Impact of cancer on school, work, and financial independence among adolescents and young adults

Abstract

Background For adolescents and young adults (AYAs), the diagnosis of cancer can impede social development, especially with respect to education, employment, and financial independence. However, there are limited quantitative data on the extent and trajectory of life disruptions during cancer treatment for AYA patients. Methods This was a longitudinal, prospective, questionnaire‐based cohort study of 145 AYA patients with cancer aged 15 to 29 years who were treated at a large academic cancer center. Questionnaires were administered shortly after diagnosis and 4 and 12 months after diagnosis. Results Although half of the participants lived with their parents 6 months before diagnosis, 61% lived with their parents after diagnosis (P = .0002 vs 6 months before diagnosis), with a similar proportion reported to be living with their parents 4 months after diagnosis (61%; P = .001) and 55% doing so 12 months after diagnosis (P = .07). Before diagnosis, 38% of the patients were not attending school. After diagnosis, that proportion rose to 61% (P < .0001), with a similar proportion 4 months after diagnosis (61%; P < .0001); 54% were not in school at 12 months (P = .001). Patients experienced similar decrements in employment (30% not working before diagnosis vs 49% not working after diagnosis; P < .0001) and financial independence (37% with complete financial independence before diagnosis vs 31% after diagnosis; P = .02). Overall, 65% of the patients (94 of 145) had not returned to their precancer baseline in at least 1 of these 4 social domains by 12 months after diagnosis. Conclusions For many AYA patients, cancer leads to less engagement with school and work activities and decreased financial independence from parents. Clinicians should engage in early and ongoing discussions with patients about the potential impact of cancer on their lives.

The global burden of adolescent and young adult cancer in 2019: a systematic analysis for the Global Burden of Disease Study 2019

“…A cancer diagnosis during these years can have a considerable impact on individuals' future life trajectory through major stressors, including feelings of isolation, anxiety and depression, concerns about infertility, discontinuing schooling or work, and financial hardship. 1 , 12 , 26 , 27 , 28 Efforts to mitigate the issues distinct to this age group have resulted in the formation of organisations to help support adolescent and young adult patients with cancer. However, although these oncology advocacy efforts focused on adolescents and young adults have been successful in creating awareness campaigns and implementing adolescent and young adult programmes at cancer centres, these efforts have largely been limited to high-income countries.…”

The Impact of Tuberculosis on the Well-Being of Adolescents and Young Adults

“…Data on educational disruption in AYAs with TB are limited and, thus far, only qualitative in nature. Literature on other chronic diseases, however, has reported serious disruptions in schooling for AYAs [73][74][75][76][77][78].…”

Development of an intervention for the social reintegration of adolescents and young adults affected by cancer

“…For AYAs, serious illness may lead to disruptions in everyday activities, school life and social and interpersonal relationships with peers. At the same time, issues of dependence and independence, concerns about physical appearance and existential issues are brought to the fore [ 9 , 11 – 14 ]. AYAs face additional challenges because of the intersection of the cancer experience with the developmental tasks associated with this phase of life, such as establishing their identity, developing a positive body image and sexual identity, separating from their parents, increasing their involvement with peers, dating, and beginning to make important life choices and decisions about education [ 14 – 18 ].…”