Age Matters: Young Adult Cancer Survivors Face Elevated Social Vulnerabilities

A new cross-sectional analysis reveals that young adult cancer survivors in the United States face a significantly higher burden of social risks relative to their older counterparts.¹ The study, published in Cancer Research Communications, provides a deeper understanding of cancer survivorship across the life course, highlighting critical age-based disparities shaped by social determinants of health (SDOH) and health policy that may compromise long-term clinical outcomes and health equity.

The social risks examined in the study, often categorized under the broader umbrella of social determinants of health (SDOH), encompassed food insecurity, housing instability, employment insecurity, transportation insecurity, and cost-related barrier to care. Specifically, the study aimed to compare the prevalence of these risks in cancer survivors vs those without a history of cancer.

Data for the analysis were derived from the 2022–2023 Behavioral Risk Factor Surveillance System (BRFSS), analyzing a nationally representative sample of 472,531 individuals. Of the total sample, 8.7% (n = 58,077) reported a history of cancer.

Findings: Social Risk Falls Heaviest on Young Adults

The findings demonstrated clear differences in social risk prevalence between cancer survivors and those without a cancer history (25.6% vs 35.4%, respectively), as well as a stark age-related gradient in social risk exposure. Young adult survivors aged 18 to 39 years were especially more likely to report housing security, participation in the Supplemental Nutrition Assistance Program, utility insecurity, food insecurity, and transportation insecurity compared with their peers without a cancer history. Notably, differences were minimal in the middle-aged cohort (40 to 64 years) and were either absent or reversed among those aged 65 years and older.

Food insecurity emerged as the most prevalent social risk factor overall. However, the burden was disproportionately distributed across survivors: 23.8% (95% CI, 19.6%-28.1%) of younger survivors reported food insecurity compared with only 7.5% (95% CI, 6.8%-8.1%) of those survivors in the 65-plus category. Similar trends were observed for housing instability, utility insecurity, and transportation barriers.

Untangling Disparities: The Role of Policy

The authors noted that the relative "protection" seen in the older cohort may be attributable to the social safety nets more readily available to seniors in the US, such as Medicare and social security. Conversely, younger survivors often face financial toxicity during their peak earning years, compounded by the high costs of modern oncology therapeutics.

Among young adults in particular, the study also identified state-level policies—specifically Medicaid expansion—and demographics to play a role in shaping differences between cancer survivors and those without a cancer history. Young adults in non-Medicaid expansion states generally had a higher prevalence of social risk factors relative to those in Medicaid expansion states. Additionally, there were larger differences between cancer survivors and those without a cancer history in the prevalence of certain social risks in non-Medicaid expansion states.

Clinical Implications: Survivorship Is Not One-Size-Fits-All

As a cross-sectional analysis based on self-reported BRFSS data, the study cannot establish causality and may be subject to recall and reporting bias, as well as limited granularity on cancer type, treatment, and survivorship duration. Nevertheless, the findings underscore a greater need to move beyond a purely disease-centered model of survivorship and toward a more comprehensive, risk-informed approach to care.

Routine screening for social risk factors—particularly among younger adult patients—may be critical to identifying those at heightened risk for poor adherence, delayed follow-up, and worse long-term outcomes into survivorship. Integrating standardized SDOH assessments along the care continuum,² along with referral pathways to social work, financial counseling, and community-based resources may help mitigate some of the downstream effects of these vulnerabilities.

Importantly, the study also highlights how structural inequities shape survivorship trajectories. Younger adults, especially those without access to robust insurance coverage or living in non-Medicaid expansion states, may encounter persistent barriers that extend well beyond active treatment. These findings reinforce the importance of policy-aware oncology practice, where clinicians understand how insurance status, geography, and socioeconomic context influence patients’ ability to engage in recommended care.

The study authors, Ami E. Sedani, PhD, MPH and colleagues, raise the need for more intentional disaggregation of survivorship data by age to better inform targeted interventions. Rather than treating survivors as a homogeneous group, stratifying by life stage may allow clinicians and health systems to design more responsive survivorship care models, particularly for young adults navigating employment disruption, insurance instability, and financial toxicity.

“Leveraging this evidence to prioritize support for young adult survivors (particularly those in non-Medicaid expansion states, racially and ethnically minoritized groups, and males) can help ensure that the highest-risk subgroups receive targeted resources and social support during survivorship,” they wrote.¹ “By identifying subgroups most vulnerable during early adulthood, these findings extend understanding of social risk across the life course and underscore the influence of demographic and local context on survivorship vulnerabilities.”

REFERENCES

1. Sedani AE, Balasubramanian BA, Wheeler SB, Ganguly A. Social risk burden among US cancer survivors across adulthood: evidence from the 2022–2023 BRFSS. Cancer Res Commun. 2026;6(3):566-576. doi:10.1158/2767-9764.CRC-25-0664

2. Rochat J, Delgado LL, Zinck L, et al. Integrating social determinants of health screening to improve oncology patient outcomes in a community cancer practice within an academic health system. JCO Oncol Pract. 2025;21(10_suppl):291-291. doi:10.1200/op.2025.21.10_suppl.291