BACKGROUND: Young adult cancer survivors report difficulties related to employment. This study investigated the association of vocational services on work in young cancer survivors unemployed prior to receipt of services. METHODS: Administrative data obtained for years 2004 and 2005 from the Rehabilitation Services Administration (RSA) database was used in the analyses. A total of 368 cases aged 18-25 who were closed during the 2 years with a diagnosis of cancer were identified. All cancer survivors were unemployed at the time of application. Data on demographic characteristics, employment and vocational services were extracted and analyzed in relation to employment. Multivariate logistic regression was used to examine the relationship among services provided and work outcomes accounting for demographic characteristics. RESULTS: Cancer survivors represented 0.4% of the total population that received vocational services in the state-federal vocational rehabilitation system. Of the unemployed cancer survivors who received services, 190 (51.6%) achieved successful employment while 178 (48.4%) were not employed following receipt of vocational rehabilitation services. Gender (woman) (OR = 1.79; 95% CI: 1.16 to 2.76), vocational training (OR = 2.03; 95% CI: 1.03 to 4.00), miscellaneous training (OR = 4.01; 95% CI: 1.80 to 8.97), job search assistance (OR = 4.01; 95% CI: 1.80 to 8.97), job placement services (OR = 2.24; 95% CI: 1.11 to 4.52), on-the-job support (OR = 4.20; 95% CI: 1.66 to 10.63), and maintenance services (OR = 2.85; 95% CI: 1.38 to 5.90) were all related to an increased odds for employment. Provision of cash or medical benefits (e.g., Social Security Disability Insurance benefits) (OR = 0.43; 95% CI: 0.28 to 0.67) was associated with lower employment following vocational services. CONCLUSION: Very few young adult cancer survivors were involved in the state-federal rehabilitation program. Despite this, the provision of certain vocational rehabilitation services was related to increased employment in this group. Those who received job search assistance and on the job support were four times more likely to be employed following such services. While those in receipt of benefits were less likely to be employed, it is very likely that those receiving such benefits are the more severe cases. It is worth noting that the exact direction of these relationships can not be determined with the current design. IMPLICATIONS FOR CANCER SURVIVORS: Young adult cancer survivors who are seeking employment and can qualify for such services may benefit from certain services offered by state vocational rehabilitation agencies. This represents another service to consider when employment is a goal.