Beyond Diagnosis: Reexamining Cancer Type In the Context of Social and Structural Determinants of Psychosocial Outcomes Among Childhood and Adolescent Cancer Survivors

Background and Purpose:
Childhood and adolescent cancer survivorship research has often identified cancer type, particularly central nervous system (CNS) tumors, as an important factor associated with poorer psychosocial outcomes. However, less is known about how cancer type functions in relation to social and structural factors that shape survivorship experiences. This study examines whether cancer type predicts psychosocial outcomes when accounting for demographic and environmental factors among survivors receiving survivorship care.

Methods:
Secondary data from 470 childhood and adolescent cancer survivors (diagnosed ages 0–19) attending a survivorship clinic in the U.S. Pacific Northwest (2009–2019) were analyzed. Participants completed the Impact of Cancer Questionnaire for Children (IOC-CS), a validated 45-item measure assessing survivors’ perceptions of both negative (NIOC; life challenges, thinking and memory problems, and financial concerns; 20 items) and positive (PIOC; health literacy, social connections, body and health, communication with parents, and personal growth; 25 items) impacts of cancer. Hierarchical regression models examined the contribution of demographic, environmental, and interaction effects.

Results:
Cancer type, including CNS/brain tumor status, was not a significant predictor of either NIOC (β = 0.09, p = .07) or PIOC (β = -0.06, p = .22). Psychosocial outcomes were more strongly associated with temporal, demographic, and structural factors. Greater years since diagnosis was associated with decreased PIOC (β = -0.17, p < .001). Public insurance predicted increased NIOC (β = 0.15, p < .001) and decreased PIOC (β = -0.12, p < .01) in earlier models. Interaction effects indicated that female survivors diagnosed during adolescence experienced higher NIOC (β = 0.15, p = .02) and lower PIOC (β = -0.21, p < .01). Additionally, survivors living in rural areas with public insurance reported higher NIOC (β = 0.13, p = .05).

Conclusions and Implications:
Findings indicate that cancer type was not a significant predictor of psychosocial outcomes in this sample and highlight the importance of social and structural determinants—including health insurance status, geographic location, and age at diagnosis—in shaping survivorship experiences. These findings point to disparities in access to care and reinforce the need for oncology social work practice and policy efforts that address structural barriers faced by underserved survivor populations. This research has direct implications for policy and practice by highlighting the need to expand equitable access to survivorship services, particularly for publicly insured and rural populations. Strengthening insurance coverage, improving access to long-term psychosocial support, and investing in survivorship services and long-term care supports represent strategies for reducing disparities and supporting the long-term well-being of childhood and adolescent cancer survivors.