Retrospective cohort study of financial hardship and nonadherence to healthy lifestyle and surveillance in childhood cancer survivors

A retrospective cohort study investigated the associations between medical financial hardship and nonadherence to healthy lifestyle and late-effects surveillance recommendations in long-term survivors of childhood cancer (CCSs). The study was performed among participants in the multiinstitutional Childhood Cancer Survivor Study. Participants were 5-year cancer survivors diagnosed at age 21 years or younger between 1970 and 1999, who completed both a medical financial hardship survey between 2017 and 2019 and a follow-up survey assessing lifestyle behaviors and adherence to risk-based surveillance between 2020 and 2022. In this cohort study of 3322 CCSs, more than on-half reported medical financial hardship. Medical financial hardship was associated with nonadherence to healthy lifestyle behaviors (lack of physical activity, abnormal body mass index, smoking) and certain recommended surveillance tests for subsequent malignant neoplasms. The authors conclude that these findings underscore the need to identify and address medical financial hardship as a potential risk factor of nonadherence to a healthy lifestyle and guideline-concordant survivorship care.