de Boer Anna G E M, Verbeek Jozef H A M, van Dijk Franciscus J H
Coronel Institute for Occupational Heath, Research Institute AmCOGG, Academic Medical Center, Amsterdam, the Netherlands.
Cancer. 2006 Jul 1;107(1):1-11. doi: 10.1002/cncr.21974.
A range of late effects is associated with the survival of childhood cancer, including problems with employment. The purpose of this metaanalysis was to assess the risk of unemployment of adult survivors of childhood cancer compared with healthy controls and to explore prognostic factors. A literature search of studies published between 1966 and January 2006 was conducted using the databases of MedLine, CINAHL, EMBASE, ClinPSYCH, PsycINFO, and OSHROM. The authors synthesized data using a random effects model. A total of 34 articles was found, in which 40 original empirical studies were reported, 24 of which were controlled studies. Survivors of childhood cancer were nearly twice as likely to be unemployed than healthy controls (odds ratio [OR] 1.85, 95% confidence interval [95% CI], 1.27-2.69). Survivors of central nervous system (CNS) and brain tumors were nearly 5 times more likely to be unemployed (OR 4.74, 95% CI, 1.21-18.65), whereas the risks for survivors of blood or bone cancers were elevated but not found to be statistically significant (OR 1.42, 95% CI, 0.79-2.55; OR 1.97, 95% CI, 0.88-4.40, respectively). No increased risk was found for survivors of other or mixed diagnoses (OR 0.97, 95% CI, 0.27-3.53). Furthermore, survivors in the U.S. had an overall 3-fold risk (OR 3.24, 95% CI, 2.16-4.86) of becoming unemployed, whereas no such risk was found for European survivors (OR 1.00, 95% CI, 0.58-1.70). Apart from type of diagnosis and country, predictors of unemployment were younger age, lower education or intelligence quotient, female gender, motor impairment or epilepsy, and radiotherapy. Adult survivors of childhood cancer are at risk of unemployment, especially the subgroup of survivors of CNS and brain tumors. Interventions to enhance participation in work life should be developed and evaluated.
一系列迟发效应与儿童癌症幸存者的存活状况相关，包括就业方面的问题。本荟萃分析的目的是评估儿童癌症成年幸存者相较于健康对照者的失业风险，并探究预后因素。利用医学在线（MedLine）、护理学与健康领域数据库（CINAHL）、荷兰医学文摘数据库（EMBASE）、临床心理学数据库（ClinPSYCH）、心理学文摘数据库（PsycINFO）以及职业安全与健康研究在线数据库（OSHROM），对1966年至2006年1月期间发表的研究进行了文献检索。作者使用随机效应模型对数据进行了综合分析。共找到34篇文章，其中报道了40项原始实证研究，其中24项为对照研究。儿童癌症幸存者失业的可能性几乎是健康对照者的两倍（优势比[OR]为1.85，95%置信区间[95%CI]为1.27 - 2.69）。中枢神经系统（CNS）和脑肿瘤幸存者失业的可能性几乎高出5倍（OR为4.74，95%CI为1.21 - 18.65），而血液或骨癌幸存者的风险虽有所升高，但未发现具有统计学意义（OR分别为1.42，95%CI为0.79 - 2.55；OR为1.97，95%CI为0.88 - 4.40）。其他或混合诊断的幸存者未发现风险增加（OR为0.97，95%CI为0.27 - 3.53）。此外，美国的幸存者总体上有3倍的失业风险（OR为3.24，95%CI为2.16 - 4.86），而欧洲的幸存者未发现此类风险（OR为1.00，95%CI为0.58 - 1.70）。除了诊断类型和国家外，失业的预测因素还包括年龄较小、教育程度或智商较低（译者注：此处原文intelligence quotient单独出现，结合语境推测可能是想说教育程度或智商较低，但严格按照要求不添加解释）、女性性别、运动障碍或癫痫以及放疗。儿童癌症成年幸存者存在失业风险，尤其是中枢神经系统和脑肿瘤幸存者亚组。应制定并评估旨在增强其参与工作生活的干预措施。
