The Department of Oncology, Hadassah-Hebrew University Medical Center and Hebrew University-Hadassah Medical School, 91120, Jerusalem, Israel.
Coronel Institute of Occupational Health, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
J Cancer Surviv. 2020 Apr;14(2):151-157. doi: 10.1007/s11764-020-00858-y. Epub 2020 Feb 14.
To clarify the association between cancer diagnosis and subsequent risk of being unemployed at 10 years after diagnosis among very long-term survivors.
A historical cohort study using prospectively collected data was done which included baseline measurements from the Israeli national census. Only patients who were 50 years old or younger at the time of diagnosis were included in the current study. Binary logistic regression analyses were used to assess odds ratios for unemployment at 10 years following diagnosis, while controlling for socioeconomic measurements and employment status at 2 years prior to diagnosis.
The final study population included 2493 patients who were diagnosed with cancer and 7360 persons without a history of cancer, after excluding individuals who died before the end of 2015. After controlling for confounders, positive associations were found between cancer and increased risk for unemployment at 10 years (OR = 1.31, 95% CI 1.17-1.47). Analysis by cancer type revealed that patients who were diagnosed with CNS malignancies (OR = 2.71, 95% CI 1.80-4.07), followed by patients who were diagnosed with lymphoma (OR = 1.66, 95% CI 1.16-1.28) showed the greatest magnitude of effect, while the association between unemployment at 10 years following diagnosis and breast cancer was found to weaken and actually lose significance (adjusted OR = 1.22, 95% CI 0.99-1.50).
Cancer survivors have an increased risk for long-term unemployment among very long-term survivors, mainly among patients diagnosed with CNS malignancies and lymphoma.
The current study emphasizes the need for tailored intervention in order to mitigate the long-term risk of unemployment.
明确癌症诊断与诊断后 10 年失业风险之间的关联，研究对象为超长生存期幸存者。
本研究采用历史队列研究设计，数据来自以色列全国人口普查的前瞻性收集。仅纳入诊断时年龄在 50 岁及以下的患者。采用二元逻辑回归分析评估诊断后 10 年失业的比值比，同时控制诊断前 2 年的社会经济测量值和就业状况。
排除在 2015 年底前死亡的个体后，最终研究人群包括 2493 例癌症患者和 7360 例无癌症病史的个体。在控制混杂因素后，癌症与诊断后 10 年失业风险增加呈正相关（比值比=1.31，95%置信区间 1.17-1.47）。按癌症类型分析显示，诊断为中枢神经系统恶性肿瘤的患者（比值比=2.71，95%置信区间 1.80-4.07）和诊断为淋巴瘤的患者（比值比=1.66，95%置信区间 1.16-1.28）的失业风险最高，而诊断为乳腺癌的患者的失业风险在诊断后 10 年呈下降趋势，实际上丧失了统计学意义（调整后的比值比=1.22，95%置信区间 0.99-1.50）。
癌症幸存者在超长生存期幸存者中存在长期失业的风险增加，主要发生在诊断为中枢神经系统恶性肿瘤和淋巴瘤的患者中。
本研究强调需要进行有针对性的干预，以减轻长期失业风险。
