Fred Hutchinson Cancer Center, Seattle, Washington.
University of Washington School of Medicine, Seattle.
JAMA Netw Open. 2024 May 1;7(5):e2410731. doi: 10.1001/jamanetworkopen.2024.10731.
Employment is an important factor in quality of life and provides social and economic support. Longitudinal data on employment and associations with chronic health conditions for adult survivors of childhood cancer are lacking.
To evaluate longitudinal trends in employment among survivors of childhood cancer.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of 5-year cancer survivors diagnosed at age 20 years or younger between 1970 and 1986 enrolled in the multi-institutional Childhood Cancer Survivor Study (CCSS). Sex-stratified employment status at baseline (2002 to 2004) and follow-up (2014 to 2016) was compared with general population rates from the Behavioral Risk Factor Surveillance System cohort. Data were analyzed from July 2021 to June 2022.
Cancer therapy and preexisting and newly developed chronic health conditions.
Standardized prevalence ratios of employment (full-time or part-time, health-related unemployment, unemployed, not in labor force) among adult (aged ≥25 years) survivors between baseline and follow-up compared with the general population. Longitudinal assessment of negative employment transitions (full-time to part-time or unemployed at follow-up).
Female participants (3076 participants at baseline; 2852 at follow-up) were a median (range) age of 33 (25-53) years at baseline and 42 (27-65) years at follow-up; male participants (3196 participants at baseline; 2557 at follow-up) were 33 (25-54) and 43 (28-64) years, respectively. The prevalence of full-time or part-time employment at baseline and follow-up was 2215 of 3076 (71.3%) and 1933 of 2852 (64.8%) for female participants and 2753 of 3196 (85.3%) and 2079 of 2557 (77.3%) for male participants, respectively, with declining standardized prevalence ratios over time (female participant baseline, 1.01; 95% CI, 0.98-1.03; follow-up, 0.94; 95% CI, 0.90-0.98; P < .001; male participant baseline, 0.96; 95% CI, 0.94-0.97; follow-up, 0.92; 95% CI, 0.89-0.95; P = .02). While the prevalence of health-related unemployment increased (female participants, 11.6% to 17.2%; male participants, 8.1% to 17.1%), the standardized prevalence ratio remained higher than the general population and declined over time (female participant baseline, 3.78; 95% CI, 3.37-4.23; follow-up, 2.23; 95% CI, 1.97-2.51; P < .001; male participant baseline, 3.12; 95% CI, 2.71-3.60; follow-up, 2.61; 95% CI, 2.24-3.03; P = .002). Among survivors employed full-time at baseline (1488 female participants; 1933 male participants), 285 female participants (19.2%) and 248 male participants (12.8%) experienced a negative employment transition (median [range] follow-up, 11.5 [9.4-13.8] years). Higher numbers and grades of chronic health conditions were significantly associated with these transitions.
In this retrospective analysis of adult survivors of childhood cancer, significant declines in employment and increases in health-related unemployment among cancer survivors compared with the general population were identified. A substantial portion of survivors in the midcareer age range fell out of the workforce. Awareness among clinicians, caregivers, and employers may facilitate clinical counseling and occupational provisions for supportive work accommodations.
就业是生活质量的一个重要因素，提供了社会和经济支持。缺乏关于儿童癌症幸存者的纵向就业数据及其与慢性健康状况的关联。
评估儿童癌症幸存者的就业纵向趋势。
设计、地点和参与者：这是一项回顾性队列研究，纳入了 1970 年至 1986 年间诊断为 20 岁或以下的多机构儿童癌症幸存者研究（CCSS）的 5 年癌症幸存者。将基线（2002 年至 2004 年）和随访（2014 年至 2016 年）时按性别分层的就业状况与行为风险因素监测系统队列中的一般人群率进行比较。数据分析于 2021 年 7 月至 2022 年 6 月进行。
癌症治疗以及新出现的慢性健康状况。
在基线和随访时，与一般人群相比，成年（≥25 岁）幸存者的就业（全职或兼职、与健康相关的失业、失业、未就业）的标准化流行率比值。对负向就业转型（随访时全职转为兼职或失业）进行纵向评估。
女性参与者（基线 3076 人，随访 2852 人）的中位（范围）年龄为基线时 33 岁（25-53 岁），随访时 42 岁（27-65 岁）；男性参与者（基线 3196 人，随访 2557 人）分别为 33 岁（25-54 岁）和 43 岁（28-64 岁）。基线和随访时女性参与者全职或兼职就业的比例分别为 2215 例（3076 例）和 1933 例（2852 例），男性参与者的比例分别为 2753 例（3196 例）和 2079 例（2557 例），随着时间的推移，标准化流行率比值逐渐下降（女性参与者基线为 1.01；95%置信区间，0.98-1.03；随访为 0.94；95%置信区间，0.90-0.98；P<0.001；男性参与者基线为 0.96；95%置信区间，0.94-0.97；随访为 0.92；95%置信区间，0.89-0.95；P=0.02）。尽管与健康相关的失业比例增加（女性参与者为 11.6%至 17.2%；男性参与者为 8.1%至 17.1%），但标准化流行率比值仍高于一般人群，且随时间推移而下降（女性参与者基线为 3.78；95%置信区间，3.37-4.23；随访为 2.23；95%置信区间，1.97-2.51；P<0.001；男性参与者基线为 3.12；95%置信区间，2.71-3.60；随访为 2.61；95%置信区间，2.24-3.03；P=0.002）。在基线时全职就业的幸存者中（女性参与者 1488 人，男性参与者 1933 人），285 名女性参与者（19.2%）和 248 名男性参与者（12.8%）经历了负向就业转型（中位数[范围]随访期，11.5[9.4-13.8]年）。更多的慢性健康状况数量和等级与这些转型显著相关。
在这项对儿童癌症幸存者的回顾性分析中，与一般人群相比，癌症幸存者的就业显著下降，与健康相关的失业增加。相当一部分处于职业生涯中期的幸存者离开了劳动力市场。临床医生、护理人员和雇主的认识可能有助于为临床咨询和职业提供支持性工作安排。
