By several measures, adolescents and young adults (AYAs, age 15–39 years) represent the population segment at greatest risk for economic calamity. In particular, AYAs with cancer face numerous financial challenges that pose barriers to their receipt of appropriate and timely medical care. The health-related financial issues examined in this chapter include employment, health insurance, out-of-pocket expenses, and selected health-related quality-of-life issues that may influence them (e.g., education and marital status). For purposes of this discussion, the AYA population is divided into two groups, the younger adolescent (less than 18 years old) and the older adolescent and young adult (18–39 years old). Younger adolescents are nearly always financially dependent on their parents or guardians, making their financial issues essentially equivalent to those of younger children. These are mostly associated with active therapy and result in increased family financial burden, especially out-of-pocket expenses, which are estimated to represent one third of after-tax income. In contrast, older AYAs tend to be or aspire to become financially independent. Their issues relate to preserving income, paying for care, and providing for dependents. For some, the priority is completing higher education or career preparation, while for others it is launching, maintaining, or returning to work. For cancer survivors, these challenges do not necessarily abate, as clinically significant late effects require medical management, pose excess financial burdens, and diminish functional status. Although the landmark Affordable Care Act of 2010 has partially improved the situation in the USA, many AYAs remain vulnerable through remaining discontinuities, incompleteness, and sheer complexity of coverage. Further, many financial challenges are universally overrepresented among AYAs, regardless of payer system. A proactive, socio-ecological, multidisciplinary approach involving physicians, nurses, oncology social workers, and other professionals is likely to be most effective for assisting individual patients and developing systemic solutions.
