Functional Disability and Multidimensional Hardship Among Cancer Survivors in the United States: A Nationally Representative Study

Purpose: Functional disability presents an emerging concern among cancer survivors, yet its contribution to long-term hardship has not been well defined. This study assessed the association between functional disabilities and survivor hardship in a nationally representative U.S. cohort. Methods: Data from the 2017–2022 Behavioral Risk Factor Surveillance System (BRFSS) were used to identify adult cancer survivors. Functional disability was defined as self-reported mobility, cognitive, or self-care limitation. Survivor hardship was defined as experiencing ≥2 of the following: inability to work, frequent mental distress (≥14 days/month), cost-related unmet medical care, or physical inactivity. Weighted multivariable logistic regression assessed the association between disability and hardship. Difference-in-differences analysis evaluated the role of Medicaid expansion among low-income survivors. Results: Among 3.57 million weighted survivors, disability prevalence was 28.0% for mobility, 12.9% for cognitive, and 6.4% for self-care disability. Each disability type was independently associated with greater hardship, with cognitive disability demonstrating the strongest association (aOR 4.15, 95% CI 3.03–5.67). Sex-stratified models showed greater hardship among women for cognitive and self-care disability compared with men. Medicaid expansion was not significantly associated with reductions in hardship among low-income cancer survivors. Conclusion: Functional disability is highly prevalent and strongly associated with multidimensional hardship among cancer survivors. Sex-based disparities and socioeconomic vulnerability underscore the need for disability-informed survivorship care and supportive policy. Implications for Cancer Survivors: Functional disability substantially increases the risk of hardship; religiosity-independent policy levers such as targeted rehabilitation, mental health support, and financial navigation may be required to mitigate long-term adverse impacts.