Financial toxicity and care access barriers among adolescent and young adult versus older melanoma survivors: A population-based analysis of 2021-2024 National Health Interview Survey data.

Abstract

e21592 Background: Adolescent and young adult (AYA) cancer survivors may experience disproportionate financial toxicity and barriers to care as compared to older cancer survivors. Contemporary national estimates in melanoma survivorship are limited. We aimed to estimate financial toxicity and care barriers among AYA and older melanoma survivors. Methods: We pooled National Health Interview Survey (NHIS) 2021–2024 data and identified adults with a history of melanoma and known age at the time of melanoma diagnosis. Survivors were classified as AYA diagnosis (15–39 years) or older diagnosis (≥40 years). Outcomes included delayed medical care due to cost, inability to afford needed medical care, no usual place for medical care, worry about medical bills (very/somewhat vs not at all), and cost-related medication nonadherence (CRN; delayed filling, taking less, or skipping doses) among those reporting prescription use in the past year. We estimated survey-weighted prevalences and fit parsimonious survey-weighted log-link models to obtain adjusted prevalence ratios (aPRs) for older vs AYA diagnosis, adjusting for sex, insurance (Private/Public/Other), poverty (< 200% vs ≥200% Federal Poverty Level ), and survey year. Results: The analytic sample included 755 melanoma survivors (unweighted): AYA n = 124 and older n = 631. Prescription use was common (n = 688 unweighted). Weighted prevalence was higher in AYA vs older survivors for CRN among prescription users (7.5% vs 4.3%), delayed care due to cost (4.5% vs 3.8%), inability to afford needed care (5.3% vs 3.6%), no usual place for care (3.2% vs 1.4%), and worry about medical bills (33.8% vs 30.5%). In adjusted models, older vs AYA diagnosis was associated with lower prevalence for CRN (aPR 0.67, 95% confidence interval [CI] 0.25–1.80) and no usual place for care (aPR 0.38, 95% CI 0.07–2.07), though the estimates were uncertain. Adjusted differences were similarly uncertain for delayed care due to cost (aPR 1.44, 95% CI 0.52–3.97), inability to afford needed care (aPR 0.98, 95% CI 0.33–2.92), and worry about medical bills (aPR 1.16, 95% CI 0.83–1.63). Conclusions: AYA-diagnosis melanoma survivors demonstrated consistently higher national point estimates of financial and access barriers compared with older-diagnosis survivors. Although adjusted comparisons were imprecise, these findings support targeted survivorship interventions addressing medication affordability and care navigation for AYA melanoma survivors.