Functional disability and multidimensional hardship among cancer survivors in the USA: a nationally representative study

PURPOSE: Functional disability is common among cancer survivors, yet its contribution to multidimensional survivorship burden remains incompletely characterized. We evaluated disability-specific and sex-stratified associations with survivorship burden in a nationally representative US cohort. METHODS: We analyzed 2017-2022 Behavioral Risk Factor Surveillance System data among adult cancer survivors. Functional disability included mobility, cognitive, or self-care limitation. Outcomes included socioeconomic hardship (ordinal composite of inability to work and cost-related unmet care), psychological burden (frequent mental distress), and psychosocial burden (leisure-time physical inactivity). Survey-weighted regression models assessed associations by disability burden and type, with sex-stratified analyses and disability-by-sex interaction testing. Difference-in-differences analyses evaluated disability-associated socioeconomic hardship by Medicaid expansion status among low-income survivors. RESULTS: Among 3.57 million weighted cancer survivors, mobility (28.0%), cognitive (12.9%), and self-care (6.4%) disabilities were prevalent. Any disability was associated with higher socioeconomic hardship (aPOR 2.48, 95% CI 2.22-2.77), psychological burden (aOR 2.54, 95% CI 2.33-2.77), and psychosocial burden (aOR 2.68, 95% CI 2.48-2.89). Disability-specific patterns differed: cognitive disability was most strongly associated with psychological burden (aOR 3.42, 95% CI 3.02-3.87), self-care disability with socioeconomic hardship (aPOR 2.63, 95% CI 2.12-3.27), and mobility disability with psychosocial burden (aOR 2.98, 95% CI 2.70-3.29). Medicaid expansion modestly attenuated disability-associated socioeconomic hardship among low-income survivors. Disability-associated socioeconomic and psychological burden was greater among women, whereas psychosocial burden was more pronounced among men. CONCLUSION: Functional disability was strongly associated with multidimensional survivorship burden, with distinct disability- and sex-specific patterns. IMPLICATIONS FOR CANCER SURVIVORS: Disability-informed survivorship care may reduce hardship and improve post-cancer quality of life.