Families of pediatric oncology patients vary widely in the use of hospital-based psychosocial support services. In a retrospective case-note analysis, potential predictor variables for use of hospital-based social work services were investigated. Results showed that a negative shift in parental paid employment status occurred for 58% of families, with an average loss of family income of approximately 53%. After controlling for disease and family demographic characteristics, including treatment intensity, the significant predictors for higher use of social work services were the timing of a negative shift in parental employment status relative to confirmation of the diagnosis and the need to obtain welfare services. Furthermore, the families of patients with brain tumors, compared with the families of patients with other solid tumors and leukemias, may have different needs concerning hospital-based psychosocial support, depending on the patient's treatment. The data have important implications for planning services, especially for caseloads that require social work staff to balance welfare-related tasks and other professional psychosocial support activities, such as counseling. © 2004 by The Haworth Press, Inc. All rights reserved.