Economic consequences of cancer in adolescents and young adults

Cancer among adolescents and young adults (AYAs), defined as those aged 15–39 years, occurs during a critical developmental period as individuals exit educational roles, establish careers, and achieve financial independence. This makes AYAs vulnerable to significant disruptions in their economic trajectories if diagnosed with cancer. Through four related studies, this thesis addresses the knowledge gaps on the economic outcomes of AYAs surviving cancer compared with the general population. The first study presents a systematic review to synthesize published evidence on the socioeconomic outcomes of AYAs surviving cancer. The review identified no evidence of a difference in educational attainment among the limited published studies. However, survivors are more likely to be unemployed, earn less income, and require social assistance for income supplementation. Studies two and three use a population-based difference-in-difference design to estimate the longitudinal financial impacts of cancer among AYAs using the Canadian Cancer Registry linked to personal income tax data. Findings demonstrate that cancer causes a significant income reduction that persists throughout survivorship compared to cancer-free individuals. Income losses are largest during the first five years after diagnosis, and there is significant heterogeneity between disease subtypes. AYA men experience larger income reductions than women, and younger-aged men and older-aged women are most vulnerable to income losses. The fourth study utilizes a linkage of the Canadian Community Health Survey and the Canadian Cancer Registry to examine the mediating role of educational attainment on the relationship between cancer diagnosed during early adulthood and subsequent employment participation. Results demonstrate that cancer survivors have a higher likelihood of unemployment compared to cancer-free individuals, and that educational attainment mediates only a small statistically insignificant proportion of this relationship. Overall, this dissertation demonstrates the substantial socioeconomic burden of cancer among AYAs. Clinical implications of this work include incorporating financial screening and navigation into the clinical care continuum. It also serves as a foundation for decision-makers to develop public health interventions that support employment reintegration and financial assistance programs to mitigate the resultant economic disparities. Future intervention strategies must account for cancer type and developmental life stage to effectively target the most vulnerable AYA populations.

Department dc:contributor.department

Dalla Lana School of Public Health

Year dc:date.issued

2025

Author dc:creator

• Di Giuseppe, Giancarlo

Advisor dc:contributor.advisor

• Pole, Jason D

• adolescents and young adults
• cancer survivors
• financial toxicity
• income
• socioeconomic factors

Handle dc:identifier.uri

https://hdl.handle.net/1807/150023

OAI identifier oai:identifier

oai:utoronto.scholaris.ca:1807/150023