Financial Hardship and Mental Health Among Cancer Survivors: Examining the Intersectional Impact of Age at Diagnosis

Background: The number of cancer survivors in the United States continues to increase each year, with approximately 18 million survivors and projections reaching 21 million by 2030. Cancer survivorship represents a critical public health challenge extending beyond medical treatment. Age at diagnosis may strongly influence both financial hardship and mental health outcomes, as younger survivors often face disrupted career trajectories, lower accumulated assets, and unique developmental challenges that could potentially amplify how financial stressors impact psychological wellbeing compared to those diagnosed later in life. This study examines whether the association between financial hardship and mental health outcomes among cancer survivors differs by age at diagnosis.

Methods: Using data from 10,262 cancer survivors aged 18 + from the 2021-2023 National Health Interview Survey, we assessed mental health concerns (daily/weekly feelings of anxiety or depression) and medical financial hardship across material, psychological, and behavioral domains. We conducted multiple logistic regression analyses to examine the association between the number of financial hardship domains and mental health concerns incorporating the complex sample design, while controlling for sociodemographic (age, sex, marital status, race/ethnicity), economic (insurance status, education, family income), and health-related factors (age at diagnosis, number of comorbid conditions). We further tested interactions between age at diagnosis and financial hardship domains.

Results: Financial hardship decreased with age at diagnosis across all domains. Younger-diagnosed survivors (<40) reported substantially higher rates of material (15.7-16.2%), psychological (44.8-47.0%), and behavioral hardship (18.7-22.8%) compared to those diagnosed at 65+ (6.6%, 26.4%, and 6.2%, respectively). Multiple hardship domains were most common in younger-diagnosed survivors. Across all age-at-diagnosis groups, individuals experiencing financial hardships reported higher rates of mental health concerns, with this pattern most pronounced among those diagnosed before age 15 (material: 83.2% vs 38.7%; psychological: 59.7% vs 33.7%; behavioral: 81.3% vs 37.8%). Notably, for survivors facing multiple financial hardship domains, mental health concerns were particularly severe, reaching 87% among those diagnosed before age 15. In the fully adjusted model, age at diagnosis was significantly associated with mental health outcomes, with survivors diagnosed at ages 15-39 having significantly higher odds of reporting anxiety or depression compared to those diagnosed at age 65 or older (OR=1.52, 95% CI: 1.04-2.22). Experiencing multiple financial hardship domains substantially increased the odds of mental health concerns (≥2 domains: OR=3.94, 95% CI: 3.29-4.70). However, the interaction between age at diagnosis and various financial hardship measures (total number of domains, material, psychological, and behavioral) were not statistically significant.

Conclusions: Our findings demonstrate that while age at diagnosis is independently associated with mental health outcomes among cancer survivors, the impact of financial hardship on mental health remains consistent regardless of diagnosis age, suggesting financial hardship interventions should be universally implemented while recognizing younger survivors' heightened baseline vulnerability. Survivorship care plans should incorporate financial navigation services and mental health screening, with particular attention to the unique developmental challenges faced by those diagnosed at younger ages. These findings underscore the importance of addressing financial hardship among the growing number of cancer survivors as a critical health and mental health intervention.