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

  • Giselle K. Perez
  • Anne C. Kirchhoff
  • Christopher Recklitis
  • Kevin R. Krull
  • Karen A. Kuhlthau
  • Paul C. Nathan
  • Julia Rabin
  • Gregory T. Armstrong
  • Wendy Leisenring
  • Leslie L. Robison
  • Elyse R. Park
Article
  • 6 Downloads

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.

Keywords

Childhood cancer Survivorship Insurance Mental health Distress 

Notes

Compliance with ethical standards

Conflict of interest

The authors have no conflict of interest to report.

Supplementary material

11764_2018_691_MOESM1_ESM.docx (40 kb)
ESM 1 (DOCX 39 kb)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Giselle K. Perez
    • 1
    • 2
  • Anne C. Kirchhoff
    • 3
  • Christopher Recklitis
    • 2
    • 4
  • Kevin R. Krull
    • 5
  • Karen A. Kuhlthau
    • 1
    • 2
  • Paul C. Nathan
    • 6
  • Julia Rabin
    • 1
  • Gregory T. Armstrong
    • 5
  • Wendy Leisenring
    • 7
  • Leslie L. Robison
    • 5
  • Elyse R. Park
    • 1
    • 2
  1. 1.Massachusetts General HospitalBostonUSA
  2. 2.Harvard Medical SchoolBostonUSA
  3. 3.Huntsman Cancer Institute and Department of PediatricsUniversity of UtahSalt Lake CityUSA
  4. 4.Dana-Farber Cancer InstituteBostonUSA
  5. 5.St. Jude Children’s Research HospitalMemphisUSA
  6. 6.The Hospital for Sick ChildrenTorontoCanada
  7. 7.Fred Hutchinson Cancer Research CenterSeattleUSA

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