Financial toxicity and healthcare disruptions among working-age cancer survivors in the United States: Insights from the COVID-19 pandemic and future challenges

The COVID-19 pandemic worsened financial toxicity (FT) for individuals with cancer. Its ongoing economic and healthcare consequences continue to influence cancer survivorship, especially for working-age cancer survivors (WACS). This study examines the association between pandemic-related FT and healthcare disruptions (HCDs) among WACS aged 27-64 years in the US, and discusses ongoing implications in the post-pandemic context. A cross-sectional study was conducted using an online survey from January - March 2022. Self-reported FT was measured as: 1) perceived FT using the COmprehensive Score for financial Toxicity (COST) instrument categorized as mild (COST score: ≥26), moderate (14-25), and severe (0-13); 2) experience of any material financial stressors (FS) in the past 12 months. Self-reported disruptions to 8 types of healthcare services were assessed. The association between FT and any HCD was assessed using multivariable logistic regression. Responses from 309 WACS were analyzed. Most WACS were aged 51-64 (56.31%), female (71.20%), and White (80.91%). 46.60% reported ≥ 1 HCD since COVID-19 pandemic began. A higher proportion of WACS reporting HCDs reported severe perceived FT (49.31% vs. 24.85%, p p < 0.001), vs. those reporting none. Adjusted odds of any HCD were higher for respondents with severe perceived FT vs. mild perceived FT (aOR: 3.26, 95% CI: 1.27-8.38) or past experiences of material FS vs. none (aOR: 2.40, 95% CI: 1.19-4.82). WACS who reported HCDs during the pandemic were more likely to report experiencing FT, with those experiencing FT havin5g 2- to 3-fold higher odds of reporting HCDs. As pandemic-era healthcare protections (e.g. Medicaid continuous enrollment, expanded unemployment benefits) end, continuing and emerging financial and health policy stressors may further limit healthcare access for WACS. These findings reinforce the need for integrated financial and psychosocial support to mitigate HCDs and improve health outcomes for vulnerable WACS in the post-pandemic era.