By Lauren Broschak, MSW, LCSW
and
Julia Leavitt, MSW, LCSW, OSW-C

Receiving a diagnosis of cancer is never easy but those diagnosed with cancer between the ages of 15 and 39 face unique challenges. One challenge often overlooked, and therefore not planned for, is the financial impact of cancer treatment on the adolescent and young adult (AYA) population. Before diagnosis, many AYAs are at a stage in life where they’re striving toward greater financial independency and security. What happens when cancer interjects into this important growth stage, and how can we support AYAs as they navigate achieving financial independence? 

AYAs are at a higher risk of having financial problems both during and post treatment. It is not uncommon for AYA patients to complete treatment only to find themselves saddled with medical debt and struggling to pay day-to-day expenses, their financial difficulties further compounding their psychosocial distress. As OSWs, it’s important to take these life events into consideration when working with AYAs, assessing how best to support these patients. (Thom, B., Friedman, D., Aviki, E., Benedict, C., Watson, S., Zeitler, M., & Chino, F. (2022 B.C.E.)). The long-term financial experiences of adolescent and young adult cancer survivors. Journal of Cancer Survivorship, 1. https://dol.org/10.1007/s11764-022-01280-2 

Pre-diagnosis, many AYAs are developing their financial literacy and moving toward financial independence but many may not have mastered these skills yet. This life stage is often focused on building financial freedom and there are many examples of how financial strain can impact this patient population. An AYA might have their first ever summer job, planning to purchase their first car or save their earnings for college. An AYA may have been working toward buying their first home, suddenly finding they must put their plans on hold for treatment, perhaps feeling overwhelmed by the possible treatment related costs and how they might delay that purchase. An AYA might be at a crossroads in their career, thinking about ways to accelerate or even change their career path. An AYA might have student loan repayments for which they are responsible, depending on their monthly earnings to complete these payments. Another factor to consider is the cost of fertility preservation, many AYAs using funds or even loans that were previously allocated for other needs.  

Health insurance is another area in which AYA patients may have limited understanding or knowledge. Many may be a dependent on their parents’ health insurance. For patients who’ve not had health challenges prior to their cancer diagnosis, navigating health insurance plans and healthcare systems can be challenging and overwhelming. Providing education on the different types of insurance can reduce feelings of anxiety and uncertainty over how one may afford treatment. Having limited knowledge about or access to health insurance, financial obligations, and minimal to no savings, it's important that we work to address these concerns. One AYA patient we spoke with shared that since being out of treatment, she recognizes she’s become fearful about making large purchases, worrying that she will never have enough money.  

When it comes to supporting AYA financial independence, we suggest empowering your patients to think about the cost of treatment. Provide a safe space for your patients to explore and share their worries. Collate relevant material, make referrals to appropriate organizations that can help with financial needs, and provide links to educational webinars and workshops which normalize the realties and fears AYA patients have about the cost of treatment.  

Here are some example questions that your AYA patient may raise with you or be thinking about: 

• “How much is my treatment going to cost? How will I afford to pay it?” 
• “What if I lose my job? How will I cover rent?”  
• “How can I estimate the cost of a scan/surgery/appointment?” 
• “How do I know if a doctor is in network?”  
• “Can I afford fertility preservation? It’s so much money!”  
• “Are there any grants I’m eligible for? Who can I reach out to for help?”   

Programs are specifically designed to help young adults with cancer: 

• Cancer Care: Assists with cancer-related costs, including copayments  

• DAM Cancer Foundation: Provides financial assistance to young adults age 18-40 for everyday living expenses  

• Health Well Foundation: Provides financial assistance through grants that support treatment-related costs not covered by insurance.  

• The Leukemia & Lymphoma Society: Offers dedicated financial assistance for copays, transportation and urgent needs, such as rent, lodging and childcare.  

• Patient Advocate Foundation Co-Pay Relief (CPR): Pays most deductibles and full copays for prescriptions.  

• The SAM Fund: Supports young adults after treatment ends, as they recover from the financial impacts of cancer treatment.  

• Social Security Administration (SSI): Provides financial services for adolescents and young adults with medical illnesses.  

• State Disability Insurance (SDI): In California, State Disability Insurance provides partial wage replacement benefits (60%-70% of earned wage, depending on income) for up to 52 weeks to eligible California workers who contributed employee payroll deductions but are unable to work.  

To learn more about managing the cost of cancer treatment, visit cancer.net/navigating-cancer-care/financial-considerations.