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Employment status among adult survivors in the Childhood Cancer Survivor Study

Authors

  • Jenny W.Y. Pang MD, MPH,

    1. University of Washington School of Public Health and Community Medicine, Department of Epidemiology, Seattle, Washington
    2. University of Washington, Department of Pediatrics, Seattle, Washington
    3. Seattle-King County Public Health, Public Health Prevention, Seattle, Washington
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  • Debra L. Friedman MD, MS,

    Corresponding author
    1. University of Washington, Department of Pediatrics, Seattle, Washington
    2. Fred Hutchinson Cancer Research Center, Seattle, Washington
    • Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, PO Box 19024, Mailstop D5-280, Seattle, WA 98109.
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  • John A. Whitton MS,

    1. Fred Hutchinson Cancer Research Center, Seattle, Washington
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  • Marilyn Stovall PhD,

    1. University of Texas, MD Anderson Cancer Center, Houston, Texas
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  • Ann C. Mertens PhD,

    1. University of Minnesota, Department of Pediatrics, Minneapolis, Minnesota
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  • Leslie L. Robison PhD,

    1. St. Jude Children's Research Hospital, Department of Epidemiology and Cancer Control, Memphis, Tennessee
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  • Noel S. Weiss MD, Dr PH

    1. University of Washington School of Public Health and Community Medicine, Department of Epidemiology, Seattle, Washington
    2. Fred Hutchinson Cancer Research Center, Seattle, Washington
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  • Jenny W.Y. Pang, Debra L. Friedman contributed equally to this manuscript.

Abstract

Background

With increased cure, childhood cancer survivors are reaching adulthood and seeking employment. Host, disease and treatment risk factors may contribute to inability to attain or maintain employment.

Procedure

The prevalence and risk factors for unemployment were evaluated using self-reported employment history in 10,399 childhood cancer survivors and 3,083 siblings ≥ age 18 in the Childhood Cancer Survivor Study (CCSS).

Results

Among survivors, 5.6% reported unemployment, compared with 1.2% of siblings (odds ratio [OR] 3.7; 95% confidence interval [CI] 2.6, 5.1). Increased risks were observed within all cancer diagnoses. In multivariate analysis, diagnosis of central nervous system (CNS) tumor (OR 1.5; 95% CI 1.1, 2.1), bone cancer (OR 1.5; 95% CI 1.0, 2.1), treatment with ≥30 Gy cranial radiotherapy (OR 4.0; 95% CI 2.9, 5.5), female gender (OR 1.4; 95% CI 1.2, 1.7) and age < 4 years at diagnosis (OR 1.4; 95% CI 1.1, 1.8) increased risk. Diagnosis of CNS or bone tumor or cranial radiotherapy ≥30 Gy remained significant after adjusting for treatment, medical late effects, age and gender. Risk of unemployment decreased with attained age (OR(year) 0.89; 95% CI 0.87, 0.91).

Conclusions

Compared to siblings, adult childhood cancer survivors are at increased risk for unemployment with highest risk defined by diagnosis, treatment and demographic factors. Pediatr Blood Cancer 2008;50:104–110. © 2007 Wiley-Liss, Inc.

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