Measuring Financial Toxicity of Cancer in Young Active-Duty Military Patients

Background & Purpose:  Cancer can be an early setback for young active-duty patients in the military, with potential implications for their financial standing, career paths, and young families. Despite the assumption of material support for active duty military patients, cancer treatment results in increased out-of-pocket expenses and lost-opportunity costs for this group; as a result, this population is vulnerable to the “financial toxicity” of cancer care.   Although extant literature suggests various measures of financial well-being (FWB) to capture socioeconomic circumstances beyond traditional measures such as education and income, it is unknown whether these existing measures are sensitive to the financial toxicity experienced by military patients during cancer survivorship. To date, the majority of investigations into the financial toxicity of cancer focus solely on the non-military population. Since active duty military adolescent and young adult (AYA) cancer patients (diagnosed between ages 15-39 years) benefit from medical coverage for the costs of cancer drugs as well as the continuation of base salary, the study of financial toxicity in this special population is a unique opportunity to control for the influence of these factors. Despite these financial benefits, clinical experience indicates that military AYA cancer patients still experience financial hardship following their cancer diagnoses. The primary objective of the current study was to develop a measure of financial well-being (FWB) to assess financial toxicity in the military AYA cancer patient population.

Methods:  The investigator team conducted focus groups and key informant interviews (n=24) with active-duty AYA cancer patients, their spouses, cancer care providers, and military unit commanders at Tripler Army Medical Center and Schofield Barracks in Honolulu, HI. Subsequently, investigators used data derived from these focus groups and interviews to draft a candidate measure of FWB in the military AYA cancer context.

Results:  Findings revealed that young active-duty military patients’ experiences of financial toxicity during cancer survivorship, can be sorted into material, psychosocial, and behavioral domains to describe the FWB of this population following a cancer diagnosis.

Conclusions & Implications:  Differentiating the financial toxicity of the military AYA cancer patient population into material, psychosocial, and behavioral domains informs the development of interventions to ensure that such efforts are informed by the aspect of FWB most impacted by cancer care.