Huntsman Cancer Institute, University of Utah, Salt Lake City.
Department of Pediatrics, University of Utah, Salt Lake City.
JAMA Oncol. 2018 May 1;4(5):707-711. doi: 10.1001/jamaoncol.2017.3372.
Childhood cancer survivors may be reluctant to make changes in their employment because of access to health insurance.
To examine the prevalence of "job lock" (staying at a job to keep work-related health insurance) in a sample drawn from an established, multi-institutional cohort of full-time employed childhood cancer survivors compared with a random sample of siblings and to explore factors associated with job lock among cancer survivors.
DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional survey of full-time employed adult survivors of childhood cancer and a random sample of siblings derived from a cohort of 25 US pediatric oncology centers.
Data collection included sociodemographic factors, insurance coverage, chronic medical conditions, and treatment.
Self-report of job lock and factors associated with job lock.
Among the 522 participants, 394 were cancer survivors (54.5% male) and 128 were siblings (51.5% male). Job lock was reported by 23.2% (95% CI, 18.9%-28.1%) of survivors, compared with 16.9% (95% CI, 11.1%-25.0%) of siblings (P = .16). Job lock was more common among survivors reporting previous health insurance denial (relative risk [RR], 1.60; 95% CI, 1.03-2.52) and problems paying medical bills (RR, 2.43; 95% CI, 1.56-3.80). Among survivors, being female (RR, 1.70; 95% CI, 1.11-2.59; P = .01) and having a severe, disabling, or life-threatening health condition (RR, 1.72; 95% CI, 1.09-2.69; P = .02) were associated with job lock.
Job lock is common among long-term childhood cancer survivors who are employed full-time. A survivor's decision to remain employed at a job in order to maintain health insurance coverage may affect career trajectory, diminish potential earning power, and ultimately impact quality of life.
儿童癌症幸存者可能不愿意改变他们的就业状况，因为他们担心无法获得医疗保险。
在一个由 25 个美国儿科肿瘤中心组成的多机构队列中抽取的全职就业儿童癌症幸存者样本中，与随机抽取的兄弟姐妹样本相比，检查“工作锁定”（为了保留与工作相关的健康保险而留在工作岗位上）的流行率，并探讨与癌症幸存者工作锁定相关的因素。
设计、地点和参与者：对来自 25 个美国儿科肿瘤中心队列的全职就业成年癌症幸存者和随机抽取的兄弟姐妹进行横断面调查。
数据收集包括社会人口统计学因素、保险覆盖范围、慢性医疗状况和治疗情况。
自我报告的工作锁定情况以及与工作锁定相关的因素。
在 522 名参与者中，有 394 名是癌症幸存者（54.5%为男性），128 名是兄弟姐妹（51.5%为男性）。报告工作锁定的幸存者占 23.2%（95%置信区间，18.9%-28.1%），而兄弟姐妹占 16.9%（95%置信区间，11.1%-25.0%）（P = .16）。报告以前医疗保险被拒绝（相对风险 [RR]，1.60；95%置信区间，1.03-2.52）和医疗账单支付问题（RR，2.43；95%置信区间，1.56-3.80）的幸存者工作锁定更为常见。在幸存者中，女性（RR，1.70；95%置信区间，1.11-2.59；P = .01）和患有严重、致残或危及生命的健康状况（RR，1.72；95%置信区间，1.09-2.69；P = .02）与工作锁定相关。
全职就业的长期儿童癌症幸存者中，工作锁定很常见。幸存者为了维持健康保险而决定继续留在工作岗位上的决定可能会影响职业轨迹、降低潜在收入能力，并最终影响生活质量。
