Marriage, employment, and health insurance in adult survivors of childhood cancer
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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.
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.
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.
- Ries LAG, Harkins D, Krapcho M, Mariotto A, Miller BA, Feuer EJ, et al. (eds). SEER Cancer Statistics Review, 1975–2003, National Cancer Institute. Bethesda, MD: National Cancer Institute: 2006. Accessed at http://seer.cancer.gov/csr/1975_2003/ (based on November 2005 SEER data submission, posted to the SEER web site, 2006).
- Pui CH, Cheng C, Leung W, Rai SN, Rivera GK, Sandlund JT, et al. Extended follow-up of long-term survivors of childhood acute lymphoblastic leukemia. N Engl J Med. 2003;349:640–649. CrossRef
- Robison LL, Mertens AC, Boice JD, Breslow NE, Donaldson LL, Green DM, et al. Study design and cohort characteristics of the Childhood Cancer Survivor Study: a multi-institutional collaborative project. Med Pediatr Oncol. 2002;38:229–239. CrossRef
- Oeffinger KC, Mertens AC, Sklar CA, Kawashima T, Hudson MM, Meadows AT, et al. Chronic health conditions in adult survivors of childhood cancer. N Engl J Med. 2006;355:1572–1582. CrossRef
- Ness KK, Mertens AC, Hudson MM, Wall MM, Leisenring WM, Oeffinger KC, et al. Limitations on physical performance and daily activities among long term survivors of childhood cancer. Ann Intern Med. 2005;13:639–647.
- Kenney LB, Yasui Y, Inskip PD, Kenney LB, Yasui Y, Knsip PD, et al. Breast cancer after childhood cancer: a report from the Childhood Cancer Survivor Study. Ann Intern Med. 2004;141:590–597.
- Oeffinger KC, Mertens AC, Sklar CA, Yasui Y, Fears T, Stovall M, et al. Obesity in adult survivors of acute lymphoblastic leukemia: a report from the Childhood Cancer Survivor Study. J Clin Oncol. 2003;21:1359–1365. CrossRef
- Zebrack BJ, Gurney JG, Oeffinger K, Whitton J, Packer RJ, Mertens A, et al. Psychological outcomes in long-term survivors of childhood brain cancer: a report from the Childhood Cancer Survivor study. J Clin Oncol. 2004;22:999–1006. CrossRef
- Mulhern RK, Hancock J, Fairclough D, Kun L. Neuropsychological status of children treated for brain tumors: a critical review and integrative analysis. Med Pediatr Oncol. 1992;20:181–191. CrossRef
- Bowers DC, Liu Y, Leisenring W, McNeil E, Stovall M, Gurney JG, et al. Late-occurring stroke among long-term survivors of childhood leukemia and brain tumors: a report from the childhood cancer survivor study. J Clin Oncol. 2006;24:5277–5282. CrossRef
- Fields J, Casper LM. America’s Families and Living Arrangements: March 2000. Current Population Reports (pp. 20-537). U.S. Washington, DC: Census Bureau; 2001.
- Center for Cost Financing Studies. Medical Expenditure Panel Survey: household component. Rockville, MD: Agency for Healthcare Research and Quality; 2000.
- Employment status: annual averages. Current population survey report. Washington, DC: Bureau of Labor Statistics (2002); 2001.
- Kalton G. Introduction to Survey Sampling, Sage University Paper series on Quantitative Applications in the Social Sciences, series no. 07-035. Beverly Hills, CA, and London: Sage; 1983.
- Lansky SB, List MA, Ritter-Sterr C. Psychosocial consequences of cure. Cancer. 1986;58:529–533. CrossRef
- Dolgin MJ, Somer E, Buchvald E, Zaizov R. Quality of life in adult survivors of childhood cancer. Soc Work Health Care. 1999;28:31–43. CrossRef
- Massimo LM, Wiley TJ, Bonassi S, Caprino D. Logitudinal psychosocial outcomes in two cohorts of adult survivors from childhood acute leukemia treated with or without cranial radiation. Minerva Pediatr. 2006;58:1–7.
- Rauck AM, Green DM, Yasui Y, Mertens A, Robison LL. Marriage in the survivors of childhood cancer: a preliminary description from the childhood cancer survivor study. Med Pediatr Oncol. 1999;33:60–63. CrossRef
- Nicholson HS, Mulvihill JJ, Byrne J. Late effects of therapy in adult survivors of osteosarcoma and Ewing’s sarcoma. Med Pediatr Oncol. 1992;20:6–12. CrossRef
- Wasserman AL, Thompson EI, Wilimas JA, Fairclough DL. The psychological stauts of survivors of childhood/adolescent Hodgkin’s disease. Am J Dis Child. 1987;141:626–631.
- Byrne J, Fears TR, Steinhorn SC, Mulvihill JJ, Connelly RR, Austin DF, et al. Marriage and divorce after childhood and adolescent cancer. JAMA. 1989;262:2693–2699. CrossRef
- Teeter MA, Holmes GE, Holmes FF, Baker AB. Decisions about marriage and family among survivors of childhood cancer. J Psychosoc Oncol. 1987;5:59–68. CrossRef
- Green DM, Zevon MA, Hall B. Achievement of life goals by adult survivors of modern treatment for childhood cancer. Cancer. 1991;67:206–213. CrossRef
- Langeveld NE, Ubbink MC, Last BF, Grootenhuis MA, Voute PA, de Haan RJ. Educational achievement, employment, and living situation in long-term young adult survivors of childhood cancer in The Netherlands. Psychooncol. 2003;12:213–225. CrossRef
- Koch SV, Kejs AMT, Engholm G, Moller H, Johansen C, Schmiegelow K. Leaving home after cancer in childhood: a measure of social independence in early adulthood. Pediatr Blood Cancer. 2006;47:61–70. CrossRef
- Benesch M, Lackner H, Sovinz P, Suppan E, Schwinger W, Eder HG. Late sequela after treatment of childhood low grade gliomas: a retrospective analysis of 69 long term survivors treated between 1983 and 2003. J Neurooncol. 2006;78:199–205. CrossRef
- Frobisher C, Lancashire ER, Winter DL, Jenkinson HC, Hawkins MM. Long-term population- based marriage rates among adult survivors of childhood cancer in Britain. Int J Cancer. 2007 (in press). DOI 10.1002/ijc.22742.
