The Impact of Insurance, Social Support on AYAs With ALL and Their Families

For adolescents and young adults (AYAs) with acute lymphoblastic leukemia (ALL), the steepest barriers to high-quality care may not be geographic but financial and social, according to new research presented at the 2025 American Society of Hematology annual meeting in Orlando, Florida.

One abstract indicated that insurance status is a more consistent determinant of access to specialized care than travel time,¹ and another revealed that lack of social support increased the likelihood of household material hardship, such as food or housing insecurity, for families of young children with leukemia.²

Insurance Status Outweighs Travel Time for Access to Care

Although it is recommended that patients with ALL receive treatment at specialized cancer centers (SCCs), fewer than half of AYAs younger than 18 years actually receive care at these centers.³ Researchers evaluated experiences of 4211 newly diagnosed AYAs with CLL in California, New York, and Texas to understand the association of travel time and health insurance coverage at diagnosis on receiving treatment for ALL at an SCC.

More than half (59.4%) of patients were between 18 and 39 years old, 65.7% were male, and 57.0% were Hispanic. While the proportion of Hispanic patients in New York (32.0%) was less than the proportion in California (62.5%) and Texas (64.6%), the age/sex distribution was similar across all 3 states.

Overall, 54.5% of AYAs were treated at an SCC, but the proportion was significantly less in Texas (27.3%) compared with California (61.5%) and New York (60.9%). Patients in New York were more likely to live 30 minutes or less from an SCC (61.1%), with patients in Texas least likely (46.5%). Patients in Texas were also far more likely to live more than 60 minutes from an SCC (31.8% vs 19.8% in California and 19.0% in New York). However, only 10% of patients treated at non-SCCs were more than 60 minutes from an SCC. New York was the only state where further travel time reduced the likelihood of receiving care at an SCC.

In all 3 states, AYAs lacking insurance were less likely to receive treatment at SCCs. Patients were more likely to be uninsured in Texas (17.8%) compared with California (2.7%) and New York (4.0%). Overall, 47.1% of patients had private health insurance. Compared with private insurance, being uninsured was significantly associated with lower odds of being treated at an SCC.

“Therefore, health policies that have the potential to further reduce insurance access will worsen outcomes for this patient population,” the researchers concluded.

Social Support Linked to Material Hardship in Pediatric ALL Care

The presence of household material hardship is a risk factor for severe parent psychological distress during a child’s cancer treatment. In adult oncology, receiving social support can improve coping, reduce psychological distress, and improve health-related outcomes. Researchers analyzed data from the Children’s Oncology Group trial AALL1731 to collect social determinants of health and examine the association between social support and household material hardship when ALL treatment is initiated.

The study included 1487 participants who were the parents/guardians—mostly mothers (76%)—of children ages 1 to 9 years undergoing treatment for standard-risk B-cell ALL. The participants completed a 75-item survey at 4 time points: at baseline, at the start of maintenance, at the end of therapy, and 1 year after therapy.

Half (52%) of patients were non-Hispanic White, 25% Hispanic, and 7% Black. The majority (81%) preferred English as their primary language. Overall, 31% reported having inadequate social support. The researchers determined through an unadjusted logistic regression that participants with inadequate social support had 4.1 times higher odds of experiencing household material hardship at baseline. After adjusting, inadequate social support was still associated with higher odds of household material hardship.

“These data identify social support as a potential target for interventions to improve parent and child wellbeing,” the researchers wrote.

They noted that they would investigate in the future if social support can protect against financial toxicity and parent psychological distress during treatment.

References

1. Muffly L, Parsons H, Miller K, Luo J, Zhang A, Keegan T. Travel time and insurance status as determinants of specialized leukemia care access in adolescents and young adult (AYA) patients with acute lymphoblastic leukemia (ALL). Presented at: ASH 2025; December 6-9, 2025; Orlando, FL. Abstract 283.

2. Mendez SM, Paul M, Kairalla J, et al. Inadequate social support and household material hardship among children with pediatric acute lymphoblastic leukemia: a report from the Children’s Oncology Group Trial AALL1731. Presented at: ASH 2025; December 6-9, 2025; Orlando, FL. Abstract 132.

3. Muffly LS, Parsons HM, Miller K, Li Q, Brunson A, Keegan TH. Impact of specialized treatment setting on survival in adolescent and young adult ALL. JCO Oncol Pract. 2023;19(12):1190-1198. doi:10.1200/OP.23.00373