title: Employment status among adult survivors in the Childhood Cancer Survivor Study.
abstract: BACKGROUND
  With increased cure, childhood cancer survivors are reaching adulthood and seeking employment. Host, disease and treatment risk factors may contribute to inability to attain or maintain employment.
  
  
  METHODS
  The prevalence and risk factors for unemployment were evaluated using self-reported employment history in 10,399 childhood cancer survivors and 3,083 siblings >/= age 18 in the Childhood Cancer Survivor Study (CCSS).
  
  
  RESULTS
  Among survivors, 5.6% reported unemployment, compared with 1.2% of siblings (odds ratio [OR] 3.7; 95% confidence interval [CI] 2.6, 5.1). Increased risks were observed within all cancer diagnoses. In multivariate analysis, diagnosis of central nervous system (CNS) tumor (OR 1.5; 95% CI 1.1, 2.1), bone cancer (OR 1.5; 95% CI 1.0, 2.1), treatment with >/=30 Gy cranial radiotherapy (OR 4.0; 95% CI 2.9, 5.5), female gender (OR 1.4; 95% CI 1.2, 1.7) and age < 4 years at diagnosis (OR 1.4; 95% CI 1.1, 1.8) increased risk. Diagnosis of CNS or bone tumor or cranial radiotherapy >/=30 Gy remained significant after adjusting for treatment, medical late effects, age and gender. Risk of unemployment decreased with attained age (OR((year)) 0.89; 95% CI 0.87, 0.91).
  
  
  CONCLUSIONS
  Compared to siblings, adult childhood cancer survivors are at increased risk for unemployment with highest risk defined by diagnosis, treatment and demographic factors.
authors.affiliation: University of Washington School of Public Health and Community Medicine, Department of Epidemiology, Seattle, Washington, USA.
authors.forename: Jenny W Y
authors.initials: JW
authors.lastname: Pang
authors.forename: Debra L
authors.initials: DL
authors.lastname: Friedman
authors.forename: John A
authors.initials: JA
authors.lastname: Whitton
authors.forename: Marilyn
authors.initials: M
authors.lastname: Stovall
authors.forename: Ann C
authors.initials: AC
authors.lastname: Mertens
authors.forename: Leslie L
authors.initials: LL
authors.lastname: Robison
authors.forename: Noel S
authors.initials: NS
authors.lastname: Weiss
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009369:Neoplasms; D035781:Siblings; D012959:Socioeconomic Factors; D017741:Survivors / Q000706:statistics & numerical data*; D014478:Unemployment / Q000706:statistics & numerical data*; D014481:United States