title: Physical, mental, and neurocognitive status and employment outcomes in the childhood cancer survivor study cohort.
abstract: BACKGROUND
  We examined the relationship of physical, mental, and neurocognitive function with employment and occupational status in the Childhood Cancer Survivor Study.
  
  
  METHODS
  We included survivors 25 years or older with available short form-36 (physical and mental health component scores), brief symptom inventory (depression, anxiety, and somatization), and neurocognitive questionnaire (task efficiency, emotional regulation, organization, and memory). We generated relative risks (RR) from generalized linear models for these measures on unemployment (n = 5,386) and occupation (n = 3,763) outcomes adjusted for demographic and cancer-related factors and generated sex-stratified models.
  
  
  RESULTS
  Poor physical health was associated with an almost eightfold higher risk of health-related unemployment (P < 0.001) compared to survivors with normal physical health. Male survivors with somatization and memory problems were approximately 50% (P < 0.05 for both) more likely to report this outcome, whereas task efficiency limitations were significant for both sexes (males: RR = 2.43, P < 0.001; females: RR = 2.28, P < 0.001). Employed female survivors with task efficiency, emotional regulation, and memory limitations were 13% to 20% (P < 0.05 for all) less likely to work in professional or managerial occupations than unaffected females.
  
  
  CONCLUSIONS
  Physical problems may cause much of the health-related unemployment among childhood cancer survivors. Whereas both male and female survivors with neurocognitive deficits--primarily in task efficiencies--are at risk for unemployment, employed female survivors with neurocognitive deficits may face poor occupational outcomes more often than males.
  
  
  CONCLUSIONS
  Childhood cancer survivors are at risk for poor employment outcomes. Screening and intervention for physical, mental, and neurocognitive limitations could improve employment outcomes for this population.
authors.affiliation: Cancer Control and Population Science Research Program, Huntsman Cancer Institute, Salt Lake City, UT 84112, USA. Anne.Kirchhoff@hci.utah.edu
authors.forename: Anne C
authors.initials: AC
authors.lastname: Kirchhoff
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Krull
authors.forename: Kirsten K
authors.initials: KK
authors.lastname: Ness
authors.forename: Gregory T
authors.initials: GT
authors.lastname: Armstrong
authors.forename: Elyse R
authors.initials: ER
authors.lastname: Park
authors.forename: Marilyn
authors.initials: M
authors.lastname: Stovall
authors.forename: Leslie L
authors.initials: LL
authors.lastname: Robison
authors.forename: Wendy
authors.initials: W
authors.lastname: Leisenring
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004651:Employment / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology / Q000523:psychology*; D011788:Quality of Life; D017741:Survivors / Q000523:psychology* / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D055815:Young Adult