Table 4.
Impact of cancer on employment outcomes in adolescent and young adult (AYA) cancer survivors.
| First Author, Publication Year | Measurements for Employment Outcomes | Employment Outcomes | Determinants for Adverse Employment Outcomes (Quantitative Studies) or Selected Citations (Qualitative Studies, Indicated in Italics) |
|---|---|---|---|
| Bhatt et al., 2021 [30] | Employment status | Employment status: The percentage of full-time employed survivors was lower 6 months after HCT treatment than before treatment, whereas the rates for part-time employment, unemployment, or medical disability were higher 6 months after treatment than before treatment. Before treatment: full-time 43%, part-time 4%, unemployed 19%, medical disability 16%, unknown 17% 6 months after treatment: full-time 18.3%, part-time 6.9%, unemployed 38.2%, medical disability 36.6%, unknown 0% |
Time after treatment: The percentages of survivors working full- or part-time increased with time after treatment (full-time: from 18.3% at 6 months to 50.7% at 3 years; part-time: from 6.9% at 6 months to 10.5% at 3 years). The percentages for unemployment and medical disability decreased over time after treatment (unemployment: from 38.2% at 6 months to 18.3% at 3 years; medical disability: from 36.6% at 6 months to 21% at 3 years). |
| Brauer et al., 2017 [48] | Resuming work and school after hematopoietic cell transplantation | Identified themes: rushing to resume school or work, motivating factors, barriers to successful and sustainable re-entry |
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| Dahl et al., 2019 [31] | Employment status, work ability (current work ability compared to the lifetime best) | Employment status: 75.5% of AYA cancer survivors were employed. Work ability: 62% of AYA cancer survivors reported high current work ability. Mean work ability among employed (8.3) vs. unemployed (3.9) AYA cancer survivors AYA cancer survivors vs. comparison group: Employment status: survivors (m = 83%, f = 73%) vs. Norwegian population (m = 81%, f = 76%) Disability pension recipient: AYA cancer survivors (m = 10%, f = 19%) vs. Norwegian population (m = 11%, f = 13%) |
Unemployment: longer time since first cancer diagnosis (OR = 1.03, CI = 1.01–1.05, p = 0.002), increased mean number of adverse events (OR = 1.21, CI = 1.16–1.26, p < 0.001), female gender (OR = 1.77, CI = 1.28–2.46, p = 0.001), low basic education (OR = 2.52, CI = 1.92–3.3, p < 0.001), comorbid cardiovascular disease (OR = 1.85, CI = 1.31–2.63, p = 0.001), decreased general health (OR = 0.98, CI = 0.97–0.98, p < 0.001), increased level of depression (OR = 1.18, CI = 1.15–1.22, p < 0.001) |
| Dieluweit et al., 2011 [20] | Employment status | AYA cancer survivors vs. comparison group: employment rate: 79.6% vs. 74.2% (Cramer’s V = 0.064, p = 0.013) |
Employment: higher age at time of study (OR = 1.04, CI = 1.01–1.08, p = 0.017), female (OR = 0.59, CI = 0.34–0.89, p = 0.016), having children (OR = 0.36, CI = 0.23–0.56, p < 0.001), having neuropsychological late effects (OR = 0.55, CI = 0.34–0.89, p = 0.0016) |
| Drake et al., 2019 [49] | Perspectives on and experiences with return to work following treatment | Identified themes: uncertainty about return to work, cancer as a catalyst for a career change, importance of employment benefits, benefit of YA-specific resources |
“Ahh because my current role in the [company] is meaningless and repetitive I’d be happy to leave that company... people they, they want to do something that’s meaningful. To come through this experience and it kind of ahh turns their world upside down, wakes them up in some ways. They have an awakening and ahh *pause* in my case I guess I have to do something. I have to do work that is meaningful, which is why I’m exploring this opportunity with [company].” |
| Ekwueme et al., 2016 [32] | Employment status, work days lost, home productivity days lost | Employment status: 75.43% of AYA cancer survivors employed Work days and home productivity days lost: AYA cancer survivors missed 19 work days and 17 home productivity days. AYA cancer survivors vs. women aged 18–44 without breast cancer: Employment status: employed: 75.43% vs. 78.38% Workdays and home productivity days lost: AYA cancer survivors missed more work days (19 days vs. 4 days, p < 0.01) and home productivity days (17 days vs. 4 days, p < 0.01). |
