Making Decisions or Enacting Shoulder Care? Challenging Assumptions About Matters of Concern in the Orthopaedic Shoulder Clinic.

Children diagnosed with cancer have experienced improved survival rates over time, with more than three-fourths becoming long-term survivors (; ). Survivors of childhood cancer often face new and continued health care challenges and require ongoing care to monitor and treat the long-term effects of their cancer and treatment (; ). Late effects may include new cancers, cardiac complications, reproductive issues, cognitive deficits, liver dysfunction, and other physical and psychosocial sequelae (). These late effects often appear decades later and can be severe or life-threatening (). Ongoing medical treatment and surveillance, with access to quality health care and insurance coverage, are critical. The United States (U.S.) health insurance system is complicated, varies in quality, and can be confusing for childhood cancer survivors. Even with the expanded options for insurance coverage under the Affordable Care Act (ACA), gaps in quality and coverage remain. Childhood cancer survivors have higher rates of uninsurance, unmet health care needs, and burdensome costs (; ; ; ; ; , ; ; ; ; ). Childhood survivors are also at high risk for job lock (; ). A recent systematic review demonstrated childhood survivors’ social and socioeconomic difficulties, compared to unaffected peers (). Survivors and siblings have similar rates of insurance coverage, yet they differ by types of coverage and experiences obtaining coverage (). Financial and health insurance disparities exist by race/ethnicity, which moderates the relationship between health insurance coverage and stage at diagnosis, and overall survival (). Health insurance disparities have persisted beyond the implementation of the ACA ().