Purpose: To examine labor force participation and employment income during early adulthood among childhood cancer survivors and matched cancer-free individuals in Canada.
Methods: Children aged 0–14 diagnosed with cancer from 2000 to 2017 in Canada were identified from the Canadian Cancer Registry and matched to cancer-free individuals by birth year, sex, and region of Canada at age 18. Matched cohorts were generated for all cancers combined, by cancer type (hematologic/central nervous system [CNS]/solid), and age at cancer diagnosis (0–4, 5–9, 10–14 years). Using linked national tax records, we examined labor force participation (declared employment income of > $0) and employment income (2017 CAD) annually during adulthood (≥ 18 years) until 2017. Absolute and relative differences in outcomes between groups were investigated using generalized estimating equations.
Results: Overall, 3635 childhood cancer survivors and 1,032,090 cancer-free individuals were included (median age by maximum follow-up: 22 years). During follow-up, survivors were 5% less likely to be employed (risk ratio [RR], 0.95; 95% CI 0.94, 0.96) and earned 6% lower income annually (ratio of income, 0.94; 95% CI 0.89, 0.98), after adjusting for age and period effects. The largest effect sizes were observed among CNS survivors (RR for, 0.89; 95% CI 0.87, 0.92; ratio of income, 0.77; 95% CI 0.67, 0.89).
Conclusions: In this pan-Canadian longitudinal matched cohort study, we observed differences in socioeconomic outcomes between adult-aged childhood cancer survivors and cancer-free individuals. Given the cohort’s young age, additional studies incorporating education data are warranted.
Implications for Cancer Survivors: Childhood cancer can impact a survivor’s career path. This study provides insight into the financial trajectory of survivors in Canada.