Childhood cancer survivors: the social impact in adulthood
The 12th PanCare Meeting for Childhood Cancer survivors was held in Amsterdam, and one session focused on social outcomes.
Sabine Karner, PanCare board member, summarizes its main findings.
The 12th PanCare Meeting was held in Amsterdam (The Netherlands). Beyond a number of scientific presentations on late effects, one of them focused on the social outcomes of childhood cancer survivors. Sabine Karner, PanCare board member, summarizes the main findings and observations of this session.
Childhood cancer survivors: The occupational challenges
The number of childhood cancer survivors is increasing. However, adverse late effects are related to decreased ability to work.
Unemployment Prevalence of Childhood Cancer Survivors :
- Childhood Cancer Survivors of Central Nervous System (CNS) and brain tumors are almost five times more likely to be unemployed
- Risks for survivors of blood or bone cancers were elevated but not statistically significant
- No increased risk was found for survivors of other or mixed diagnosis
Unemployment Prevalence of Adult Cancer Survivors: They have “only” a 37% higher chance of unemployment compared to controls. Compared to childhood cancer survivors, they already have work experience, have professional relationship with employer, and they have access to occupational physician as well as rehabilitation services. Finally, the treatment process focuses early on return to work, and may result in fewer disabilities. 
Risk factors for unemployment in childhood cancer survivors are as follows:
- Younger Age (on average, career starts at a later age than siblings)
- Female (young female childhood cancer survivors are more likely to choose not to start working compared to males and healthy females)
- Treatment (Cranial Radiotherapy)
- Physical late effects (poor physical functioning)
- Neurocognitive late effects (task efficiency limitations, memory problems)
- Emotional problems (depression, anxiety, emotional regulation, coping with illness)
- Discrimination (reported in US and Japan)
- Pain and fatigue
Employment is important for patients and for the psychosocial oncological care; therefore early interventions are needed and can greatly influence quality of life. 
What must be done?
It is very important to increase the knowledge about occupational health in childhood cancer survivors, and to identify those patients who are at risk for unemployment. Furthermore, intervention program must be developed, which should be based on guidelines. , 
So far, very few intervention programs exist for childhood cancer survivors in European countries. Two projects were presented during the session: one from the Netherlands and one from Austria.
EMMA@Work is a job training program in the Netherlands. It empowers survivors for work and job mediation. More information about the program is available at www.emma-at-work.nl. 
“Youth and their Future – guidance into work force” is the newly established intervention program in Austria. It is the result of cooperation between the Austrian Childhood Cancer Organization, the hospitals and a private consultancy for coaching and training “die Berater”. 
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 De Boer et al. (2006): Adult Survivors of Childhood Cancer and Unemployment. A Metananalysis. Cancer. http://onlinelibrary.wiley.com/doi/10.1002/cncr.21974/pdf
 De Boer et al. (2009): Cancer Survivors and Unemployment. A Meta-analysis and Meta-regression. YAMA. http://jama.jamanetwork.com/article.aspx?articleid=183387
 Powerpoint presentation from Angela de Boer (2013). http://www.pancare.eu/documents/meetings/amsterdam-2013/presentations/session-3/01-occupational-health-outcomes-in-childhood-cancer-survivors.pdf
 Powerpoint presentation from Martha Groothenhuis (2013). http://www.pancare.eu/documents/meetings/amsterdam-2013/presentations/session-3/02-wajong-study.pdf
 Powerpoint presentation from Andrica de Vries (2013). PanCare Meeting. http://www.pancare.eu/documents/meetings/amsterdam-2013/presentations/session-3/03-dutch-guideline-occupational-health-after-childhood-cancer.pdf
 Powerpoint presentation from Anita Kienesberger (2013). PanCare Meeting. http://www.pancare.eu/documents/meetings/amsterdam-2013/presentations/session-3/04-youth-and-their-future-guidance-into-the-work-force.pdf
 Powerpoint presentation from Rod Skinner (2013). PanCare Meeting. http://www.pancare.eu/documents/meetings/amsterdam-2013/presentations/session-3/06-socialoutcomesguidelines-2oct2013.pdf
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