Strauser David, Klosky James L, Brinkman Tara M, Wong Alex W K, Chan Fong, Lanctot Jennifer, Ojha Rohit P, Robison Leslie L, Hudson Melissa M, Ness Kirsten K
University of Illinois Urbana-Champaign, Champaign, IL, USA,
J Cancer Surviv. 2015 Mar;9(1):20-9. doi: 10.1007/s11764-014-0380-4. Epub 2014 Jul 22.
Adult survivors of childhood cancer experience difficulties in obtaining and maintaining employment. Employment-related challenges are associated with treatment-related health conditions and may also be related to vocational factors such as career readiness, skill acquisition, and work experience. Unfortunately, little is known about how treatment-, health-, and vocational-related factors interact to impact career development among childhood cancer survivors.
Three hundred eighty-five adult survivors of childhood cancer (42.1% male, median age 38 years (21-62)), participating in the St. Jude Lifetime Cohort Study, completed a work experiences survey that included measures of career readiness and vocational identity. Logistic regression was used to compare characteristics of survivors in the low career readiness category to those in the medium or high career readiness category, and structural equation modeling (SEM) was utilized to evaluate associations between career readiness, vocational identity, treatment intensity, and physical/emotional health.
Low career readiness was prevalent in 17.4% of survivors. Univariate analysis did not identify any significant associations between cancer treatment-related factors and career readiness. Unemployed survivors (odds ratio (OR) 2.3, 95% confidence interval (CI) 1.2-4.5), those who were not college graduates (OR 3.0, 95% CI 1.6-5.6), and those who had no personal income (OR 5.9, 95% CI 1.7-30.9) were at increased risk of low career readiness. SEM indicated that associations between treatment intensity, physical health, age at diagnosis, and career readiness were mediated by emotional health and vocational identity. Sixty-three, 35, and 10% of the variance in career readiness, vocational identity, and emotional health, respectively, were explained by this theoretical model.
The results of this study indicate that individuals who reported low levels of career readiness were more likely to be unemployed and earn less than US$40,000 per year and were less likely to graduate from high school. The final structural model indicates that vocational identity and emotional health accounted for the indirect effect of treatment intensity, age at diagnosis, and physical health on career readiness.
Addressing career readiness may be important to improve employment outcomes for adult survivors of childhood cancer.
儿童癌症成年幸存者在获得和维持就业方面存在困难。与就业相关的挑战与治疗相关的健康状况有关，也可能与职业因素有关，如职业准备、技能获取和工作经验。不幸的是，对于治疗、健康和职业相关因素如何相互作用以影响儿童癌症幸存者的职业发展，人们知之甚少。
385名儿童癌症成年幸存者（男性占42.1%，中位年龄38岁（21 - 62岁））参与了圣裘德终身队列研究，完成了一项工作经历调查，其中包括职业准备和职业认同的测量。使用逻辑回归比较低职业准备组与中等或高职业准备组幸存者的特征，并利用结构方程模型（SEM）评估职业准备、职业认同、治疗强度和身体/情绪健康之间的关联。
17.4%的幸存者职业准备水平较低。单因素分析未发现癌症治疗相关因素与职业准备之间存在任何显著关联。失业的幸存者（优势比（OR）2.3，95%置信区间（CI）1.2 - 4.5）、非大学毕业生（OR 3.0，95% CI 1.6 - 5.6）以及没有个人收入的幸存者（OR 5.9，95% CI 1.7 - 30.9）职业准备水平低的风险增加。结构方程模型表明，治疗强度、身体健康、诊断年龄与职业准备之间的关联由情绪健康和职业认同介导。该理论模型分别解释了职业准备、职业认同和情绪健康中63%、35%和10%的方差。
本研究结果表明，报告职业准备水平低的个体更有可能失业，年收入低于4万美元，且高中毕业的可能性较小。最终的结构模型表明，职业认同和情绪健康解释了治疗强度、诊断年龄和身体健康对职业准备的间接影响。
解决职业准备问题对于改善儿童癌症成年幸存者的就业结果可能很重要。
