Income and Employment Outcomes of Survivors of Childhood Cancer in Early Adulthood: A Population-Based Longitudinal Matched Cohort Study in Canada

Background and Aims: In addition to impacts on physical and mental health, childhood cancer can affect a survivor’s education, employment, and career path. We examined the effect of childhood cancer on employment income and employment status throughout early adulthood, using linked administrative data. Methods: Children diagnosed with cancer (aged ≤14 years from 2000-2017) in Canada were identified from a population-based cancer registry and exact-matched to cancer-free individuals by birth year and sex. Using national tax records, we examined longitudinal effects in annual employment income (in 2017 CAD) and employment (declared income of $>$$0) from adulthood (≥18 years) until 2017. Absolute and relative effect sizes were examined using generalized estimating equations. Subgroup analysis was conducted by cancer type (hematologic/central nervous system [CNS]/solid). Results: A total of 4,320 adult-aged survivors were matched to 1,479,480 cancer-free individuals. Survivors had a median attained age of 22 years by 2017 (range: 18-32) and 49% were diagnosed with a hematologic malignancy. After matching on baseline characteristics and adjusting for age and period effects, survivors, on average, had lower earnings than cancer-free individuals (4% lower per year; -$333CAD, 95%CI: -$669, $4), and were less likely to be employed (risk ratio [RR] 0.96, 95%CI: 0.95-0.97). Survivors of CNS tumors had the most pronounced differences in income (17% lower; -$1,919 CAD, 95%CI: -$2,768, -$1,071), and were 11% less likely to be employed (RR 0.89, 95%CI: 0.85-0.92). Conclusions: This study generated the first pan-Canadian evidence on socioeconomic outcomes of adult-aged childhood cancer survivors. Important subgroup differences were observed, which may help inform programming for vocational supports across Canadian provinces. Given the cohort’s young age, results may be confounded by pursuit of further education/training. Future directions include an expanded data linkage including older survivor populations, treatment-related information, wider range of financial and educational outcomes (e.g., wealth, postsecondary attainment), and parent/sibling information.

International Society of Pediatric Oncology