age standards should be promulgated for effective cancer survivorship care, and must include interventions for which there is good evidence of effectiveness (e.g., certain post-treatment surveillance strategies, treatments for late effects, management of symptoms, rehabilitative services). Importantly, coverage standards should include the development of a post-treatment survivorship care plan (see Chapter 3, Recommendation 2). National coverage standards should evolve with the development of clinical guidelines and evidence-based research into quality and effectiveness, and provide adequate reimbursement for quality care provided by cancer centers as well as specialists and primary care providers in communities. The application of cost-sharing requirements to cancer survivorship care must be limited so that financial barriers do not deter access to covered services. Congress has already taken preliminary steps to assure adequacy of some cancer survivorship care. The Women’s Health and Cancer Rights Act requires health insurance to cover reconstructive surgery, prostheses, and care for complications following mastectomy, including lymphedema. This model could be expanded to assure minimum federal standards for all cancer survivorship care under all health insurance.
Information on the health insurance status of cancer survivors ages 25 to 64 is based on analyses of 4 years of NHIS data (2000 through 2003) (NCHS, 2002, 2003a,b, 2004). The NHIS is a multipurpose health survey conducted by the National Center for Health Statistics, Centers for Disease Control and Prevention. The NHIS is the principal source of information on the health of the civilian, noninstitutionalized, household population of the United States. Analyses were limited to the adult sample component of the survey. Sample sizes and response rates for the sample adult component are shown by year in Table 6A-1.
Computer-assisted personal interviews are conducted in the homes of respondents. The data collected in the NHIS are obtained through a complex sample design involving stratification, clustering, and multistage sampling. African Americans and Hispanics/Latinos are oversampled. All pro-