Surviving more than cancer: the unseen toll of financial toxicity and basic needs insecurity in adolescent and young adult cancer survivors.

Résumé

BACKGROUND: Adolescent and young adult (AYA) survivors of cancer are at elevated risk for financial challenges, food insecurity, and basic needs instability. However, little is known about their lived experiences. Hence, this study explored the lived experiences of financial toxicity, basic needs instability, and food insecurity among AYA survivors and described the impact of financial toxicity on the overall well-being of AYA survivors.METHODS: Using a systematic content analysis approach, this study examined 3,868 Reddit items (original posts and associated comments) drawn from 26 Reddit communities from 2005 to July 2025. Reddit cancer community posts were screened to determine those made by someone who self-identified as an individual diagnosed with cancer between the ages of 15–39, completed primary treatment, and shared about financial or food access challenges. Posts were excluded if the age at diagnosis could not be ascertained. Posts were coded by two researchers into major themes and sub-themes using MAXQDA software.RESULTS: The most common cancer types reported in the Reddit data were breast, cervical, and colon. The data revealed four main themes: four main themes: (1) Distress caused and amplified by navigating broken systems; (2) Barriers to social support that worsen financial toxicity; (3) Spiraling consequences of financial toxicity: Food, housing, employment, and education instability; and (4) Healthcare system and policy barriers that exacerbate treatment burden and financial toxicity.CONCLUSIONS: Ongoing financial impacts of cancer, and associated psychosocial distress, created numerous challenges for AYAs in terms of managing the costs of treatment, medications, lodging, relocation, food, education, and retaining employment. Cancer centers, insurers, and community organizations need to prioritize multi-level safety net programs that ensure AYA survivors have access to resources that meet their basic necessities and other long-term survivorship needs.