How Public Insurance Creates Barriers for Childhood Cancer Survivors

How Public Insurance Creates Barriers for Childhood Cancer Survivors

According to a recent study, childhood cancer survivors with public health insurance will face more barriers to transfer to adult care.

Adolescents and young adults (AYA) face an increased risk of late effects of childhood cancer after surviving the disease, such as stroke, congestive heart failure, and cognitive deficits. This has led to recommended follow-up care every year to address the effects and the risk of effects.

Care for childhood cancer survivors is provided by subspecialists such as pediatric oncologists, who eventually progress to adult cancer centers or primary care. However, this transition is seen in only 1/3 of survivors, and less than 20% of survivors receive adult-appropriate care that includes education on managing the risk of follow-up effects.

Follow-up effects in childhood cancer survivors are also influenced by health disparities caused by socioeconomic factors, race, and age. This affects the quality of long-term treatment. Investigators sought to analyze the impact of these factors on transition goals, expectations and beliefs.

To assess the association between sociodemographic factors and expectations of transition to adult care, the researchers conducted a longitudinal randomized controlled trial. Pediatric patients were recruited into the study, completed baseline measures, and received care at a pediatric center.

Patients were included if they were 15-29 years old, had received cancer treatment at a pediatric cancer center, were in remission at that time, had the cognitive ability to complete study procedures and were receiving follow-up care at a pediatric care center. center.

Liquid cancer diagnoses were made in 54% of patients, solid tissue diagnoses in 37.4% and brain tumor diagnoses in 8.7%. Patients were on average about 10 years old at diagnosis, and the time off treatment for AYA was on average 8.17 years.

About 7.7% of patients’ primary insurance was public insurance, and 9 private insurance users received it through school or work. For employment status, 33% of participants worked part-time, 10.3% full-time, 7.2% were part-time students, and 75.2% were full-time students.

AYAs lived with caregivers 86% of the time, while 1.5% lived alone and the remainder lived with a roommate or friend. Among primary caregivers, 15% were sole caregivers.

Data were collected on patient race and ethnicity, primary caregiver education, primary caregiver partner status, type of insurance, and home address. Home address was used to measure neighborhood income, with neighborhood median income used for the study.

A Transition Readiness Inventory (TRI) was used to determine AYAs’ goals, expectations, and beliefs about transition. A health skills belief inventory was used to determine participants’ perceptions of health, satisfaction with health care, autonomy, and cognitive skills.

Responses to the TRI were not affected by sociodemographic factors. Health competence beliefs and transition readiness were instead influenced by the type of insurance. Participants with public insurance had lower transition goals and overall health care satisfaction than those with private insurance. Health competence beliefs and transition expectations were significantly associated.

Because participants with public insurance had lower beliefs about health competence and therefore lower transition goals, expectations, and beliefs, the investigators concluded that public insurance is a barrier to outcomes. positive expectations for the transition.


Prussian KV, Barakat LP, Darabos K, Psihogios AM, King-Dowling S, O’Hagan B. Sociodemography, health competence, and transition readiness among adolescent/young adult cancer survivors. Journal of Pediatric Psychology. 2022;47(10):1096–1106. doi:10.1093/jpepsy/jsac039

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