New Study Finds Significant Mental Health Care Gaps for Childhood Cancer Survivors

Childhood cancer can be devastating for patients and their families, not only for the physical and financial toll they carry, but for the accompanying psychological burden that often accompanies cancer. With rising survival rates of childhood cancers, ensuring survivors receive mental health services is essential for long-term well-being.

A recent study led by Rollins School of Public Health and Emory School of Medicine researchers published in JNCI Cancer Spectrum looked at how often childhood cancer survivors utilized mental health services after their diagnosis. The answer is: not nearly enough.

Using Medicaid and Children's Health Insurance Program (CHIP) claims data from 43 states and Washington, D.C., the researchers provided one of the first large-scale, real-world portraits of mental health care utilization among Medicaid- and CHIP-enrolled childhood cancer survivors.

What They Found 

They discovered that less than 4 in 10 children and only around 1 in 5 young adults with depression, anxiety, or trauma/stress received at least four counseling or mental health visits in the 12 weeks after diagnosis—a threshold used to identify a minimal course of care.

“The low likelihood of receiving at least four mental health visits after a new mental health diagnosis is very concerning, given the greater complexity of childhood cancer survivors’ ongoing health needs and the interrelationship between physical and mental health,” says Janet Cummings, PhD, professor of health policy and management and senior author on the paper.

“Survivors of childhood cancer face lifelong emotional and psychological challenges, yet until now there has been little multistate, real-world evidence on whether publicly insured survivors actually receive mental health services after a new diagnosis,” says Xu Ji, PhD, first author on the paper and an associate professor of pediatrics at Emory School of Medicine and the Aflac Cancer and Blood Disorders Center of Children’s Healthcare of Atlanta. Ji also holds a secondary appointment at Rollins and is a member of the Winship Cancer Institute. “By shining a light on where the system is falling short, the work fills a critical evidence gap for policymakers, clinicians, payers, and advocates.”

Inequities in Mental Health Service Usage

Data from the analysis also pointed to profound inequities in who receives mental health care. The study found that Hispanic children were significantly less likely than non-Hispanic white survivors to receive any mental health visit or to complete four or more visits after a diagnosis. Survivors living in the most disadvantaged communities were also less likely to receive mental health services than those in the least disadvantaged areas, underscoring how both ethnicity and neighborhood deprivation independently shape the receipt of needed psychological support.

These findings highlight specific, actionable targets for improving childhood cancer survivorship care. They point to the need to: 
●    strengthen mental health screening and referral within oncology and primary care
●    expand the mental health workforce that accepts Medicaid and CHIP (including through telehealth)
●    develop culturally and linguistically responsive services for Hispanic families
●    support investing in survivorship care models that ensure continuity of psychological support as survivors age into young adulthood.

“By guiding reforms in policy and practice, this research can help improve mental health, quality of life, and long-term outcomes for thousands of young cancer survivors across the United States,” says Ji.