352 Background: Frailty contributes to healthcare expenditures. Cancer and its therapies can further increase or accelerate the rate of frailty. Addressing geriatric deficits contributing to frailty of older cancer survivors (ages 65+) could potentially reduce health expenditures. However, little is known about how frailty affects health expenditures during the continuing survivorship period, a period after initial treatment but before the end-of-life. Given that older adults with cancer can live for years, it is important to examine health expenditures during this period by levels of frailty. Methods: We used the 2-year longitudinal panels of the Medical Expenditure Panel Survey, a nationally representative survey, to identify cancer survivors who are likely in the continuing survivorship period. We created 5 cohorts who were surveyed in 2016, 2017, 2019, 2020, and 2021, and in the previous year. In each cohort, we selected older individuals with an invasive cancer diagnosis in both previous and current years who did not die in the current year. We pooled the cohorts to estimate annual healthcare expenditures, representing a cancer population of 11,802,386 in the US (n=2,206). We constructed a deficit accumulation frailty index using survey items and divided patients into 3 categories: robust, pre-frail, and frail. We used generalized linear regression to estimate the associations of frailty with annual healthcare expenditures during the continuing survivorship period for older adults, controlling for age, sex, race/ethnicity, marital status, immigration background, insurance coverage, family size, family income, and education. Costs were inflated to 2023 US dollars. Results: The per person annual healthcare expenditure among older adult survivors of all cancer types was $13499.13, $24698.77, and $34352.23 for those who were robust (75.2%), pre-frail (12.0%), and frail (12.8%), respectively, and being pre-frail and frail was associated with higher expenditures (P<0.001). In analyses by cancer type, being frail (vs. robust) was associated with higher expenditures for bladder (P<0.05), breast (P<0.01), cervical (P<0.01), and prostate (P<0.01) cancers. Pre-frail breast cancer patients also incurred more costs than those who were robust (P<0.01). Conclusions: Increased frailty was associated with higher annual healthcare expenditures among older cancer survivors during the continuing survivorship period. Addressing geriatric deficits and intervening to maintain function and prevent frailty progression during survivorship care could improve quality of life and reduce healthcare expenditures.
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