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Mental health insurance access and utilization among childhood cancer survivors: a report from the childhood cancer survivor study

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Abstract

Purpose

To describe and compare the prevalence of mental health access, preference, and use among pediatric cancer survivors and their siblings. To identify factors associated with mental health access and use among survivors.

Methods

Six hundred ninety-eight survivors in the Childhood Cancer Survivor Study (median age = 39.4; median years from diagnosis = 30.8) and 210 siblings (median age = 40.4) were surveyed. Outcomes included having mental health insurance coverage, delaying care due to cost, perceived value of mental health benefits, and visiting a mental health provider in the past year.

Results

There were no differences in mental health access, preferences, and use between survivors and siblings (p > 0.05). Among respondents with a history of distress, most reported not having seen a mental health provider in the past year (80.9% survivors vs. 77.1% siblings; p = 0.60). Uninsured survivors were more likely to defer mental health services due to cost (24.6 vs. 8.4%; p < 0.001). In multivariable models, males (OR = 2.96) and survivors with public (OR = 6.61) or employer-sponsored insurance (ESI; OR = 14.37) were more likely to have mental health coverage.

Conclusions

Most childhood cancer survivors value having mental healthcare benefits; however, coverage and use of mental health services remain suboptimal. The most vulnerable of survivors, specifically the uninsured and those with a history of distress, are at risk of experiencing challenges accessing mental health care.

Implications for Cancer Survivors

Childhood cancer survivors are at risk for experiencing high levels of daily life stress that is compounded by treatment-related sequelae. Integrative, system-based approaches that incorporate financial programs with patient education about insurance benefits can help reduce some of the financial barriers survivors face.

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Funding

This work was supported by the LIVESTRONG Foundation (E. Park, Principal Investigator) and the National Cancer Institute (CA55727, G.T. Armstrong, Principal Investigator). Support to St. Jude Children’s Research Hospital also provided by the Cancer Center Support (CORE) grant (CA21765, C. Roberts, Principal Investigator) and the American Lebanese-Syrian Associated Charities (ALSAC).

Author information

Authors and Affiliations

  1. Massachusetts General Hospital, Boston, MA, USA

    Giselle K. Perez, Karen A. Kuhlthau, Julia Rabin & Elyse R. Park

  2. Harvard Medical School, Boston, MA, USA

    Giselle K. Perez, Christopher Recklitis, Karen A. Kuhlthau & Elyse R. Park

  3. Huntsman Cancer Institute and Department of Pediatrics, University of Utah, Salt Lake City, UT, USA

    Anne C. Kirchhoff

  4. Dana-Farber Cancer Institute, Boston, MA, USA

    Christopher Recklitis

  5. St. Jude Children’s Research Hospital, Memphis, TN, USA

    Kevin R. Krull, Gregory T. Armstrong & Leslie L. Robison

  6. The Hospital for Sick Children, Toronto, ON, Canada

    Paul C. Nathan

  7. Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Wendy Leisenring

Authors
  1. Giselle K. Perez
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  2. Anne C. Kirchhoff
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  3. Christopher Recklitis
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Correspondence to Giselle K. Perez.

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Perez, G.K., Kirchhoff, A.C., Recklitis, C. et al. Mental health insurance access and utilization among childhood cancer survivors: a report from the childhood cancer survivor study. J Cancer Surviv 12, 528–536 (2018). https://doi.org/10.1007/s11764-018-0691-y

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  • DOI: https://doi.org/10.1007/s11764-018-0691-y

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