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Purpose: Describe associations between changes in employment during the COVID-19 pandemic and financial toxicity among adolescent and young adult (AYA) cancer patients and survivors. Methods: Eligible individuals were diagnosed between 15-39 years of age, currently age ≥18, and recruited through the Huntsman-Intermountain Adolescent and Young Adult Cancer Care Program. We sent the survey to N=709. Survey questions included demographics, employment, and the 11-item COmprehensive Score for financial Toxicity (COST) which captures financial toxicity in the last four weeks. COST is scored from 0 to 44 with lower scores indicating greater financial toxicity. Scores were dichotomized as high (0-21) or low (22-44). Changes in employment since March 2020 were categorized as no change, increase in hours, and decrease in hours/lost job. We calculated descriptive statistics and fit a multivariable logistic regression to examine the association between employment change and financial toxicity controlling for current age, gender, and treatment status. Results: Of 280 respondents (39.5% participation), 198 (70.7%) were employed prior to the pandemic and were thus included in analyses. Employed individuals were a mean of 29.4 years of age (range 18-58), 64.3% were female, and 50.5% had received cancer treatment since March 2020. Nearly a third (31.3%) had lost their job or reported reduced hours; 50.3% reported high financial toxicity. Among those previously employed, participants who lost their job or had their hours reduced had nearly six times the odds of high financial toxicity than those who reported no change in hours (Odds Ratio [OR]=5.8, 95% Confidence Interval [CI]: 2.6-12.9). In the same model, the odds of reporting high financial toxicity was over twice as high among females than males (OR=2.3, 95% CI: 1.2-4.5). Treatment status and age were not significant. Conclusions: Employment changes during the COVID-19 pandemic resulted in increased financial toxicity among a population already susceptible to high financial hardship. Societal gender inequity appears to be mirrored in participants’ financial toxicity during the pandemic. Employment interventions for patients and survivors of AYA cancers who have experienced job loss or reduction in work hours during the pandemic are needed and may particularly benefit females. Citation Format: Austin Waters, Heydon Kaddas, Karely Mann, Perla L. Vaca Lopez, Echo L. Warner, Joemy Ramsay, Judy Ou, Nicole Ray, Tomoko Tsukamoto, Douglas B. Fair, Joseph M. Letourneau, Mark A. Lewis, David A. Gill, Lauri Linder, Anne C. Kirchhoff. Adolescent and young adult cancer patient and survivor employment changes during COVID-19 are associated with financial toxicity [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2021 Feb 3-5. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(6_Suppl):Abstract nr S10-03.

Purpose: To describe adolescent and young adult (AYA) cancer patients’ and survivors’ experiences with telehealth during the COVID-19 pandemic. Methods: Eligible participants were identified through the Huntsman Intermountain Adolescent and Young Adult Cancer Care Program, which provides age-specific programming and patient navigation to AYA cancer patients and survivors in Utah and surrounding Mountain West states. Participants were emailed an online survey if they were currently age 18 or older and had been diagnosed with cancer between the ages of 15-39 years. We applied descriptive statistics to summarize demographics, comfortability with technology, access to reliable internet connection, and perceived quality of care while using telehealth. Results: AYAs (N=280) were an average of 29.4 years old at survey (range 18-58); 65.2% were female and 82.4% non-Hispanic white. Over half (54.2%) had received cancer treatment since March 2020. All participants reported owning a computer, tablet, and/or smart phone they could use for telehealth appointments. The majority (93.5%) reported almost always or always having a reliable internet connection. AYAs felt most comfortable having a telehealth appointment in their own home (96.4%); only 12.5% felt comfortable using telehealth at work. Since March 2020, (N=183) 65.4% had a health care visit moved to a telehealth platform due to COVID-19. Of those who recently moved to telehealth, 60.1% had an oncology visit, 33.9% had a primary care visit, and 31.1% had a mental health visit. Additionally over one-third (35.2%) reported the quality of their medical care had decreased since moving to telehealth. This was most commonly due to 1) troubles with audio, video, or connecting through telehealth platforms; 2) telehealth visits feeling impersonal; and 3) feeling that providers more easily dismissed or did not fully address their symptoms. Conclusions: Although AYAs are digital natives, over one-third of AYAs feel the quality of their medical care has decreased since moving to telehealth for COVID-19. Further research should explore medical provider training in using telehealth systems and encourage telehealth practices that help AYAs feel more supported and understood. Citation Format: Karely Mann, Austin R. Waters, Perla L. Vaca Lopez, Echo L. Warner, Judy Ou, Heydon Kaddas, Joemy Ramsay, Nicole Ray, Tomoko Tsukamoto, Douglas B. Fair, Joseph M. Letourneau, Mark A. Lewis, David Gill, Lauri Linder, Anne C. Kirchhoff. Telehealth experiences of adolescent and young adult cancer patients and survivors during the COVID-19 pandemic [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2021 Feb 3-5. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(6_Suppl):Abstract nr S06-04.

