Neurocognitive impairment and financial hardship in adult survivors of childhood cancer

More than 60% of adult childhood cancer survivors (CCSs) report medical financial hardship due to the cumulative costs of cancer-directed therapy and related chronic health conditions. Whether neurocognitive impairment as a late effect is associated with increased financial hardship is unknown. Analysis of participants of the Childhood Cancer Survivor Study (n=3023 adult CCSs) found a dose-dependent relationship between neurocognitive impairment and financial hardship outcomes. Individuals with 4 impaired neurocognitive domains had over a 3-fold increased odds of debt collection (OR 3.12; 95% CI 1,91-5.09) and bankruptcy (3.77; 2.01-7.07) compared to individuals with no impaired cognitive domains. After adjusting for education, employment, and household income, the independent association between neurocognitive impairment and financial hardship outcomes persisted, suggesting that other mechanisms may play a role. The authors conclude that neurocognitive impairment is an important risk factor for financial hardship in this patient population.