Long-Term Dynamic Financial Impacts Among Adolescents and Young Adults With Cancer: A Longitudinal Matched-Cohort Study

Abstract

PURPOSE Surviving cancer has significant financial implications for adolescents and young adults (AYAs). It is unclear how cancer affects AYA income over time compared with the general population, and how this differs by subtype. METHODS We performed a population-based retrospective matched-cohort study of AYAs age 15-39 years diagnosed from 1994 to 2013 in Canada's universal health care system. Survivors were 1-to-10 variable-ratio matched to cancer-free comparators in the year before diagnosis on birth year, sex, migration background, geography, family composition, and ±5% of income. Participants were followed until death, second cancer, loss to follow-up, 10 years after diagnosis, or December 31, 2015. The primary outcome was annual total income, inflation-adjusted to 2015 Canadian dollars (CAD). Doubly robust difference-in-difference analyses estimated relative and absolute income changes for survivors versus cancer-free peers. Analyses were conducted for cancer overall and stratified by subtype. RESULTS A total of 93,325 survivors with an average diagnosis age of 32.0 (standard deviation [SD], 4.9) years were matched to 765,240 cancer-free peers. Mean follow-up was 8.1 (SD, 2.9) years. Cancer led to an average loss of 5.3% (95% CI, 4.3% to 6.4%), or $2,023 CAD (95% CI, $1,706 to $2,340), in total income. Losses varied by subtype, with CNS malignancies experiencing the largest reduction of 28.4% (95% CI, 23.9% to 32.6%). Hematologic, lung, GI, and breast cancer losses ranged from 7.7% to 16.8%. Income reductions were largest in the first 5 years after diagnosis. After 10 years, income losses ranged from 9% to 32% for survivors of hematologic and CNS malignancies. CONCLUSION Cancer in AYAs leads to decreased income with varying magnitudes by subtype, with the largest burden in the first 5 years after diagnosis. Policy interventions to mitigate income inequalities among survivors can ensure stable financial well-being throughout survivorship.