Occupational outcomes of adult childhood cancer survivors: A report from the childhood cancer survivor study

Abstract

Background: The authors examined whether survivors from the Childhood Cancer Survivor Study were less likely to be in higher-skill occupations than a sibling comparison and whether certain survivors were at higher risk for lower-skill jobs.

Methods: The authors created 3 mutually exclusive occupational categories for participants aged ≥ 25 years: Managerial/Professional, Nonphysical Service/Blue Collar, and Physical Service/Blue Collar. The authors examined currently employed survivors (4845) and their siblings (1727) in multivariable generalized linear models to evaluate the likelihood of being in 1 of the 3 occupational categories. Multinomial logistic regression was used among all participants to examine the likelihood of these outcomes compared to being unemployed (survivors, 6671; siblings, 2129). Multivariable linear models were used to assess survivor occupational differences by cancer- and treatment-related variables. Personal income was compared by occupation.

Results: Employed survivors were less often in higher-skilled Managerial/Professional occupations (relative risk, 0.93; 95% confidence interval 0.89-0.98) than their siblings. Survivors who were black, were diagnosed at a younger age, or had high-dose cranial radiation were less likely to hold Managerial/Professional occupations than other survivors. In multinomial models, female survivors' likelihood of being in full-time Managerial/Professional occupations (27%) was lower than male survivors (42%) and female (41%) and male (50%) siblings. Survivors' personal income was lower than siblings within each of the 3 occupational categories in models adjusted for sociodemographic variables.

Conclusions: Adult childhood cancer survivors are employed in lower-skill jobs than siblings. Survivors with certain treatment histories are at higher risk for lower-skill jobs and may require vocational assistance throughout adulthood.

Figure 1. Distribution of jobs among survivors and siblings by occupation

* N=4845 survivors and N=1727 siblings who were currently employed; Professional: N=2589 survivors and N=1026 siblings; Non-Physical N=1787 survivors and N=551 siblings; Physical N=469 survivors and N=150 siblings ^†The proportions reporting specific Professional jobs did not differ significantly between survivors and siblings. ^‡The proportion of survivors and siblings reporting Non-Physical work was significantly different for this job. ^§The proportion of survivors and siblings reporting Physical work was significantly different for this job.

Figure 2. Predicted probabilities of occupational status for survivors and siblings by sex*

*Survivors (N=6662) and siblings (N=2072); estimates adjusted for current age and race and an interaction for survivor status by sex. Unemployment does not include full or part-time status.

Figure 3. Predicted probabilities yearly personal income by occupation for survivors vs. siblings

*Income category difference significant at p<0.05; models adjusted for sex, age, race, marital status and full- or part-time employment status