Racial and ethnic disparities in financial toxicity among survivors of early-onset cancer

BACKGROUND: We examined racial and ethnic disparities in three aspects of financial toxicity-material hardships, coping behaviors, and psychological effects-among survivors of early-onset cancer (diagnosed at age 18-49 years). METHODS: Survivors of early-onset cancer were identified from the National Health Interview Survey (2019-2023). We used survey questions to measure aspects of financial toxicity and estimated prevalence of each, overall and by race and ethnicity. We then used logistic regression models to estimate associations between race and ethnicity and each aspect, adjusting for time since diagnosis, sex, geographic region, insurance type, family income as percent of federal poverty level, education, employment, self-rated health status, number of comorbidities, cancer type, and number of cancer diagnoses. RESULTS: Among 5,159 survivors (8.7% Hispanic/Latino, 81.0% White, 5.8% Black, 2.0% Asian, 2.5% Other or multiple race), almost half (48.7%) experienced at least one aspect of financial toxicity: 15.4% experienced material hardships, 9.6% experienced coping behaviors, and 45.0% experienced psychological effects. By race and ethnicity, Hispanic/Latino survivors had over twice the odds of being very worried about medical bills compared to non-Hispanic White survivors (aOR: 2.21, 95% CI: 1.46, 3.36). CONCLUSIONS: Financial toxicity is prevalent among survivors of early-onset cancer, particularly for psychological effects among Hispanic/Latino survivors. IMPACT: Policy efforts are needed to curb the rising costs of cancer care, and tailored interventions are needed to address the unique needs of this population.