in adolescent and young adult cancer survivors,” Abdelhadi said.
“Screening to identify those with psychological distress and referring survivors to treatment or interventions can mitigate the impact of psychological distress.”
 Abdelhadi OA, Joseph J, Pollock BH, Keegan THM. Additional medical costs of chronic conditions among adolescent and young adult cancer survivors. J Cancer Surviv. 2021 Apr 26. doi: 10.1007/s11764-021-01044-4. Epub ahead of print. PMID: 33899161.
 Abdelhadi OA, Pollock BH, Joseph JG, Keegan THM. Psychological distress and associated additional medical expenditures in adolescent and young adult cancer survivors. CANCER; Published Online: January 10, 2022 (DOI: 10.1002/cncr.34064).
Featured image: A young adult cancer survivor and the unmet medical needs – continued to take medications for post cancer treatment. Photo courtesy: © Fotolia/Adobe 2016 – 2022. Used with permission.