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Letters
July 1, 2009

Employment Status Among Cancer Survivors—Reply

JAMA. 2009;302(1):32-35. doi:10.1001/jama.2009.906

In Reply: We agree with Drs Mols and van de Poll-Franse that being treated with chemotherapy is a significant predictor of work changes after cancer. However, these work changes are not necessarily equal to unemployment, and we could therefore not include the cited studies. Being treated with chemotherapy is nevertheless associated with cancer diagnosis, which in turn showed a relationship with unemployment in our meta-regression.

Dr Farley Short and colleagues added valuable individual studies to the complicated field of cancer survivors and employment. However, they were not the only researchers. It has long been discussed whether cancer survivors are at higher risk of unemployment. The purpose of our meta-analysis was to systematically review the results of all available sound epidemiological studies on unemployment of cancer survivors. In this case, it is important not to focus on individual studies.1 In addition, whenever possible we excluded from our analyses patients who were students, homemakers, or retired to ensure that the remaining persons were likely unemployed. Farley Short et al suggest that very few nonworking survivors in their studies were looking for work. However, we do not know of any articles in which these results have been reported. Their suggestion that cancer survivors can shift to other pursuits would mean that having a job for a cancer survivor would be unimportant, both financially and socially. For the majority of cancer survivors, the opposite is true.2

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