The hidden toll: Social isolation and affordability barriers among cancer caregivers.

299 Background: Cancer caregiving involves substantial emotional, physical, and financial hardship. Caregiver social isolation and financial toxicity are frequently underrecognized, yet can profoundly impact caregiver well-being and thus patient care. This study focuses on these burdens in cancer caregivers, aiming to guide support strategies. Methods: Data from the nationally representative Health Information National Trends Survey from 2022-2024 compared questions on household financial concerns and social isolation (grouped Very Often/Often/Sometimes True for Affordability and Always/Usually/Sometimes for Social Isolation) between cancer caregivers (CC), other/non-cancer caregivers (OC), and those with no caregiver duties (NC). Demographics included: age, gender, race, ethnicity, education, marital status, and employment. Analysis was done in STATA with a logistic multivariate analysis (MVA) focused on cancer caregivers. Results: 2,326 were included; 10.4% were CC, 80.6% were OC, and 9.0% were NC. CC were demographically different: they were older (median 59 vs 56 vs 46), more commonly White than NC (68.9% vs 70.8% vs 46.3%), more commonly than NC to report some college, college or post graduate coursework (64.9% vs 68.8% vs 56.8%). Household income also varied: i.e. annual income < $50,000 was 42.3% CC vs 39.6% OC vs 48.8% NC (p < 0.05 for all). Financial strain for the entire household was common but CC were less likely to report: food insecurity (54.2% CC vs. 57.3% OC vs. 61.5% NC), concerns about being forced to move (including potential eviction or foreclosure) (55.3% CC vs. 58.3% OC vs. 63.7% NC) and transportation insecurity limiting access to medical appointments, work, or daily necessities (50.8% CC vs. 54.1% OC vs. 58.7% NC) (p < 0.001 for all). Feelings of social isolation were common, including feeling that people "barely knew them" (86.8% CC vs 85.7% OC vs 83.4% NC). OC more likely to report feeling left out (90.1% OC vs 88.6% CC vs 86.4% NC). Feelings of social isolation were also highest among OC (87.7% OC vs 85.5% CC vs 84.3% NC). CC were least likely to report that people were physically present but not emotionally connected ("around but not with them") (82.2% CC vs. 85.9% OC vs. 84.0% NC) (p < 0.001 for all). In an MVA limited to CC, older caregivers were less likely to feel left out compared to younger counterparts [OR: 0.950, 95%CI 0.926 - 0.975, p < 0.001] but otherwise there was no difference in social isolation by gender, race, ethnicity, education, marital status, or employment. Conclusions: This national sample found high levels of social isolation and affordability concerns, affecting over half of surveyed US residents. Cancer caregivers did not appear to consistently have higher unmet social needs or health related social needs. These findings highlight the need for targeted support services that address both emotional and practical burdens faced by all US residents, with or without caregiver status.