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

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.