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

JAMA Oncol. 2018 May 1;4(5):707-711. doi: 10.1001/jamaoncol.2017.3372.


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.

MeSH terms

  • Adolescent
  • Cancer Survivors*
  • Child
  • Child, Preschool
  • Cross-Sectional Studies
  • Employment*
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Neoplasms / epidemiology*
  • Siblings
  • Socioeconomic Factors