cancer, and 69 percent of patients with Hodgkin lymphoma experienced a depressive event (570). Psychological distress is more prevalent among those who are AYA or belong to a racial and ethnic minority (13,568-570). Those who belong to sexual and gender minority populations are also at a greater risk of having lower psychological well-being, which is exacerbated in cancer patients living with HIV (571). Controlling depression can improve survival, with a recent study showing that 1-year survival in patients with cancer whose depression symptoms improved was 64 percent versus only 42 percent for those whose symptoms worsened (573). Emerging evidence suggests that the level of depression directly correlates with the degree of systemic inflammation in patients with cancer as measured by immune system markers, such as levels of cytokine or certain immune cells (574-576). For example, patients with lung cancer with moderate to severe depression were two to three times more likely to have inflammation levels that predict poor survival rates. Immune system dysregulation may also lead to a poor response of these patients to immunotherapies, which rely on a functional immune system to be effective. Financial Challenges Financial toxicity refers to the financial hardship associated with cancer treatment and management. Evidence indicates that cancer survivors who experience financial toxicity such as difficulty paying for prescriptions, mental health care, and other health services, and/or who delay medical care due to cost, are also at greater risk of mortality, regardless of insurance status (578). Financial toxicity is pervasive and is, in part, exacerbated by the rising cost of cancer care (480). For instance, between 2009 and 2016, the average cost of treatment increased 29 percent for breast cancer, 11 percent for lung cancer, and four percent for prostate cancer. In addition, out-of-pocket costs have also increased by 15 percent for all patients with cancer (579). Survivors can face challenges maintaining a job or going back to a previous job after the conclusion of treatment. Cancer survivors between the ages of 50 and 64 years were more likely to have a work-limiting disability and less likely to be employed, equating to 505,768 fewer employed individuals between 2010 and 2016 (580). Apart from direct financial costs, it is also common for cancer survivors to have housing, food, and transportation insecurity. As a result of these challenges, patients may forgo, miss, delay, alter, and/or prematurely terminate necessary care (582-584). Food insecurity is pervasive among people navigating a cancer diagnosis, with anywhere between 17 and 55 percent of patients with cancer facing food insecurity (584). This may explain why cancer survivors are more likely to be on supplemental nutrition assistance programs (SNAP) than the general population (580). Caregivers of patients with cancer are also susceptible to many of the same challenges faced by the patients. Lost income due to taking time off or leaving their employment can increase susceptibility to financial toxicity. For instance, 68.1 percent of partners of those diagnosed with colorectal cancer reported adverse financial outcomes following diagnosis, which led to worsening of health-related quality of life for these caregivers (585). Another study found that cancer caregivers from lower socioeconomic backgrounds were more likely to increase debt and incur work loss compared to noncancer caregivers in similar households (586). Suicide risk was found to be higher in patients with cancer undergoing surgery compared to the general population, with approximately 50 percent of suicides being committed within the first three years after surgery (572). The National Suicide Prevention Lifeline has established a new three-digit telephone number, 988, to provide free and confidential support for those experiencing thoughts of suicide or distress. 988 calling... Systemic inflammation occurs when the immune system is constantly active due to stress, infection, or chronic disease. This condition has been shown to alter the blood-brain barrier, which controls what type of cells and chemicals can reach the brain (577). In 2021, 78.8 percent of patients with breast cancer in low- and middle-income countries and 35.3 percent in high-income countries experienced financial toxicity (581). Supporting Cancer Patients and Survivors AACR Cancer Progress Report 2023 135
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