“Job Lock” among long-term survivors of childhood cancer

A report from the childhood cancer survivor study

Anne C. Kirchhoff, Ryan Nipp, Echo L. Warner, Karen Kuhlthau, Wendy M. Leisenring, Karen Donelan, Julia Rabin, Giselle K. Perez, Kevin C. Oeffinger, Paul C. Nathan, Leslie L. Robison, Gregory Armstrong, Elyse R. Park

Research output: Contribution to journalArticle

9 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)707-711
Number of pages5
JournalJAMA Oncology
Volume4
Issue number5
DOIs
StatePublished - May 1 2018

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Survivors
Neoplasms
Health Insurance
Siblings
Insurance Coverage
Self Report
Cross-Sectional Studies
Quality of Life
Pediatrics
Health

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Cite this

Kirchhoff, A. C., Nipp, R., Warner, E. L., Kuhlthau, K., Leisenring, W. M., Donelan, K., ... Park, E. R. (2018). “Job Lock” among long-term survivors of childhood cancer: A report from the childhood cancer survivor study. JAMA Oncology, 4(5), 707-711. https://doi.org/10.1001/jamaoncol.2017.3372

“Job Lock” among long-term survivors of childhood cancer : A report from the childhood cancer survivor study. / Kirchhoff, Anne C.; Nipp, Ryan; Warner, Echo L.; Kuhlthau, Karen; Leisenring, Wendy M.; Donelan, Karen; Rabin, Julia; Perez, Giselle K.; Oeffinger, Kevin C.; Nathan, Paul C.; Robison, Leslie L.; Armstrong, Gregory; Park, Elyse R.

In: JAMA Oncology, Vol. 4, No. 5, 01.05.2018, p. 707-711.

Research output: Contribution to journalArticle

Kirchhoff, AC, Nipp, R, Warner, EL, Kuhlthau, K, Leisenring, WM, Donelan, K, Rabin, J, Perez, GK, Oeffinger, KC, Nathan, PC, Robison, LL, Armstrong, G & Park, ER 2018, '“Job Lock” among long-term survivors of childhood cancer: A report from the childhood cancer survivor study', JAMA Oncology, vol. 4, no. 5, pp. 707-711. https://doi.org/10.1001/jamaoncol.2017.3372
Kirchhoff, Anne C. ; Nipp, Ryan ; Warner, Echo L. ; Kuhlthau, Karen ; Leisenring, Wendy M. ; Donelan, Karen ; Rabin, Julia ; Perez, Giselle K. ; Oeffinger, Kevin C. ; Nathan, Paul C. ; Robison, Leslie L. ; Armstrong, Gregory ; Park, Elyse R. / “Job Lock” among long-term survivors of childhood cancer : A report from the childhood cancer survivor study. In: JAMA Oncology. 2018 ; Vol. 4, No. 5. pp. 707-711.
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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.",
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AU - Leisenring, Wendy M.

AU - Donelan, Karen

AU - Rabin, Julia

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AU - Oeffinger, Kevin C.

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N2 - 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.

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