Chronic health conditions and employment transition in childhood-cancer survivors 

1. Compared to the general population, survivors of childhood cancer had a greater association with negative employment transition. 

2. There was an association between negative employment transition and chronic health conditions, and individuals with more chronic health conditions had worse transitions.

Evidence Rating Level: 2 (Good) 

Study Rundown: Survival rates for pediatric cancer have been increasing and have even surpassed 85% with more than 500 000 adult survivors living in the United States. Studies in the past have found higher association between childhood cancer survival and unemployment rates, however, this association has not been well understood. With the goal of addressing these gaps in literature, a retrospective cohort study was conducted with a follow-up period of 5 years. To understand the longitudinal changes in employment along with associations to chronic health conditions, participation was limited to those that participated in a cross-sectional analysis and later answered the baseline and follow-up surveys. Self-reported employment included full-time, part-time, unable to work, unemployed and looking for work, or not part of the labour force as categories from the CCSS surveys. A negative employment transition, meaning transitioning from full-time employment at baseline to part-time employment, unemployed, or health-related unemployment at follow-up, was used as the outcome. Outside factors could have affected employment rates, such as economic instability or seasonal employment ultimately leading to a study limitation. Overall, there was an association between employment rates and chronic health conditions in childhood cancer survivors, however, more research on the topic is needed.  

Click here to read the study in JAMA Network Open 

Relevant Reading: Lower prevalence of employment seen for survivors of childhood cancer. 

In-Depth [Retrospective Cohort Study]: A retrospective cohort study evaluated the association between childhood cancer survival and employment rates by enrolling survivors who were diagnosed with cancer at 20 years or younger. Of the participants that responded to both surveys, the median (range) age for female participants was 33 (25-53) years at baseline, and 42 (27-65) years at follow-up. Whereas for the male participants that responded to both the median (range) age at baseline was 33 (25-54) years and at follow-up was 43 (28-64) years. The most commonly presenting cancers at both periods were acute lymphoblastic leukemia, sarcomas, and Hodgkin lymphoma. Full-time and part-time employment prevalence were measured together and found to be 2215 of 3076 (71.3%) and 1933 of 2852 (64.8%) at baseline and follow up respectively for female patients. The same was measured for male patients and found to be 2753 of 3196 (85.3%) and 2079 of 2557 (77.3%) at baseline and follow-up respectively. The standardized prevalence ratios declined for both sexes between measurement periods (female participant baseline, 1.01; 95% CI, 0.98-1.03; follow-up, 0.94; 95% CI, 0.90-0.98; male participant baseline, 0.96; 95% CI, 0.94-0.97; follow-up, 0.92; 95% CI, 0.89-0.95). From the baseline to follow-up periods, health-related unemployment was reported more in women (328 of 3076 [11.6%] to 422 to 2852 [17.2%]) and in men (244 of 3196 [8.1%] to 320 of 2557 [17.1%]). Compared to the regular population, the standardized prevalence ratio for health-related unemployment declined in female (baseline, 3.78; 95 CI, 3.37-4.23; follow-up, 2.23; 95% CI, 1.97-2.51) and male participants (baseline, 3.12; 95% CI, 2.71-3.60; follow-up, 2.61; 95% CI, 2.24-3.03). Of the survivors that had full-time employment, 285 female (21.3%) and 248 male (14.5%) participants had a negative employment transition between baseline and follow-up measurements. Having more chronic health conditions was associated with negative employment transitions among the survived participants. Overall, compared to the general population, there were higher rates of unemployment among childhood-cancer survivors. 

Image: PD

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