Quality of Life and Comorbidities Impact Education and Employment for Survivors of Adolescent and Young Adult Cancers

• Published in: Cancer epidemiology, biomarkers & prevention Vol. 23; no. 3; p. 568
• Main Authors: Kirchhoff, AC, McFadden, M, Warner, EL, Kinney, AY
• Format: Journal Article
• Language: English
• Published: 01.03.2014
• ISSN: 1055-9965; 1538-7755
• DOI: 10.1158/1055-9965.EPI-14-0077

Abstract Survivors of adolescent and young adult (AYA) cancers have a high risk of chronic conditions such as cardiovascular disease and asthma. These conditions may affect their ability to attend school or to work. We examined the impact of quality of life (QOL) and comorbidities on educational attainment and employment status for survivors of AYA cancers relative to a non-cancer comparison group. Methods: Using data from the 2009 Behavioral Risk Factor Surveillance System (BRFSS), we identified 7,471 individuals who were diagnosed with cancer between ages 15 and 39 and were ≥5 years from diagnosis and 326,821 controls without a history of cancer. Participants were ≥25 years of age. QOL was measured by a general health measure (excellent/very good/good/fair/poor). Comorbidities included self-reported cardiovascular disease, hypertension, asthma, and diabetes. Multivariable regressions using BRFSS survey weights were adjusted for sex, race/ethnicity and age, and compared the effects of QOL and comorbidities on educational attainment (college graduate or more vs. less education) and being employed or unable to work (compared to out of work or not in labor force) among the survivor and control groups. Results: Compared to controls, survivors in fair-poor health were less likely to be college graduates or more (survivors 18.5% vs. controls 37.9%, p < 0.01) and less likely to be employed (survivors 31.7% vs. controls 61.6%, p < 0.001), whereas survivors in good-excellent health did not differ from controls for either outcome. In addition, survivors in fair-poor health self-reported being unable to work more often than controls (31.4% vs. 5.4%, respectively; p < 0.001). For comorbidities, inability to work ranged from 14.9% of survivors with hypertension to 27.9% of survivors with cardiovascular conditions compared to 5.4% of controls (all p < 0.001), while survivors with no comorbidities did not differ from controls. Conclusions: AYA cancer survivors with ongoing health problems may face educational or work-related limitations. Early detection and management of health problems could help AYA cancer survivors control health problems before their ability to attend school or employment is disrupted.