Project Summary/Abstract Financial toxicity, the economic distress related to cancer treatment, has been reported at higher rates among young adult (YA) cancer survivors than older survivors. Financial toxicity can negatively impact long-term financial well-being, including risk for bankruptcy, asset depletion, and medical debt; increase levels of anxiety, worry, and stress; and decrease engagement with necessary survivorship care and other healthcare. Young adult survivors of adolescent and young adult (AYA) cancer [survivors aged 18-39 years who were diagnosed with cancer after age 14] are particularly susceptible to financial toxicity, and they have higher out-of-pocket medical expenses, are less likely to be able to afford medication, and experience more difficulty maintaining work/school productivity than their healthy peers. There is limited research on the context and implications of financial toxicity in this population and, to our knowledge, no tailored interventions to address financial toxicity among YA cancer survivors specifically. The proposed study aims to address financial toxicity and subsequent financial barriers to survivorship care by developing and pilot-testing a health cost literacy and financial capability intervention with a national sample of YA survivors. Using mixed methodology, the intervention will be guided by the Developmental Model of Financial Capability and developed in consultation with survivors of AYA cancer, clinical experts, and a non-profit organization dedicated to reducing financial toxicity in YA survivors. The planned web-based intervention will use virtual role-play simulations that allow survivors to practice skills associated with health cost literacy and financial capability in scenarios tailored to their cancer survivorship experience, and we will pilot test the intervention in a randomized controlled trial of 50 YA survivors recruited via social media and through hospital-based programming. The intervention content will be based upon our previous work developing a toolkit to help YA survivors manage their finances after cancer. The primary aims are to 1) Assess the usability, acceptability, and user satisfaction of an iteratively developed online skills-based health cost literacy and financial capability intervention for survivors of AYA cancer; 2a) Use a randomized controlled trial to pilot-test the efficacy of the developed intervention to improve health cost literacy and financial capability in a sample of 50 survivors of AYA cancer; 2b) Examine the relationship between survivors’ reported financial toxicity and their health cost literacy and financial capability. Measurement for Aims 2a and 2b will occur at baseline and 1- and 3-month follow-up. The proposed study will create a new intervention to address factors associated with financial toxicity in YA cancer survivors. Contextually, it is important to understand the health cost literacy and financial capability of YA cancer survivors to determine their impact on health-related financial decision-making and health services utilization, particularly cancer survivorship care

Project Narrative Individuals treated for cancer during adolescence and young adulthood face significant financial burdens as a result of their cancer treatment. These burdens, known as financial toxicity, have been shown to yield a negative impact on young adult survivors’ quality of life and their engagement with necessary cancer survivorship care. The proposed study aims to fill a gap in the public health literature by developing and pilot- testing a novel intervention to address financial capability and health cost literacy, factors known to influence financial toxicity at the patient-level.