title: Impact of cancer on work and education among adolescent and young adult cancer survivors.
abstract: OBJECTIVE
  To examine the impact of cancer on work and education in a sample of adolescent and young adult (AYA) patients with cancer.
  
  
  METHODS
  By using the Adolescent and Young Adult Health Outcomes and Patient Experience Study (AYA HOPE)-a cohort of 463 recently diagnosed patients age 15 to 39 years with germ cell cancer, Hodgkin's lymphoma, non-Hodgkin's lymphoma, sarcoma, and acute lymphocytic leukemia from participating Surveillance, Epidemiology, and End Results (SEER) cancer registries-we evaluated factors associated with return to work/school after cancer diagnosis, a belief that cancer had a negative impact on plans for work/school, and reported problems with work/school after diagnosis by using descriptive statistics, χ(2) tests, and multivariate logistic regression.
  
  
  RESULTS
  More than 72% (282 of 388) of patients working or in school full-time before diagnosis had returned to full-time work or school 15 to 35 months postdiagnosis compared with 34% (14 of 41) of previously part-time workers/students, 7% (one of 14) of homemakers, and 25% (five of 20) of unemployed/disabled patients (P < .001). Among full-time workers/students before diagnosis, patients who were uninsured (odds ratio [OR], 0.21; 95% CI, 0.07 to 0.67; no insurance v employer-/school-sponsored insurance) or quit working directly after diagnosis (OR, 0.15; 95% CI, 0.06 to 0.37; quit v no change) were least likely to return. Very intensive cancer treatment and quitting work/school were associated with a belief that cancer negatively influenced plans for work/school. Finally, more than 50% of full-time workers/students reported problems with work/studies after diagnosis.
  
  
  CONCLUSIONS
  Although most AYA patients with cancer return to work after cancer, treatment intensity, not having insurance, and quitting work/school directly after diagnosis can influence work/educational outcomes. Future research should investigate underlying causes for these differences and best practices for effective transition of these cancer survivors to the workplace/school after treatment.
authors.affiliation: Department of Epidemiology and Biostatistics, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, Mail Code 7933, San Antonio, TX 78229-3900, USA. parsonsh@uthscsa.edu
authors.forename: Helen M
authors.initials: HM
authors.lastname: Parsons
authors.forename: Linda C
authors.initials: LC
authors.lastname: Harlan
authors.forename: Charles F
authors.initials: CF
authors.lastname: Lynch
authors.forename: Ann S
authors.initials: AS
authors.lastname: Hamilton
authors.forename: Xiao-Cheng
authors.initials: XC
authors.lastname: Wu
authors.forename: Ikuko
authors.initials: I
authors.lastname: Kato
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Schwartz
authors.forename: Ashley W
authors.initials: AW
authors.lastname: Smith
authors.forename: Gretchen
authors.initials: G
authors.lastname: Keel
authors.forename: Theresa H M
authors.initials: TH
authors.lastname: Keegan
mesh_terms: D000293:Adolescent; D000328:Adult; D004522:Educational Status; D004651:Employment / Q000523:psychology* / Q000706:statistics & numerical data; D006801:Humans; D015999:Multivariate Analysis; D009369:Neoplasms / Q000523:psychology* / Q000628:therapy; D017741:Survivors / Q000523:psychology*; D055815:Young Adult