title: Marriage, employment, and health insurance in adult survivors of childhood cancer.
abstract: BACKGROUND
  Adult survivors of childhood cancer are at risk for disease- and therapy-related morbidity, which can adversely impact marriage and employment status, the ability to obtain health insurance, and access to health care. Our aim was to identify factors associated with survivors' attainment of these outcomes.
  
  
  METHODS
  We surveyed 1,437 childhood cancer survivors who were >18 years old and >10 years past diagnosis. We compared our cohort's data to normative data in the Medical Expenditure Panel Survey and the U.S. Census Bureau's Current Population Surveys. Respondents were stratified by hematologic malignancies, central nervous system tumors, or other solid tumors and by whether they had received radiation therapy.
  
  
  RESULTS
  Most respondents were survivors of hematologic malignancies (71%), white (91%), and working full-time (62%); 43% were married. Compared with age- and sex-adjusted national averages, only survivors of hematologic malignancies who received radiation were significantly less likely to be married (44 vs. 52%). Full-time employment among survivors was lower than national norms, except among survivors of hematologic malignancies who had not received radiation therapy. The rates of coverage of health insurance, especially public insurance, were higher in all diagnostic groups than in the general population. While difficulty obtaining health care was rarely reported, current unemployment and a lack of insurance were associated with difficulty in obtaining health care (P < 0.05 and P < 0.001, respectively). CONCLUSIONS/IMPLICATIONS FOR CANCER SURVIVORS: Subgroups of cancer survivors do experience long-term differences in functional outcomes that should be addressed early. Survivors who are unmarried, unemployed, and uninsured experience difficulty accessing health care needed to address long-term health concerns.
authors.affiliation: Department of Oncology, St. Jude Children's Research Hospital, 332 N. Lauderdale St., Mail Stop 735, Memphis, TN 38105-2794, USA. debbie.crom@stjude.org
authors.forename: Deborah B
authors.initials: DB
authors.lastname: Crom
authors.forename: Shelly Y
authors.initials: SY
authors.lastname: Lensing
authors.forename: Shesh N
authors.initials: SN
authors.lastname: Rai
authors.forename: Mark A
authors.initials: MA
authors.lastname: Snider
authors.forename: Darlene K
authors.initials: DK
authors.lastname: Cash
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Hudson
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004651:Employment / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D016304:Hospitals, Private / Q000706:statistics & numerical data; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D008393:Marriage / Q000706:statistics & numerical data*; D008875:Middle Aged; D009369:Neoplasms / Q000145:classification / Q000453:epidemiology* / Q000628:therapy; D017741:Survivors / Q000706:statistics & numerical data*; D013714:Tennessee; D013997:Time Factors; D014478:Unemployment / Q000706:statistics & numerical data