Background: Adolescent and young adult (AYA) cancer patients commonly report health insurance concerns and financial burden that emerge due to their cancer treatment. AYAs often have limited experience with health care prior to their cancer diagnosis, which may limit their understanding of health insurance concepts and affect their medical costs. As part of the development of an insurance navigation program, we conducted an evaluation of health insurance experiences, expectations, and literacy among a sample of AYA cancer patients. Methods: Eligible participants were 18-39 years of age with cancer, and currently insured. Participants were recruited in-person and online through a statewide AYA cancer navigation program in Utah. We selected the sample stratified on current age (18-25 and 26-39 years). Participants completed a brief survey and a semi-structured interview. We summarized demographic factors and the Health Insurance Literacy Measure (HILM), a continuous measure ranging from 0-84. The HILM score was examined by age (18-25 vs. 26-39 years) and insurance policy holder (yes vs. no) using t-tests. The semi-structured interviews were recorded, transcribed, and analyzed. Two cycles of inductive coding were applied to open-ended questions regarding health insurance knowledge, areas of confusion, their coverage expectations, and their experiences with medical costs. Results: Of AYA participants, N=13 were 18-25 and N=11 were 26-29 years; participants were female (58%) and Non-Hispanic White (79%), and most had completed at least had some college (92%). Less than half of participants were policy holders for their health insurance (41.7%). Mean HILM score was 55.63 (SD=10.06). There were no differences in the HILM measure by age or policy holder status. Three emergent qualitative themes included: 1) Lack of insurance knowledge affected experiences throughout treatment. While some AYAs understood the basics of their insurance coverage, most were unaware of the specifics of their plan, including how their coverage impacted their out-of-pocket costs. 2) Unclear expectations of health insurance. Most AYA participants were unsure what their health insurance should cover, but at the same time, were surprised about the lack of coverage and high costs. 3) Difficulties navigating coverage and the complexity of the health care system. Most AYAs reported struggled with handling insurance coverage issues, particularly when appeals were necessary to have their health care covered. Conclusions: AYAs with cancer report difficulty navigating the complexities of health insurance and lack understanding about what services their insurance should cover. Education focusing on insurance concepts (e.g., cost-sharing mechanisms such as deductibles) and areas where out-of-pocket costs could be managed (e.g., appeals process, in- vs. out-of-network services) could help AYA cancer patients make more informed health insurance decisions during their cancer treatment. Citation Format: Anne C. Kirchhoff, Karely Mann, Austin R. Waters, Echo L. Warner, Perla Vaca Lopez, Heydon K. Kaddas, Nicole Ray, Tomoko Tsukamoto, Doug Fair, Mark Lewis, Giselle K Perez, Elyse R. Park. Addressing gaps in health insurance literacy among adolescent and young adult cancer patients [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr IA21.