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| Ghazal et al., 2021 [51] | Perspectives of work-related goals | Identified themes: self-identity and work, perceived health and work ability, financial toxicity |
“(…) in order to take care of myself, I had to quit this job that had been my end goal… I had to go back to the job that I had worked all through school... [with diagnosis and treatment] it’s taxing for me to do the job that I chose as my career, and then now I can’t even afford to do that job… despite everything I’ve done in my education to get to this point… I’m literally thinking to myself, “What have I been working my whole life for?” |
| Guy et al., 2014 [34] | Functional limitations, employment status | Functional limitations: 17% of AYA cancer survivors experienced limitations at work, with housework, or in school; 11.9% were completely unable to work at a job, do housework, or go to school. Employment status: 33.4% of AYA cancer survivors were not employed; reasons for not being employed were retirement (41%), inability to work because of illness or disability (34.1%), and not being able to find work (20.7%) AYA cancer survivors vs. comparison group: Functional limitations: limitations in work, housework, or school: 17 vs. 10.5%, p < 0.001; being completely unable to work at a job, do housework, or go to school: 11.9 vs. 6.7%, p < 0.001 Employment status: not employed: 33.4% vs. 27.4%, p < 0.001 |
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| Hamzah et al., 2021 [35] | Employment status, career engagement and quality of working life | Employment status: 67.5% of AYA cancer survivors had permanent employment, 12.5% had temporary employment, 14.8% were self-employed, 5.2% worked part-time. Career engagement and quality of working life: positive correlation of career engagement with meaning of work (r = 0.578, p < 0.001), perception of the work situation (r = 0.665, p < 0.001), atmosphere in the work environment (r = 0.648, p < 0.000), understanding and recognition in the organization (r = 0.553, p < 0.001), negative correlation of career engagement with problems because of health situation (r = −0.688, p < 0.001), effect of disease and treatment (r = −0.656, p < 0.000) |
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| Ketterl et al., 2019 [24] | Employment status, physical and mental impairment of work-related tasks, extended paid or unpaid time off from work | Employment status: 84.4% of AYA cancer survivors were employed. Physical and mental impairment of work-related tasks: Among employed survivors, 70.2% reported a physical component in their job and 58.6% reported that cancer interfered with physical tasks required by their job. A total of 54.2% reported that cancer interfered with their ability to perform mental tasks required by their job. |
Treatment: Chemotherapy: inference with job-related physical tasks (OR = 1.97, CI = 1.22 to 3.11, p < 0.01), inference with mental tasks required by a job (OR = 3.22, CI, 2.15 to 4.79, p < 0.01), time off from work (OR = 3.56, CI = 2.31 to 5.47, p < 0.01), borrowing ≥ USD 10,000 (OR = 3.05, CI = 1.53 to 6.09, p < 0.01) compared with survivors who were not exposed to chemotherapy. Radiation: interference with job-related physical tasks (OR = 1.66, CI = 1.08 to 2.41, p < 0.05) compared with survivors who did not receive radiation. Surgery: extended paid time off from work (OR = 0.54, CI = 0.54 to 1.00, p < 0.05) compared with survivors who did not receive surgery. |
| Lim et al., 2020 [37] | Employment status | Employment status: pre- and post-treatment: unemployment: from 9.5% to 23.8%, employment with sick leave: from 14.3% to 0%, employment: from 42.9% to 63.5%, in education: from 33.3% to 12.7% |
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| Mader et al., 2017 [19] | Employment status | AYA cancer survivors vs. comparison group: employment status: 91.2% vs. 89.5% (p = 0.515) |
Unemployment: female gender (OR = 2.52, CI 1.36 to 4.68, p = 0.004), having only basic education (OR = 2.78, CI = 1.01 to 7.65, p = 0.048), being married (OR = 0.53, CI = 0.29 to 0.98, p = 0.042), younger age at diagnosis (OR = 5.29, CI = 1.32 to 30.79, p = 0.010), self-reported late effects (OR 4.70, CI = 1.26 to 19.49, p = 0.009) |
| Meernik et al., 2020 [25] | Employment status, employment disruption | Employment status: 17% part-time employment, 82.6% full-time employment Employment disruption: 32% of AYA cancer survivors reported an employment disruption, categorized as stopping work completely (14%), reducing work hours (12%), taking temporary leave (6%), or both a reduction in hours and temporary leave (5%). |
