OBJECTIVES

To quantify direct medical costs, indirect costs and work outcomes among Singaporean adolescent and young adult (AYA) cancer survivors.

METHODS

This was a cross-sectional study conducted between July 2016 and October 2018 at the National Cancer Centre Singapore. Cancer patients between 16-39 years old who had completed antineoplastic treatment were eligible. Siblings of participants were recruited as non-cancer controls. Direct medical costs were extracted from the hospital financial database and converted to 2017 US dollars while indirect costs were estimated from employment status, income levels and absenteeism self-reported by participants. Mixed-effects logistic regression was used to compare employment status between cancer survivors and sibling controls.

RESULTS

Thirty-seven cancer survivors consented to the study with a mean (±SD) age of 27.4 (±5.8) years. The most common cancer diagnosis was lymphoma (48.6%), followed by germ cell tumors (37.8%) and sarcomas (10.8%). Demographic characteristics were similar between cancer survivors and sibling controls. The median direct medical costs incurred within 6 months post treatment completion was USD 5022, with out-of-pocket expenditure ranging from 14.3% to 100%. 40.5% of survivors were employed at the time of survey, while 10.8% were unemployed yet actively seeking employment. The odds of employment were not significantly different (OR:0.52, 95% CI:0.14-6.28) between cancer survivors and sibling controls. However, in the past 3 months preceding study recruitment, employed cancer survivors reported a median of 1 day missed at work due to health issues (range: 0-90 days), with estimated indirect costs of USD 41 (range: USD 0-2895). In comparison, sibling controls did not report missing work due to significant health issues.

CONCLUSIONS

Despite treatment completion, Singaporean AYA cancer survivors still experience substantial medical expenditure and inferior employment outcomes. Further work is necessary to describe financial and work-related outcomes in this group of patients who are in a critical point of their careers.