Childhood Cancer Increases Likelihood of Unemployment as Adult

One out of 6 survivors of childhood cancer was unemployed, according to results from a meta-analysis of 56 studies conducted in the United States, Canada, Asia, and Europe.

Overall, adult survivors of childhood cancer were 1.5 times more likely to be jobless than their peers (odds ratio [OR], 1.48; 95% CI, 1.14-1.93).

Survivors in Europe were more likely to be unemployed than controls (OR, 1.39; 0.97-1.97). The problem was even more acute for survivors from the United States and Canada, who were nearly twice as likely as controls to be unemployed (OR, 1.86; 1.26-2.75). Survivors from Asia were not at increased risk for unemployment (OR, 0.87; 95% CI, 0.42-1.81).

The investigators wrote that more patients are surviving pediatric cancer than ever before but the growing population of adult survivors are at increased risk for late physical sequelae. As many as two-thirds of long-term survivors report at least 1 chronic health impairment, and almost 30% have severe impairments. But many survivors experience impaired psychosocial functioning in adult life, particularly in terms of employment.

“Lower education is of concern regarding survivors’ vocational progress, as it may compromise the ability to engage in competitive working environments,” wrote lead author Luzius Mader, PhD, Danish Cancer Society Research Center, and colleagues. “Survivors encountering educational difficulties might benefit from special education services to minimize disparities compared to controls. The implementation of consistent monitoring of childhood cancer survivors’ vocational progress has been suggested as a standard of care in pediatric oncology.

“Currently, the availability of cancer-specific vocational rehabilitation services is limited. Moreover, existing services for the general population are often not systematically offered to survivors, even though previous studies have shown that more than half of survivors who received state assistance in job search, placement, and maintenance achieved successful employment.”

Mader et al identified 1416 potentially relevant articles and reviewed a total of 56. Twenty-four of the studies were conducted in Europe, 23 were performed in the United States or Canada, and 9 were conducted in Asia. Twenty-seven of the studies were controlled and 29 were uncontrolled. Eighteen studies provided stratified employment data for blood cancer, 15 for central nervous system (CNS) tumor, and 7 for bone tumor/soft tissue sarcoma survivors.

Across all included studies, average age at diagnosis ranged from 2 to 16 years and mean age at study ranged from 18 to 38 years. Men made up 19% to 69% of survivors.

Unemployment rates were similar across regions in controlled studies (Europe, 16%; the United States and Canada, 17%; Asia, 24%). In the uncontrolled studies, unemployment rates were lower in Europe (8%), but higher in the United States and Canada (26%) and Asia (48%).

Investigators found that survivors who had CNS tumors were nearly 5 times more likely to be unemployed compared with controls (OR, 4.62; 95% CI, 2.56-8.31). The odds for unemployment were also higher for blood cancer survivors (OR, 1.35; 95% CI, 0.89-2.06) and bone tumor/soft tissue sarcoma survivors (OR, 1.25; 95% CI, 0.8-1.95), though these findings were not statistically significant. For all diagnostic groups, unemployment was higher in uncontrolled studies compared with controlled studies: CNS tumors (46% vs 27%), blood cancers (27% vs 13%), and bone tumors/soft tissue sarcomas (20% vs 16%).

Sociodemographic predictors for unemployment included female sex, dropping out of school, and lower parental education. Clinical predictors were cranial radiation, stem cell transplantation, and cancer-related late effects, including neurocognitive impairment or hearing loss.

Metaregression in controlled studies showed no association between unemployment and survivors’ age at study (P = .624), age at diagnosis (P = .566), and time since diagnosis (P = .422).

Mader L, Michel G, Roser K. Unemployment following childhood cancer—a systematic review and meta- analysis. Dtsch Arztebl Int. 2017; 114:805-812. doi: 10.3238/arztebl.2017.0805.