"Job Lock" Among Long-term Survivors of Childhood Cancer

JAMA Oncol. 2017 Oct 19. doi: 10.1001/jamaoncol.2017.3372. [Epub ahead of print]

"Job Lock" Among Long-term Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study.

Kirchhoff AC1,2, Nipp R3,4, Warner EL1, Kuhlthau K5,6, Leisenring WM7, Donelan K8, Rabin J8,9, Perez GK8,9, Oeffinger KC10, Nathan PC11,12, Robison LL13, Armstrong GT13, Park ER8,9.

Author information

1

Huntsman Cancer Institute, University of Utah, Salt Lake City.

2

Department of Pediatrics, University of Utah, Salt Lake City.

3

Department of Medicine, Massachusetts General Hospital Cancer Center, Boston.

4

Harvard Medical School, Boston.

5

Department of Pediatrics, Massachusetts General Hospital, Boston.

6

Department of Pediatrics, Harvard Medical School, Boston.

7

Clinical Research Division and Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.

8

Mongan Institute Health Policy Center, Massachusetts General Hospital, Boston.

9

Massachusetts General Hospital Cancer Survivorship Program, Massachusetts General Hospital Cancer Center, Boston.

10

Department of Medicine, Duke University Medical Center, Durham, North Carolina.

11

Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada.

12

Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.

13

Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee.

Abstract

IMPORTANCE:

Childhood cancer survivors may be reluctant to make changes in their employment because of access to health insurance.

OBJECTIVE:

To examine the prevalence of "job lock" (staying at a job to keep work-related health insurance) in a sample drawn from an established, multi-institutional cohort of full-time employed childhood cancer survivors compared with a random sample of siblings and to explore factors associated with job lock among cancer survivors.

DESIGN, SETTING, AND PARTICIPANTS:

Cross-sectional survey of full-time employed adult survivors of childhood cancer and a random sample of siblings derived from a cohort of 25 US pediatric oncology centers.

EXPOSURES:

Data collection included sociodemographic factors, insurance coverage, chronic medical conditions, and treatment.

MAIN OUTCOMES AND MEASURES:

Self-report of job lock and factors associated with job lock.

RESULTS:

Among the 522 participants, 394 were cancer survivors (54.5% male) and 128 were siblings (51.5% male). Job lock was reported by 23.2% (95% CI, 18.9%-28.1%) of survivors, compared with 16.9% (95% CI, 11.1%-25.0%) of siblings (P = .16). Job lock was more common among survivors reporting previous health insurance denial (relative risk [RR], 1.60; 95% CI, 1.03-2.52) and problems paying medical bills (RR, 2.43; 95% CI, 1.56-3.80). Among survivors, being female (RR, 1.70; 95% CI, 1.11-2.59; P = .01) and having a severe, disabling, or life-threatening health condition (RR, 1.72; 95% CI, 1.09-2.69; P = .02) were associated with job lock.

CONCLUSIONS AND RELEVANCE:

Job lock is common among long-term childhood cancer survivors who are employed full-time. A survivor's decision to remain employed at a job in order to maintain health insurance coverage may affect career trajectory, diminish potential earning power, and ultimately impact quality of life.