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Marriage, employment, and health insurance in adult survivors of childhood cancer

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Abstract

Introduction

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.

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Acknowledgments

This research was supported by Cancer Center Support (CORE) grant CA 21765 from the National Cancer Institute and by the American Lebanese Syrian Associated Charities (ALSAC). We thank David Galloway, ELS, for editorial assistance; Margie Zacher and Lawrence Buirse for technical support.

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Authors and Affiliations

  1. Department of Oncology, St. Jude Children’s Research Hospital, 332 N. Lauderdale St., Mail Stop 735, Memphis, TN, 38105-2794, USA

    Deborah B. Crom, Darlene K. Cash & Melissa M. Hudson

  2. Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN, USA

    Shelly Y. Lensing & Shesh N. Rai

  3. College of Nursing, University of Tennessee Health Science Center, Memphis, TN, USA

    Deborah B. Crom

  4. Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA

    Mark A. Snider & Melissa M. Hudson

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  1. Deborah B. Crom
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Correspondence to Deborah B. Crom.

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Crom, D.B., Lensing, S.Y., Rai, S.N. et al. Marriage, employment, and health insurance in adult survivors of childhood cancer. J Cancer Surviv 1, 237–245 (2007). https://doi.org/10.1007/s11764-007-0026-x

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