Employment status and occupational level of adult survivors of childhood cancer in Great Britain: The British childhood cancer survivor study

Abstract

The British Childhood Cancer Survivor Study (BCCSS) provides the first detailed investigation of employment and occupation to be undertaken in a large population‐based cohort. Previous studies have been limited by design issues such as using small numbers of survivors with specific diagnoses, and involved limited assessment of employment status and occupational level. The BCCSS includes 17,981 5‐year survivors of childhood cancer. Employment status and occupational level were ascertained by questionnaire from eligible survivors (n = 14,836). Multivariate logistic regression was used to explore factors associated with employment and occupation, and to compare survivors to their demographic peers in the general population. Employment status was available for 10,257 survivors. Gender, current age, cancer type, radiotherapy, age at diagnosis and epilepsy were consistently associated with being: employed; unable to work; in managerial or non‐manual occupations. Overall, survivors were less likely to be working than expected (OR (99% CI): 0.89 (0.81–0.98)), and this deficit was greatest for irradiated CNS neoplasm survivors (0.34 (0.28–0.41)). Compared to the general population, survivors were fivefold more likely to be unable to work due to illness/disability; the excess was 15‐fold among CNS neoplasm survivors treated with radiotherapy. Overall survivors were less likely to be in managerial occupations than expected (0.85 (0.77–0.94)). However, bone sarcoma survivors were more likely to be in these occupations than expected (1.37 (1.01–1.85)) and also similarly for non‐manual occupations (1.90 (1.37–2.62)). Survivors of retinoblastoma (1.55 (1.20–2.01)) and ‘other’ neoplasm group (1.62 (1.30–2.03)) were also more likely to be in non‐manual occupations than expected.

Surviving childhood cancer: a systematic review of studies on risk and determinants of adverse socioeconomic outcomes

“…Studies of the employment status of survivors of a broad range of childhood cancers in comparison with the general population or sibling comparisons had inconsistent findings . Seven studies observed higher unemployment rates among survivors, whereas five studies found similar unemployment rates . Studies with stratification by type of unemployment found that survivors were more likely to be unemployed due to illness or disability .…”

“…Seven studies observed higher unemployment rates among survivors, whereas five studies found similar unemployment rates . Studies with stratification by type of unemployment found that survivors were more likely to be unemployed due to illness or disability . A study in North America reported that survivors were six times more likely to be unemployed for health reasons than their siblings (10.4% vs .…”

Post‐transplantation employment status of adult survivors of childhood allogeneic hematopoietic cell transplant: A report from the Center for International Blood and Marrow Transplant Research (CIBMTR)

“…Additionally, TBI has a known association with debilitating long-term complications such as endocrinopathies, and end-organ damage 18 . Similarly, the studies focusing on cancer survivors have consistently shown negative effects of radiation, especially cranial radiotherapy on employment outcomes 13–15 . Cranial radiation has also been shown to affect educational outcomes in long-term survivors of childhood cancer 19 .…”

“…Previous studies focusing on employment outcomes in adult survivors of childhood cancer who did not undergo HCT have also shown that younger age at diagnosis was associated with decreased likelihood of being employed. Frobisher and colleagues studied the employment and occupational status of pediatric cancer survivors using the British Childhood Cancer Survivorship Study (BCCSS) 13 . Compared to the general population, survivors were less likely to be employed.…”

“…A few single-center studies have assessed the employment outcomes in adult survivors of childhood HCT, and have consistently shown higher unemployment rates in survivors compared to the general population or sibling controls 11, 12 . Studies focusing on adult survivors of childhood cancer who did not receive alloHCT have also shown higher unemployment rates in survivors compared to the controls 13–15 .…”