MONDAY, May 22 (HealthDay News) -- Adult survivors of childhood cancer are twice as likely to be jobless as those who don't have that health history, a new report finds.

With certain cancers -- those of the brain and central nervous system -- the gap widens even further: those survivors were five times more likely than their counterparts to be unemployed. But people who had had cancers of the blood or bone were not that much more likely than the general population to be unemployed as adults.

The news is worst for U.S. survivors, according to the new review, which will appear in the July 1 issue of Cancer. The researchers looked at 40 studies, including 24 controlled studies that looked at cancer survivors and compared them with healthy control subjects. When they looked by country, they found that U.S. survivors were three times more likely than the control groups to be unemployed, but there was no difference in joblessness between the patient and control groups in Europe.

"We do not know for sure what the best explanation is [for the country differences]," said study author Angela de Boer, a researcher at the Coronel Institute for Occupational Health of the Academic Medical Center in Amsterdam, The Netherlands. "It could be that in the U.S., the viewpoint of the society and employers regarding long-term survivors of cancer is different compared to that in Europe. Another possibility could be that the health insurance system in Europe is different to that in the U.S. In Europe, health insurances are generally not linked to employment in the way they are in the U.S. It would be a nice subject for further research to investigate this issue."

The topic will be of growing interest, since advances in treatment have meant more and more children diagnosed with cancer survive to adulthood. Overall, de Boer noted, the five-year survival rate is now more than 70 percent for pediatric cancers in the United States and the United Kingdom.

It has long been known that childhood cancers can result in problems with depression, anxiety, post-traumatic stress and learning difficulties. Some survivors of childhood cancers may have cardiac or lung damage, chronic fatigue or other handicaps that make securing a job more difficult, deBoer noted.

How can parents help minimize the risk of joblessness later?

"Unfortunately, we did not find many factors that can be influenced to reduce the risk of adult joblessness," she said. "The predictors of unemployment were younger age, younger age at diagnosis, lower education, lower IQ, female gender, motor impairment or epilepsy and receiving radiotherapy. Most of these factors can not be influenced, except for education. Furthermore, we know from other research on employment in patients with a chronic disease that an active attitude does help. So I think that, if possible, a good education and active involvement in [holiday or temporary] jobs in spite of the limitations of the child or adolescent will be most beneficial."

When adult survivors do get jobs, de Boer suggests communicating with their new employer about their difficulties and maintaining an active social network for support.

The link between surviving childhood cancer and encountering difficulties later has long been known, said Wendy Hobbie, associate director of the pediatric oncology nurse practitioner program at the University of Pennsylvania, who has published research on the topic.

"We know that CNS [central nervous system cancer] survivors are at highest risk due to cognitive and other neurological issues," she said. But the conclusion about U.S. and European differences concerned her. In the paper, the authors speculate that despite the Americans with Disabilities Act, which prohibits discrimination towards those with cancer histories and others, perhaps "there is more discrimination regarding cancer in the U.S."

More information

To learn more about childhood cancer effects, visit the American Cancer Society.

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