Financial Difficulty Over Time in Young Adults With Breast Cancer

Young adults aged 18 to 39 years represent the minority of breast cancer diagnoses but are particularly vulnerable to financial hardship. A total 1008 patients were included (median age at diagnosis, 36 years). Patients' tumors were primarily stage I-II (778), estrogen receptor/progesterone receptor-positive (754), and ERBB2-negative (686). Patients were more frequently treated with mastectomy than breast conservation (771 vs 297; P < .001).Three distinct trajectories of experiences with finances emerged: 551 patients (54.7%) had low financial difficulty (trajectory 1), 293 (29.1%) had mild difficulty that improved (trajectory 2), and 164 (16.3%) had moderate to severe difficulty peaking several years after diagnosis before improving (trajectory 3). Hispanic ethnicity (OR, 3.71), unemployment at baseline and 1 year (OR, 2.66), and arm symptoms (OR, 1.77) were associated with increased odds of experiencing trajectory 3. Having a college degree (OR, 0.20) or being partnered (OR, 0.24) were associated with increased odds of experiencing trajectory 1. In this cohort study of young adults with breast cancer, we identified a subset of patients who experienced a high degree of financial difficulty persisting into early survivorship. Targeted interventions to mitigate financial toxicity-modifiable factors that include support for the employability or return to work support for those experiencing arm symptoms after treatment-are needed.