Emotional Distress and Financial Toxicity in Younger Adult Patients Undergoing Oncologic Surgery
*Thuy Tran1, *Gautam Malhotra1, *Marianne Razavi2, *Karen Clark2, *Matthew Loscalzo2, *Mustafa Raoof1, *Yanghee Woo1, *Laura Kruper1,*Vijay Trisal1, Yuman Fong1, *Laleh Melstrom1
1Surgery, City of Hope, Duarte, CA, United States. 2Supportive Medicine, City of Hope, Duarte, CA, United States.
Objective: There has been an alarming rise in younger adults diagnosed with cancer. The emotional, psychosocial, and financial distress in young adults newly diagnosed and undergoing cancer surgery remains largely unknown.
Methods: A 48-question biopsychosocial distress screening tool was administered to new patients diagnosed with cancer prior to surgery from 2009 to 2017. Patients were stratified into young adults (<45) and older adults (>45). Univariate and multivariate logistic regressions were used to analyze distress outcomes.
Results: A total of 4,136 patients were identified, with younger adults consisting of 13.4% (n=554) of the cohort. Surgery was performed for 43% abdominal, 32% breast, and 25% other cancers. Most patients were female (56%). Young adults reported higher emotional distress including increased anxiety (34% vs. 27%, P=0.002), greater fear of procedures (28% vs. 22%, P=0.018), and more difficulties managing emotions (26% vs. 20%, P=0.018). Younger adults more frequently struggled with managing work/school/home (30% vs. 19%, P<0.001), finding resources (18% vs. 11%, P=0.018), changes in physical appearance (22% vs. 13%, P<0.001), fatigue (36% vs. 27%, P<0.001), and the ability to have children (18% vs. 3%, P<0.001). Financial toxicity was significantly higher in young adults (41% vs. 28%, P<0.001). While income level was strongly protective against emotional distress and financial toxicity in older adults, income level was less protective for young adults. Female sex (OR 1.72, P<0.001) and young age (OR 1.55, P<0.001) were independent predictors of financial toxicity.
Conclusion: Younger adults in the prime of their personal and professional years of productivity require special attention when undergoing surgical evaluation for cancer. Resource allocation and counseling interventions should be integrated as part of their routine care in order to expedite their return to optimal physical and holistic health and to mitigate psychosocial distress and financial toxicity.
Back to 2022 Abstracts