- Bowman KK, Bodegard G. Life after cancer in childhood: social adjustment and educational and vocational status of young-adult survivors. J Pediatr Hematol Oncol. 2004;26:354–362. CrossRef
- Steiner JF, Cavender TA, Main DS, Bradley CJ. Assessing the impact of cancer on work outcomes. Cancer. 2004;101:1703–1711. CrossRef
- de Boer AGEM, Verbeek JHAM, van Dijk FJH. Adult survivors of childhood cancer and unemployment: A metaanalysis. Cancer. 2006;107:1–11. CrossRef
- Pang JWY, Friedman DL, Whitton JA, Stovall M, Mertens AC, Robison LL, et al. Employment status among adult survivors in the childhood cancer survivor study. Pediatr Blood Cancer: 2007 (in press).
- Briere ME, Scott JG, McNall-Knapp RY, Adams RL. Cognitive outcome in pediatric brain tumor survivors: delayed attention deficit at long-term follow-up. Pediatr Blood Cancer: 2007 (in press). DOI 10.1002/pbc.21223.
- Meeske KA, Patel SK, Palmer SN, Nelson MB, Parow AM. Factors associated with health-related quality of life in pediatric cancer survivors. Pediatr Blood Cancer: 2006 (in press). DOI 10.1002/pbc.20923.
- Muller HL, Bruhnken G, Emser A, Faldum A, Etavard-Gorris N, Gebhardt U, et al. Longitudinal study on quality of life in 102 survivors of childhood craniopharyngioma. Childs Nerv Syst. 2005;21:975–980. CrossRef
- Mabbott DJ, Spiegler BJ, Greenberg ML, Rutka JT, Hyder DJ, Bouffet E. Serial evaluation of academic and behavioral outcome after treatment with cranial radiation in childhood. J Clin Oncol. 2005;23:2256–2263. CrossRef
- Buizer AI, de Sonneville LMJ, van den Heuvel-Eibrink MM, Veerman AJP. Behavioral and educational limitations after chemotherapy for childhood acute lymphoblastic leukemia or Wilms Tumor. Cancer. 2006;106:2067–2075. CrossRef
- Barrera M, Shaw AK, Speechley KN, Maunsell E, Pogany L. Educational and social late effects of childhood cancer and related clinical, personal, and familial characteristics. Cancer. 2005;104:1751–1760. CrossRef
- Mitby PA, Robison LL, Whitton JA, Zevon MA, Gibbs IC, Tersak JM, et al. Utilization of special education services and educational attainment among long-term survivors of childhood cancer. Cancer. 2003;97:1115–1126. CrossRef
- Equal Employment Opportunity Commision. Equal opportunities for individuals with disabilities; final rules. Fed Regist. 1991;56:35725–35755.
- Hoffman B. Cancer survivors’ employment and insurance rights: a primer for oncologists. Oncology. 1999;13:841–846.
- Park ER, Li FP, Liu Y, Emmons KM, Ablin A, Robison LL, et al. Health insurance coverage in survivors of childhood cancer: the childhood cancer survivor study. J Clin Oncol. 2005;23:9187–9197. CrossRef
- Health Insurance Portability and Accountability Act of 1996, Pub L. no. 104–191.
- Teta MJ, Del Po MC, Kasl SV, Meigs JW, Myers MH, Mulvihill J. Psychosocial consequences of childhood and adolescent cancer survival. J Chronic Dis. 1986;39:751–759. CrossRef
- Holmes GE, Baker A, Hassanein RS, Bovee EC, Mulvihill JJ, Myers MH, et al. The availability of insurance to long-time survivors of childhood cancer. Cancer. 1986;57:190–193. CrossRef
- Nagarajan R, Neglia JP, Clohisy DR, Yasui Y, Greenberg M, Hudson M, et al. Education, employment, insurance, and marital status among 694 survivors of pediatric lower extremity bone tumors. Cancer. 2003;97:2554–2564. CrossRef
- Taylor L, Simpson K, Bushardt R, Reeves C, Elkin TD, Fortson BL, et al. Insurance barriers for childhood survivors of pediatric brain tumors: the case for neurocognitive evaluations. Pediatr Neurosurg. 2006;42:223–227. CrossRef
- Mertens AC, Yasui Y, Neglia JP, Potter JD, Nesbeit ME, Ruccione K, et al. Late mortality experience in five-year survivors of childhood and adolescent cancer: the childhood cancer survivor study. J Clin Oncol. 2001;19:3163–3172.
- Oeffinger KC, Mertens AC, Hudson MM, Gurney JG, Casillas J, Chen H, et al. Health care of young adult survivors of childhood cancer: A report from the childhood cancer survivor study. Ann Fam Med. 2004;2:61–70. CrossRef
- Marriage, employment, and health insurance in adult survivors of childhood cancer
Journal of Cancer Survivorship
Volume 1, Issue 3 , pp 237-245
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- 1. Department of Oncology, St. Jude Children’s Research Hospital, 332 N. Lauderdale St., Mail Stop 735, Memphis, TN, 38105-2794, USA
- 3. College of Nursing, University of Tennessee Health Science Center, Memphis, TN, USA
- 2. Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN, USA
- 4. Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA