Are lymphoma survivors really at higher risk for unemployment/underemployment?

In this issue of Leukemia and Lymphoma , Chen and colleagues retrospectively investigated the impact on employment and health insurance status of undergoing treatment for Hodgkin lymphoma (HL). The study found that, compared to their siblings, survivors of HL were more likely to report job denial, difficulty obtaining insurance due to medical history, and difficulty changing jobs due to fear of losing insurance coverage. Factors associated with job denial included: male gender, lower income, and presence of physical disfigurement such as scarring of the head and neck. Being male and having an impairment interfering with a job were associated with difficulty obtaining health insurance. Difficulty changing jobs due to fear of losing insurance was associated with 4 physician visits in 2 years (more frequent ongoing medical care), 10 years from time of diagnosis, and permanent hair loss from treatment [1]. Though survivors of HL reported similar rates of employment and health insurance coverage as their siblings, they faced greater challenges in obtaining desired work positions or obtaining and maintaining health insurance coverage. With increasing numbers of survivors of HL and all cancers in general, there is a need to increase our awareness of potential adverse long-term effects that in turn have profound effects on the ability of survivors of cancer to return to being productive members of society. Th e Childhood Cancer Survivor Study (CCSS) off ered many insights regarding the relationships of employment, insurance and other post-treatment eff ects among long-term survivors of cancer. Having cancer diagnoses and receiving cancer treatments were associated with signifi cant cognitive or physical disability, and were found to increase unemployment risk [2]. Another study has shown that survivors of all types of childhood cancer diagnoses were at increased risk of unemployment, being highest among those with brain tumors [3]. Th is was attributed to defi cits in perception, cognition or movement, which are critical functions for most jobs. It has also been shown that, compared to siblings, adult survivors of childhood cancer had signifi cantly lower rates of health insurance coverage and more diffi culties obtaining coverage [4]. Th is is particularly concerning, since survivors of cancer are at risk for second primary tumors and need close medical surveillance throughout life [5]. Other factors shown to aff ect a cancer survivor ’ s ability to return to work include persistent fatigue, physical ability, amount of work to be performed, and perceived workplace support [6 – 9]. Survivors of lymphoma who received a bone marrow transplant (BMT) may also encounter an additional myriad of medical and psychosocial long-term aff ects infl uencing employment and insurance status post-therapy. Among childhood survivors of BMT, 19% rated fi nding work as their main concern in life, compared to only 2% of their agematched controls [10]. Th ere are also reports of persistent defi cits in work-related functioning [11]. Th ese fi ndings are in line with a report of Barrera and colleagues who found that young adults who underwent BMT during childhood experienced more problems, compared to their peers, with regard to their studies and work possibilities [12]. Th e three aspects of fatigue (physical, mental and total), as well as chronic fatigue in the transplant group assessed, were signifi cantly more pronounced in all patients compared with the general population [13].