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财务困境的年龄和性别差异。

目的 癌症具有长期的财务后果。青少年和青年 (AYA) 以及中年癌症幸存者可能比老年人经历更多的经济毒性。这项研究检查了造血细胞移植幸存者财务困境的年龄差异，以及这些差异是否是由测量偏差、更多的护理财务障碍或整体更高水平的困境引起的。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分。项目反应理论分析测试了年龄和性别的偏见。多变量线性回归测试了年龄和性别与 CTXD 分数的关联，同时控制了护理的经济障碍。结果 在 CTXD 上没有发现偏差。AYA (p < 0.01) 和中年人 (p < 0.001) 报告的财务和整体压力比老年人（65 岁以上）更多。在女性中观察到相同的年龄和财务困境相关性（p < 0.01）。然而，只有中年男性 (p < 0.01) 报告的财务和整体压力比老年男性更多；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总体困境的风险更高。