PURPOSE Cancer has long-term financial consequences. Adolescent and young adult (AYA) and middle-aged cancer survivors may experience more financial toxicity than older adults. This study examined age differences in financial distress in hematopoietic cell transplant survivors and whether these differences result from measurement bias, more financial barriers to care, or an overall higher level of distress. METHODS Hematologic malignancy survivors (n = 1135, 2-10 years post-transplant) completed the Cancer and Treatment Distress Scale (CTXD) and demographics as part of the baseline assessment for a randomized clinical trial. The CTXD has seven subscales, but for this study, we examined the financial distress subscale and the overall score. Item response theory analyses tested for bias by age and gender. Multivariate linear regression tested the association of age and gender with the CTXD scores while controlling for financial barriers to care. RESULTS No bias was found on the CTXD. AYA (p < 0.01) and middle-aged adults (p < 0.001) reported more financial and overall distress than older (age 65+) adults. The same association of age and financial distress was observed in women (p < 0.01). However, only middle-aged men (p < 0.01) reported more financial and overall distress than older men; AYA men did not (p > 0.18). Financial barriers to care were not associated with financial or overall distress. CONCLUSIONS Part of the increase in financial distress with younger age may be due to a higher risk of general distress. Policy initiatives to control cancer costs should consider life stage and the unique financial challenges at different ages for men and women.

中文翻译：

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造血细胞移植幸存者经济困难的年龄和性别差异。


目的 癌症会产生长期的经济后果。青少年和青年 (AYA) 以及中年癌症幸存者可能比老年人遭受更多的经济损失。这项研究调查了造血细胞移植幸存者经济困难的年龄差异，以及这些差异是否是由于测量偏差、更多的护理经济障碍或总体较高的经济困难水平造成的。方法 血液恶性肿瘤幸存者（n = 1135，移植后 2-10 年）完成了癌症和治疗痛苦量表 (CTXD) 和人口统计学，作为随机临床试验基线评估的一部分。 CTXD 有七个分量表，但在本研究中，我们检查了财务困境分量表和总体得分。项目反应理论分析测试了年龄和性别的偏差。多元线性回归测试了年龄和性别与 CTXD 评分的关联，同时控制了护理的经济障碍。结果 CTXD 未发现偏差。 AYA (p < 0.01) 和中年成年人 (p < 0.001) 比老年人（65 岁以上）报告更多的财务和整体困境。在女性中也观察到年龄与经济困难之间存在相同的关联（p < 0.01）。然而，只有中年男性 (p < 0.01) 比老年男性报告更多的财务和整体困境； AYA 男性没有（p > 0.18）。护理的财务障碍与财务或整体困境无关。结论 随着年龄的增长，财务困境增加的部分原因可能是由于一般困境的风险较高。控制癌症费用的政策举措应考虑生命阶段以及男性和女性不同年龄阶段独特的财务挑战。