Cancer-Related Impacts on Employment and Strategies for Support Among Long-Term Young Adult Survivors of Hematologic Malignancies

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Abstract
PURPOSE: Employment is a core component of development in young adulthood and may be drastically affected by cancer. As part of a multi-institution financial navigation trial (ClinicalTrials.gov identifier: NCT05620979 ), we sought to explore employment-related experiences of long-term young adult (YA) survivors of cancer. METHODS: We conducted a secondary qualitative analysis of YA (age 18-39 years) survivors of hematologic malignancies. Participants completed baseline questionnaires pertaining to education and work. A subset of participants completed an optional semistructured interview after trial completion, focused on financial experiences. To contextualize the cohort and supplement qualitative findings, survey data were analyzed using descriptive statistics. We analyzed interview transcripts using directed content analysis and inductive reasoning to examine employment-related themes. RESULTS: One hundred thirty YA participants (median 31 years; Q1-Q3, 27-35) were enrolled with median time from cancer diagnosis of 10 years (Q1-Q3, 6-16). Most (82%) were currently employed, 77% of whom worked full time; 21% were students. Almost half (46%) reported that cancer continued to affect their education and/or employment; 29% had taken extended work leave in the previous year for cancer-related reasons. Challenges expressed in interviews with 45 participants included difficulties maintaining work because of treatment and side effects, interruptions affecting employment trajectory, and choosing work primarily for insurance/health-related reasons. Recommendations from YAs included building personal financial literacy, seeking financial resources, and suggesting clinicians incorporate screening and training for vocational and financial challenges. CONCLUSION: Many long-term YA survivors of cancer reported substantial, ongoing impacts on their work-related achievement and trajectory. These findings underscore the need for universal screening and support throughout the cancer care continuum.

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