Cancer among adolescents and young adults contributes to reduced employment: relationship not mediated by educational attainment

PURPOSE: To determine if the level of educational attainment mediates the relationship between a history of cancer experienced as an adolescent and young adult (AYA) and subsequent employment status. METHODS: We identified AYAs with a history of cancer diagnosis between the ages of 15 and 22 using the Canadian Community Health Survey (years 2000 to 2017) linked to the Canadian Cancer Registry. Marginal structural mediation models were used to decompose the total effect of cancer on employment into the natural direct effect and the natural indirect effect through education completed. Employment status was categorized as full-time (reference category), part-time, or not employed and analyzed using a multinomial logistic marginal structural model. RESULTS: We identified 202,960 individuals, of whom 270 were diagnosed with cancer as an AYA. The average elapsed time from diagnosis to survey completion was 8.7 (SD, 5.1) years. Compared to cancer-free peers, survivors had 1.62 (95% CI, 1.22, 2.10) times the odds of non-employment compared to full-time employment. Educational attainment mediated 14.0% (95% CI, -2.1%, 30.8%) of this total effect. No evidence of a significant effect of cancer on part-time employment was observed. CONCLUSIONS: Being diagnosed with cancer between the ages of 15 and 22 contributes to subsequent non-employment. Findings highlight the employment challenges faced by AYA survivors of cancer. IMPLICATIONS FOR CANCER SURVIVORS: Cancer's adverse effect on AYA survivors is directly on employment status rather than through the level of education attained, highlighting opportunities for interventions that promote work ability among survivors