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Brief Report
May 2018

“Job Lock” Among Long-term Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study

Author Affiliations
  • 1Huntsman Cancer Institute, University of Utah, Salt Lake City
  • 2Department of Pediatrics, University of Utah, Salt Lake City
  • 3Department of Medicine, Massachusetts General Hospital Cancer Center, Boston
  • 4Harvard Medical School, Boston
  • 5Department of Pediatrics, Massachusetts General Hospital, Boston
  • 6Department of Pediatrics, Harvard Medical School, Boston
  • 7Clinical Research Division and Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
  • 8Mongan Institute Health Policy Center, Massachusetts General Hospital, Boston
  • 9Massachusetts General Hospital Cancer Survivorship Program, Massachusetts General Hospital Cancer Center, Boston
  • 10Department of Medicine, Duke University Medical Center, Durham, North Carolina
  • 11Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
  • 12Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
  • 13Department of Epidemiology and Cancer Control, St Jude Children’s Research Hospital, Memphis, Tennessee
JAMA Oncol. 2018;4(5):707-711. doi:10.1001/jamaoncol.2017.3372
Key Points

Question  What are the associations between “job lock” and a history of childhood cancer?

Findings  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.

Meaning  The need for insurance coverage may limit childhood cancer survivors’ employment trajectory.


Importance  Childhood cancer survivors may be reluctant to make changes in their employment because of access to health insurance.

Objective  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.

Exposures  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.

Results  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.