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

J Cancer Surviv. 2018 Aug;12(4):528-536. doi: 10.1007/s11764-018-0691-y. Epub 2018 Apr 15.


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.

Keywords: Childhood cancer; Distress; Insurance; Mental health; Survivorship.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age of Onset
  • Cancer Survivors* / psychology
  • Cancer Survivors* / statistics & numerical data
  • Child
  • Cross-Sectional Studies
  • Female
  • Health Services Accessibility* / economics
  • Health Services Accessibility* / statistics & numerical data
  • Humans
  • Insurance Coverage / statistics & numerical data*
  • Insurance, Health / statistics & numerical data
  • Longitudinal Studies
  • Male
  • Medically Uninsured / psychology
  • Medically Uninsured / statistics & numerical data
  • Mental Health Services* / economics
  • Mental Health Services* / statistics & numerical data
  • Mental Health Services* / supply & distribution
  • Middle Aged
  • Neoplasms / economics
  • Neoplasms / epidemiology*
  • Neoplasms / psychology
  • Patient Acceptance of Health Care / psychology
  • Patient Acceptance of Health Care / statistics & numerical data
  • Retrospective Studies
  • Siblings / psychology
  • Stress, Psychological* / economics
  • Stress, Psychological* / epidemiology
  • Stress, Psychological* / therapy
  • Surveys and Questionnaires
  • Young Adult