Addressing financial hardship in adolescent and young adult cancer survivors: Efficacy and implementation of a multilevel intervention in community-based oncology practices

Wake Forest University Health Sciences, Winston-Salem NC

Investigators

Abstract

Project Summary Adolescent and young adult cancer survivors (AYAs; ages 15-39 years) are an important underserved group at risk for significant financial hardship. There are nearly 90,000 new diagnoses of cancer annually in AYAs, and nearly 680,000 AYA cancer survivors living in the United States. Five-year survival rates among AYAs are high (>80%) and AYAs have approximately 35 to 59 years of life expectancy remaining, including 25 to 40 years of productive employment in the paid workforce. Unfortunately, AYAs with cancer may have inadequate insurance coverage, limited financial assets, and experience significant work interruption, leading to greater financial hardship during and after treatment. Thus, AYA cancer survivors are at greater risk of financial hardship than AYAs without a history of cancer. Interventions to address financial hardship exist, but few address AYAs’ unique needs, and, to our knowledge, none address determinants of financial hardship, which lie at multiple levels. At the individual level, AYAs lack financial and health insurance literacy. At the organizational level, assessment of AYAs’ eligibility for financial support resources is haphazard, and access to financial assistance programs is uncoordinated. CHAT (“Let’s CHAT about health insurance”) is a program designed to educate AYAs about health insurance; Lessening the Impact of Financial Toxicity (LIFT) was designed to systematically assess cancer patients’ eligibility and coordinate access to financial support resources. To address multilevel determinants of financial hardship among AYAs, LIFT must be combined with CHAT. Combining CHAT with LIFT may also facilitate implementation in community-based settings, where most AYAs receive cancer care, yet resources required to implement new interventions are limited. This proposal responds to the National Cancer Institute’s call “to develop and/or test interventional approaches to prevent and/or mitigate financial hardship in individuals diagnosed with cancer” by assessing the influence of a multilevel financial hardship intervention on AYAs’ health insurance literacy and financial hardship. We propose the following specific aims: (1) To synthesize CHAT and LIFT to create FinFit, an intervention to address the unique, multilevel determinants of financial hardship among AYAs treated in community oncology practices; (2) to conduct a randomized controlled trial (RCT) of FinFit, a multilevel intervention, to address financial hardship among AYAs (n=408); and (3) to develop guidance for implementing FinFit to be tested in a future hybrid effectiveness- implementation trial. This study will be the first, real world efficacy trial of a multilevel intervention to reduce financial hardship among a representative, geographically diverse sample of AYAs treated in community oncology practices. Study results will guide future efforts to scale up FinFit to the diverse settings where AYA cancer survivors are served.