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| Nord et al., 2015 [39] | Mean days of sick leave or disability pension | AYA cancer survivors vs. comparison group: Mean days of sick leave or disability pension: AYA cancer survivors having received no or limited treatment vs. comparisons: 3rd year after diagnosis: 16 vs. 14 days, 5th year after the diagnosis: 15 vs. 12 days AYA cancer survivors having received extensive treatment vs. comparisons: 3rd year after diagnosis: 26 vs. 14 days, 5th year after diagnosis: 23 vs. 12 days |
Treatment intensity: Mean days of sick leave or disability pension: AYA cancer survivors having received no or limited treatment: 3rd year after diagnosis: 16 days, 5th year after diagnosis: 15 days AYA cancer survivors having received extensive treatment: 3rd year after diagnosis: 26 days, 5th year after diagnosis: 23 days |
| Nugent et al., 2018 [40] | Employment status, occupational function | AYA cancer survivors vs. comparisons: Employment status: full-time student, not working (17.4% vs. 21.4%); student and part-time work (21.7% vs. 28.6%); student and full-time work (4.3% vs. 0%); part time work only (13% vs. 0%); full-time work only (43.4% vs. 50%) Occupational function: no significant difference between AYA cancer survivors (mean score = 4.5 ± 5.28 [2.13–6.87]) and comparisons (mean score 4.67 ± 4.34), Cohen’s d = −0.034 [−0.78 to 0.72] |
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| Parsons et al., 2008 [55] | Lived experiences of resuming vocational work | 50% of AYA cancer survivors returned to their pre-illness occupation, whereas the other half were forced to change careers. Regardless of whether their professional status changed, all respondents recounted how their relationship with their vocation had been profoundly altered by the illness. Return to work was interconnected with aspects of life such as support (including financial), possession of disability and unemployment benefits, and entitlements to sick leave from employment/training/educational programs. All AYA cancer survivors expressed a strong desire to resume vocational pursuits but experienced returning to work as hard work. They portrayed themselves as “hard workers” due to drawing heavily on discourses of “work ethics.” Concerns were raised regarding financial pressures, but willingness to physically return was also expressed. | “I’m afraid to apply for jobs, to be rejected. ‘Cause I could send my resume in, and I’m sure I’ll get an interview, but I go in there with my crutches or a cane, it’s like, even my brother-in-law was saying, “How much work can this person do for me?” (31 years old at diagnosis, 35 years old at interview) |
| Parsons et al., 2012 [17] | Full-time work or school participation, belief of cancer leading to a negative impact | Results for the 388 AYA cancer survivors who had been working or in school full-time before diagnosis: Full-time work or school participation: 15–19 months since diagnosis: 74.0% full-time or work at follow-up, 20–24 months since diagnosis: 75.8% full-time or work at follow-up, 25–29 months since diagnosis: 69.9% full-time or work at follow-up, 30–35 months since diagnosis: 66.7% full-time or work at follow-up Belief: 15–19 months since diagnosis: 44.0% negative impact on plans, 20–24 months since diagnosis: 33.9% negative impact on plans, 25–29 months since diagnosis: 30.8% negative impact on plans, 30–35 months since diagnosis: 38.5% negative impact on plans |
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| Raque-Bogdan et al., 2015 [56] | Effect of breast cancer on work lives and career development | Identified themes: cancer-related work challenges, coping with cancer-related work challenges, reappraisal of career development after cancer and components of career, components of career and life satisfaction after cancer |
“So the 2 months that I missed, it has slowed down my learning in my career at a time that learning is very important. Part of that is time away from work. But much of that is that I have not had the capacity to work as intensely at the level that is necessary.” |
| Stone et al., 2019 [57] | Work experiences | Identified themes: process of revealing the survivor-self, process of sustaining work ability, process of accessing support |
“I was back working, you know, full-time, maybe 3 or 4, 5 days later.” |
