Childhood survivors’ poor health leads to higher unemployment

Childhood cancer survivors with poor physical health and neurocognitive deficits are more likely to be unemployed or work part time in adulthood, according to a study published Aug. 15 online in Cancer Epidemiology, Biomarkers & Prevention.

Corresponding author Dr. Anne Kirchhoff was a Hutchinson Center postdoctoral research fellow when the study was conducted, working with Dr. Wendy Leisenring of the Clinical Research Division, senior author of the study.

Key findings were:
• Poor health of childhood cancer survivors led to an eightfold higher risk for unemployment.
• Those with neurocognitive deficits were less likely to hold professional positions and more likely to hold part-time jobs.
• Neurocognitive limitations affected women’s occupation status more than men’s.

 “We know from earlier studies that childhood cancer survivors are more likely to be unemployed compared to unaffected samples. Our research points to factors such as physical health limitations that may be important to address to improve employment outcomes in this population,” said Kirchhoff, who is now a Huntsman Cancer Institute investigator and an assistant professor of pediatrics at the University of Utah School of Medicine.

While at the Center, Kirchhoff was on the Biobehavioral and Cancer Prevention and Control Training Grant of Dr. Donald Patrick of the Public Health Sciences Division and University of Washington Health Services Department. Kirchhoff previously examined similar employment issues among hematopoietic transplant survivors with Dr. Karen Syrjala in the Biobehavioral Sciences Department of Clinical Research.

Data for this study came from the Childhood Cancer Survivor Study (CCSS), a multi-institutional, NCI-funded, cohort study. The statistical center for CCSS is directed by Leisenring and resides in the PHS Cancer Prevention Program; the coordinating center is at St Jude Children’s Research Hospital. Kirchhoff and colleagues examined data from 5,836 adult childhood cancer survivors from CCSS who were aged 25 years and older to determine how their physical, mental and neurocognitive function affected their employment and occupational status.

Poor physical health = higher unemployment

Childhood cancer survivors in poor physical health as defined by standard questionnaires were approximately eight times more likely to be unemployed in adulthood compared with adult cancer survivors in good health, according to the study.

“Although mental health and neurocognitive limitations were also linked to unemployment, it was surprising that physical deficits were such a major factor for childhood cancer survivors who were unable to work due to their poor health status,” Kirchhoff said. 

Lower-skilled occupations

Among employed survivors, those with neurocognitive limitations were less likely to hold professional positions and more likely to hold part-time or lower-skilled jobs, according to the researchers. Women with neurocognitive limitations, such as task-efficiency issues, were more likely to be working in lower-skilled occupations than men with the same neurocognitive deficits.

In addition, Kirchhoff and colleagues stressed that changes in employment status could affect survivors’ access to health insurance coverage, which is essential to managing any long-term complications from cancer. 

“Childhood cancer survivors should be educated about the risks, be screened for any limitations, and learn strategies to manage those limitations in an effort to ensure they have more successful employment outcomes,” she said.

[Adapted from an American Association for Cancer Research news release]