Background Insomnia, the most commonly reported sleep wake disturbance in people with cancer, has an adverse affect on quality of life including emotional well being, distress associated with other symptoms, daily functioning, relationships and ability to work. Objective The aim of this study was to describe the content of discussions between clinicians and 120 patients with self-reported insomnia and to examine the associations of socio-demographic, clinical and environmental factors with insomnia. Interventions/Methods A secondary analysis was conducted with self reported symptom data, socio- demographic, clinical and environmental factors. Recordings of clinician and patient discussions during clinic visits were examined by conducting a content analysis. Results Severe insomnia was more likely to be reported by women, minority and lower income individuals. Seven major topics were identified in the discussions. The clinicians did not always discuss insomnia; discussion rates differed by diagnosis and clinical service. Conclusions Reporting of insomnia by the patient and clinician communication about insomnia may have differed by demographic and clinical characteristics. Clinicians attended to insomnia about half the time with management strategies likely to be effective. Explanations may be that insomnia had a low clinician priority for the clinic visit or lack of clear evidence to support insomnia interventions. Implications for Practice A better understanding is needed about why insomnia is not addressed even when reported by patients; it is well known that structured assessments and early interventions can improve quality of life. Research is warranted to better understand potential disparities in cancer care.