Mental health insurance access and utilization among childhood cancer survivors: a report from the childhood cancer survivor study
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.
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.
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.
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.
KeywordsChildhood cancer Survivorship Insurance Mental health Distress
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).
Compliance with ethical standards
Conflict of interest
The authors have no conflict of interest to report.
- 3.Philips SM, Padgett LS, Leisenring WM, et al. Survivors of childhood cancer in the United States: prevalence and burden of morbidity. Cancer Epidemiology, biomarkers & prevention: a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventative Oncology. 2015;24(4):653–63.CrossRefGoogle Scholar
- 4.Howlander N, Noone AM, Krapacho M, et al. SEER cancer statistics review, 1975-2010. Bethesda: National Cancer Institute; 2013.Google Scholar
- 5.Mueller S, Fullerton HJ, Stratton K, Leisenring W, Weathers RE, Stovall M, et al. Radiation, atherosclerotic risk factors, and stroke risk in survivors of pediatric cancer: a report from the childhood cancer survivor study. Int J Radiat Oncol Biol Phys. 2013;86(4):649–55.CrossRefPubMedPubMedCentralGoogle Scholar
- 15.Lipari R, Hedden S, Blau G, Rubenstein L. Adolescent mental health service use and reasons for using services in specialty educational and general medical setting. Rockville: Substance Abuse and Mental Health Services Administration; 2016.Google Scholar
- 18.Fair DB, Kirchhoff AC, Nipp RD, et al. Impact of health care costs on utilization of needed health care in the Childhood Cancer Survivor Study (CCSS). J Clin Oncol. 2016; 34(3).Google Scholar
- 25.Robison LL, Armstrong GT, Boice JD, et al. The childhood Cancer survivor study: a National Cancer Institute—supported resource for outcome and intervention research. J Clin Oncol. 2009;27(14):2308–18.Google Scholar
- 28.Derogatis LR. (2001). Brief Symptom Inventory (BSI)-18: Administration,scoring and procedures manual. Minneapolis, MN: NCS Pearson.Google Scholar
- 33.The Mental Health Parity and Addiction Equity Act of 2008, Pub L (Feb 2, 2010).Google Scholar