UC Davis

Abstract

Background: Adolescent and young adult (AYA; those who were diagnosed with cancer at age of 15-39 years) cancer survivors are more likely to suffer from long-term chronic conditions and psychological distress compared to AYAs without history of cancer. Engagement of AYAs in their own care through shared decision-making (SDM) can lead to better health outcomes. The associated economic impact of health status and SDM was examined in a population-representative sample of AYA cancer survivors. Methods: We utilized 2011-2016 Medical Expenditure Panel Survey (MEPS) data to identify the AYA cancer survivors and an age-matched comparison population. We estimated the prevalence of health status (chronic medical conditions, psychological distress) and SDM in 2,326 AYA cancer survivors. The association between health status, SDM and medical expenditures was assessed using multivariable regression. Analyses were adjusted for age, sex, income level, insurance, health behavior, health care access, race/ethnicity, education, and marital status. Expenses were adjusted for inflation to 2016 dollars. Results: The prevalence of chronic conditions, psychological distress and poor SDM was 74%, 12% and 11% in AYA cancer survivors. AYA cancer survivors with at least one chronic condition ($2,777; 95% CI, $480 to $5,958), psychological distress ($4,415; 95% CI, $993 to $9690) and poor SDM ($3037; 95%CI; 109.72 to 7032.18) experienced additional annual medical expenditures. Medical expenditures associated with health status and poor SDM were more pronounced in AYA cancer survivors than adults without a history of cancer. Conclusions: Chronic conditions and psychological distress in AYA cancer survivors are associated with substantial medical expenses well after cancer diagnosis. Interventions to improve SDM in AYA cancer survivors may result in lower medical expenses.