What are the associations between “job lock” and a history of childhood cancer?
In this cross-sectional survey study, almost 1 in 4 of the 394 full-time employed survivors of childhood cancer reported a history of “job lock” (staying at a job to keep work-related health insurance). Job lock was associated with factors including female sex, history of health insurance denial, problems paying medical bills, and a severe, disabling, or life-threatening chronic health condition.
The need for insurance coverage may limit childhood cancer survivors’ employment trajectory.
Childhood cancer survivors may be reluctant to make changes in their employment because of access to health insurance.
To examine the prevalence of “job lock” (staying at a job to keep work-related health insurance) in a sample drawn from an established, multi-institutional cohort of full-time employed childhood cancer survivors compared with a random sample of siblings and to explore factors associated with job lock among cancer survivors.
Design, Setting, and Participants
Cross-sectional survey of full-time employed adult survivors of childhood cancer and a random sample of siblings derived from a cohort of 25 US pediatric oncology centers.
Data collection included sociodemographic factors, insurance coverage, chronic medical conditions, and treatment.
Main Outcomes and Measures
Self-report of job lock and factors associated with job lock.
Among the 522 participants, 394 were cancer survivors (54.5% male) and 128 were siblings (51.5% male). Job lock was reported by 23.2% (95% CI, 18.9%-28.1%) of survivors, compared with 16.9% (95% CI, 11.1%-25.0%) of siblings (P = .16). Job lock was more common among survivors reporting previous health insurance denial (relative risk [RR], 1.60; 95% CI, 1.03-2.52) and problems paying medical bills (RR, 2.43; 95% CI, 1.56-3.80). Among survivors, being female (RR, 1.70; 95% CI, 1.11-2.59; P = .01) and having a severe, disabling, or life-threatening health condition (RR, 1.72; 95% CI, 1.09-2.69; P = .02) were associated with job lock.
Conclusions and Relevance
Job lock is common among long-term childhood cancer survivors who are employed full-time. A survivor’s decision to remain employed at a job in order to maintain health insurance coverage may affect career trajectory, diminish potential earning power, and ultimately impact quality of life.
Kirchhoff AC, Nipp R, Warner EL, et al. “Job Lock” Among Long-term Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study. JAMA Oncol. 2018;4(5):707–711. doi:10.1001/jamaoncol.2017.3372
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