| Strauser et al., 2010 [41] | Competitive employment, use of vocational services | Competitive employment: 51.6% of AYA cancer survivors were competitively employed. |
AYA cancer survivors using more services and spending more time in services were more likely to be employed. Employment was associated with the use of following services: vocational training (OR = 2.03, CI: 1.03 to 4.00), miscellaneous training (OR = 3.4, CI: 1.47 to 7.96), job search assistance (OR = 4.01, CI: 1.80 to 8.97), job placement assistance (OR = 2.24, CI: 1.11 to 4.52), on-the-job support (OR = 4.2, CI: 1.66 to 10.63), maintenance (OR = 2.85, CI: 1.38 to 5.90) |
| Sylvest et al., 2022 [42] | Being outside the workforce | AYA cancer survivors vs. comparison group: The percentage of cancer survivors being outside the workforce (retired/receiving transfer income) was higher (9%) than the percentage in the comparison group with no cancer diagnosis (6%). |
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| Tangka et al., 2020 [43] | Employment status, work benefits at diagnosis, impact on employment status | Employment status: 73.4% of participants were employed at the time of diagnosis. Out of these, 64.9% worked for a private or non-profit organization; 21.0% for a branch of federal, state, or local government; and 7.5% were self-employed. Work benefits at diagnosis: The respondents reported that the following work benefits at diagnosis were available for them: paid sick leave: 55.1%, flexible scheduling: 49.4%, disability: 40.5%, unpaid sick leave: 36.8%, flexible location: 21.5%, none of the above: 10.9%. For most of the women, their employer was very supportive during treatment (66.8%). For the others, their employer was neutral or somewhat supportive (17.9%), unsupportive (5.5%), or unaware of the diagnosis (3.7%). Impact on employment status: Survivors reported that their diagnosis and treatment impacted their employment as follows: changed jobs within company: 5.4%, avoided changing jobs to keep health insurance: 23.5%, changed jobs to get health insurance: 1.5%, took paid time off: 55.1%, took unpaid time off: 47.3%, quit job: 12.2%, retired early: 1.2%, lost job: 7.5%, job performance suffered: 40.4%, kept job for health insurance: 30.2%, increased work hours to cover medical costs: 5.1%. |
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| Tebbi et al., 1989 [44] | Employment status, job-related questions, experience in the work environment | Employment status: 62.5% of AYA cancer survivors were full-time employed, 10% part-time employed, and 27.5% unemployed. Job-related questions: 5% of AYA cancer survivors changed jobs as part of the adjustment to cancer. Experience in the work environment: 79% of AYA cancer survivors believed that readjustment to the job would be easier for survivors if the attitudes of others were changed, 64% of AYA cancer survivors believed that changes in certain physical features of the workplace were necessary to facilitate such readjustment, and 16% of AYACS believed that no changes in the workplace were necessary. AYA cancer survivors vs. comparison group: Employment status: full-time employed (62.5% vs. 65%), part-time employed (10% vs. 17.5%), unemployed (27.5% vs. 17.5%), p = 0.422 Job-related questions: No significant difference in experience of discrimination in hiring or promotion or problems performing their job or using job-related facilities. |
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| Yanez et al., 2013 [46] | Employment status, cancer-related education or work interruption | Employment status: employed: 69%, homemaker: 11.5%, unemployed: 10.7%, student: 6.2% Cancer-related education/work interruption: 62.3% of AYA cancer survivors reported an interruption in education or work. |
Time since diagnosis: AYA cancer survivors 25–60 months since diagnosis vs. 13–24 months since diagnosis vs. 0–12 months since diagnosis. Employment status: employed (% vs. 77.5 vs. 64.2), homemaker (11.5% vs. 9.8% vs. 9.2%), unemployed (10.7% vs. 3.8% vs. 15.8%), student (6.2% vs. 7.8% vs. 9.2%), cancer-related education/work interruption: 62.3% vs. 56.1% vs. 66.1% |
Abbreviations: m, male; f, female; OR, odds ratio; CI, confidence interval; p, p-value; r, correlation coefficient; WAI, work ability index; aOR, adjusted odds ratio; CI, confidence interval; AYA, adolescent and young adult; HCT, allogeneic hematopoietic cell transplantation.