ASPO Abstracts
Financial burden is associated with decreased healthcare utilization and medication use among AYA cancer survivors during the COVID-19 Pandemic
Category: Survivorship & Health Outcomes/Comparative Effectiveness Research
Conference Year: 2022
Abstract Body:
Purpose: Examine how financial burdens impacted healthcare and medication utilization during the COVID-19 pandemic among adolescent and young adult (AYA) cancer survivors.Methods: We surveyed AYAs enrolled in a Utah cancer program (n=341) about healthcare utilization, changes to medication access and use, and financial burden. Greater financial burden was denoted as having the median or greater number of material hardships (4 to 24) since March 2020 and greater financial toxicity in the past 4 weeks, defined as COST score <21. Four outcomes were "Yes/No"¬ù reports of voluntary skipped/delayed cancer or non-cancer appointments, as well as changes in medication access (e.g. asking for less expensive medicine, shopping for lowest cost medication) or medication use (e.g. lowered dose, skipped refills) that occurred since March 2020. Logistic regression models examined associations between these outcomes while adjusting for appropriate demographics.Results: Most AYAs were 26-39 years (57.8%), female (61.3%), and non-Hispanic White (81.5%). In our sample, 19.1% reported skipped/delayed cancer appointments and 35.2% reported skipped/delayed non-cancer appointments. The most commonly skipped/delayed appointments were primary care and oncology/supportive oncology visits. In addition, 23.0% changed their medication access and 15.2% changed their medication use. Skipped/delayed non-cancer appointments were associated with COST score <21 (Odds Ratio=2.51 [95% CI=1.30-4.86]) and ‚â•4 material hardships (2.17 [1.18-4.00]). AYAs with ‚â•4 material hardships had increased odds of skipped/delayed cancer appointments (2.88 [1.32-6.28]). AYAs with ‚â•4 material hardships also had increased odds of changing their medication access (2.54 [1.36-4.76]). Changes in medication use were associated with reporting ‚â•4 material hardships (4.64 [2.14-10.10]) and COST score <21 (3.71 [1.6-8.60]).Discussion: Primary care, oncology care, and utilization of medications are critical to the detection and management of health conditions among AYAs. Financial burdens reported during the pandemic appear to have adversely interfered with AYAs' ability to engage in these necessary healthcare activities.
Keywords: AYA, survivorship, healthcare utilization, COVID-19