Financial hardship in adolescent and young adult cancer survivors and adult survivors of childhood cancers.

PURPOSE: Adolescent and young adult (AYA) cancer survivors and adult survivors of childhood cancer (CCSs) represent growing populations facing unique survivorship challenges. Among these, financial hardship has emerged as a critical late effect, with profound implications for quality of life and health equity. METHODS: This narrative review synthesizes literature published between January 2020 and April 2025 on financial hardship in AYA cancer survivors and CCSs. Studies were identified through PubMed, Medline (Ovid), and Scopus and we compared the prevalence, determinants, and consequences of financial hardship across these populations. RESULTS: Financial hardship represents a critical late effect with implications for quality of life and health equity. Common drivers include high out-of-pocket medical costs, educational and employment disruptions, job lock, and fertility preservation expenses. Marginalized groups, including racial and ethnic minorities, LGBTQIA+ individuals, and rural residents, face disproportionate risk. Financial hardship is linked to treatment non-adherence, delayed follow-up, and adverse psychosocial outcomes, which may be exacerbated during care transitions and insurance changes. Interventions remain limited, but emerging strategies include early financial risk screening, integration of financial navigation into survivorship care, policy reforms to decouple insurance from employment, and leveraging digital tools for resource delivery. CONCLUSIONS: Gaps persist in prospective, population-based research, culturally tailored interventions, and systematic inclusion of underserved survivors. IMPLICATIONS FOR CANCER SURVIVORS: Addressing financial hardship in AYA cancer survivors and CCSs requires coordinated clinical, policy, and community efforts to ensure equitable survivorship outcomes.