We adapted CHAT, a four-session virtual program to help individuals affected by cancer manage insurance and medical costs for caregivers of pediatric cancer patients (called CHAT-C); we then pilot-tested CHAT-C. Eligible caregivers were ages 18+ and the primary caregiver to a pediatric cancer patient (≤25 years old) diagnosed in the past five years and treated at Primary Children’s Hospital. We conducted engagement studios to adapt the program. Feedback was evaluated using a rapid qualitative analysis framework and included content preferences, navigator preferences, logistics/structure, timing of delivery, and feasibility/acceptability. A small pilot test of CHAT-C was conducted; feasibility, acceptability, and preliminary efficacy were evaluated based on enrollment rates, qualitative feedback, and baseline/follow-up surveys. Participants in the pilot (n = 14) were primarily white (93%), married (93%), female (86%), ages 40–49 (50%), and college-educated (57%). Most participants (64%) completed all four sessions of CHAT-C. Those who did not complete the sessions cited a lack of time, a child’s disease progression, and a perceived lack of benefit. Health insurance literacy (measured by nine items) improved by 10.8 points on average (SD = 6.0, range: 9–36) after CHAT-C. Caregivers of childhood cancer patients are willing to participate in a health insurance program, but some caregivers need less time-intensive options.

We investigated insurance coverage among adolescents and young adults (AYA) with cancer before and during the COVID-19 pandemic. AYAs diagnosed with cancer 15-39 years of age were identified using Utah Cancer Registry records and linked with University of Utah electronic health records. Poisson models calculated incidence rate ratios (IRRs) of health insurance coverage during pre-pandemic (11/4/2017-3/5/2020; n = 2,140) and pandemic (3/6/2020-7/6/2022; n = 1,894) periods. Prior to the pandemic, insurance gaps were higher (pre-pandemic = 16.40%, pandemic = 13.73%; IRR = 0.84, 95%CI = 0.71-0.98); more AYAs had continuous public insurance during the pandemic (pre-pandemic = 8.60%, pandemic = 10.98%; IRR = 1.28, 95%CI = 1.05-1.56). Research is needed on the durability of pandemic relief programs on insurance coverage among AYA cancer survivors.

We explored how sociodemographics and health insurance literacy (HIL) are associated with financial toxicity (FT) among adolescent and young adult (AYA) cancer patients using linear regression. Participants ( N = 86; ages: 18–39) diagnosed with cancer in the past year completed baseline surveys of an intervention trial assessing HIL (range: 4–36, lower scores = worse literacy) and the COmprehensive Score for financial Toxicity (COST; range: 0–44, lower scores = higher toxicity). Policyholders had higher FT (β = −5.24, p = 0.02). Among AYAs aged 26–39, each one-point HIL increase correlated with a 0.55 increase in COST score ( p = 0.05). Improving HIL could address FT among AYAs aged 26–39, suggesting a potential target for intervention.