Systematic Review of Health Insurance and Survival among Adolescent and Young Adult Cancer Patients

Abstract

Cancer is the leading cause of disease-related death among female adolescents and young adults (AYAs) and the second leading cause after heart disease among males in the United States. Despite recent improvements in survival outcomes, AYAs continue to experience poorer cancer survival rates compared with pediatric and older adult populations. Health care access and quality are substantially influenced by insurance coverage, and AYAs represent the age group with the highest proportion of uninsured individuals. The objective of this review was to examine the association between insurance status and cancer survival among AYAs to inform future policy interventions. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, peer-reviewed studies published in the United States between 2018 and 2024 were identified from PubMed, CINAHL, and Web of Science. Eligible studies examined associations between insurance status and survival outcomes among the AYA cancer population. Ten studies, encompassing 468,583 AYAs with cancer (60.1% female), were included. Individuals with Medicaid/public insurance, as well as those uninsured, exhibited poorer survival outcomes compared with those privately insured across multiple cancer types, including head and neck cancer, lymphoma, central nervous system tumors, hepatic carcinomas, sarcoma, germ cell, breast, thyroid, cervical, colorectal, uterine, ovarian, kidney, lung, and melanoma. Several associations appeared to be age-dependent (e.g., lymphoma). Findings from this review suggest that insurance status is associated with both short- and long-term cancer outcomes among AYAs. The results also highlight persistent challenges in accurately assessing and categorizing insurance status within this population.