Massachusetts General Hospital, Boston, MA, USA.
Harvard Medical School, Boston, MA, USA.
J Cancer Surviv. 2018 Aug;12(4):528-536. doi: 10.1007/s11764-018-0691-y. Epub 2018 Apr 15.
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.
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.
描述并比较儿科癌症幸存者及其兄弟姐妹的心理健康获取、偏好和使用的普遍性。确定与幸存者心理健康获取和使用相关的因素。
对童年癌症幸存者研究中的 698 名幸存者（中位数年龄=39.4；中位数诊断后年限=30.8）和 210 名兄弟姐妹（中位数年龄=40.4）进行调查。结果包括是否有心理健康保险覆盖、因费用而延迟治疗、对心理健康福利的认知价值以及在过去一年中是否看心理健康提供者。
幸存者和兄弟姐妹之间在心理健康获取、偏好和使用方面没有差异（p>0.05）。在有过困扰史的受访者中，大多数人报告在过去一年中没有看过心理健康提供者（80.9%的幸存者与 77.1%的兄弟姐妹；p=0.60）。未参保的幸存者因费用而更有可能推迟心理健康服务（24.6%比 8.4%；p<0.001）。在多变量模型中，男性（OR=2.96）和有公共保险（OR=6.61）或雇主赞助保险（ESI；OR=14.37）的幸存者更有可能获得心理健康保险。
大多数儿童癌症幸存者重视获得心理健康保健福利；然而，心理健康服务的覆盖范围和使用仍然不理想。最脆弱的幸存者，特别是没有保险的幸存者和有困扰史的幸存者，面临着获得心理健康护理的挑战。
儿童癌症幸存者面临着日常生活压力水平高的风险，这些压力因治疗相关后遗症而加剧。综合、基于系统的方法，将财务计划与关于保险福利的患者教育相结合，可以帮助减少幸存者面临的一些经济障碍。
