Abstract
Many adolescent and young adult (AYA) survivors are transitioning not only from patient to survivor but also transitioning to the workforce. AYA survivors report many career-related concerns. Career service professionals are well positioned to provide targeted resources. A survey of 40 career service professionals at colleges and universities in the United States revealed that although they have had experience working with AYA survivors, most do not feel adequately trained or aware of survivors' unique needs. However, they are highly receptive to specific resources for AYA survivors. Maximizing connections between career service professionals and AYA survivors may help address survivors' career-related concerns.
Introduction
T
Adolescent and young adult (AYA) cancer survivors, for this study defined as survivors of pediatric or AYA cancers, who are between the ages of 15–39, also face career-related long-term effects of cancer. Like cancer survivors in general, many AYA survivors return to work or school, but struggle with the negative effects of cancer on their careers.5,6 AYA cancer survivors also have excess economic burden compared with those without a history of cancer, estimated at $3170 for excess annual medical expenditures and $2250 in productivity loss. 7 Like adult survivors, AYA survivors have concerns about employment and financial security.8,9
Many survivors in this stage of life face a double transition—the transition from patient to survivor and the career-related transition from student to career. We have only begun to conceptualize and study the complex career-related issues from the perspective of AYA survivors during these key transitions.6,10 In a recent review of studies on unmet needs of AYA survivors, 19% of qualitative studies addressed career development and unemployment in this population. 8 AYA survivors report concerns about career development and employment, including job seeking, employment discrimination, and concerns about work demands and accommodations. They also report wanting information about how to disclose their cancer history. AYA survivors report that job opportunities may be limited by desire for financial security and concerns about insurance coverage. Making career-related decisions and establishing a vocational identity, defined as the long-term career goals and abilities, may be more difficult for AYA survivors than students without a history of cancer. 11 In an analysis of the St. Jude Lifetime Cohort Study, childhood cancer survivors who were unemployed had lower levels of career readiness, and this was mediated by their reported vocational identity. 10
There are estimated to be 47,180 survivors aged 15–19 and 187,490 survivors aged 20–29 living in the United States as of January 1, 2016. 12 Most studies suggest that AYA survivors have educational attainment comparable to their peers and are only slightly less likely to attend college than those without a cancer history.6,13 Therefore, many cancer survivors in this age group are attending institutes of higher education and joining the workforce. At a time of tremendous career development and growth, AYA survivors report wanting the career-related resources to help them with this transition. 14
University services may be critical to meeting AYA survivorship care needs. While student health centers and academic services address medical and academic accommodations, university career services focus on helping students establish career readiness, vocational identity, and transition to employment after college. Although we are beginning to understand the career-related issues from the survivor perspective, no study has focused on those providing career-related services to AYA survivors. The goal of the present study was to assess university career service professionals' experience working with AYA survivors, preparedness for working with AYA survivors, and openness to resources for students who are AYA cancer survivors.
Methods
Procedure
Four hundred universities were randomly selected from a list of all active colleges and universities in the United States. For this randomly selected subset, we obtained the contact email for their undergraduate career services office from the university website. Note that we use the term “university” to refer to both colleges and universities.
An email was sent inviting participation in a 5-minute survey on career-services resources. The survey was conducted through the Qualtrics online survey platform. A survey reminder email was sent after 2 weeks.
Participants could choose to confidentially enter their email for a drawing for a $50 Amazon gift card. Before entering the survey, participants completed an informed consent. Study protocol and all study materials were approved by the Bentley University Institutional Review Board.
Survey
Participants were asked the following questions: “I am aware of the unique career service needs of cancer survivors”; “I feel adequately equipped to address the needs of cancer survivors seeking career services advice”; “I have had training on the career services needs of college students who are cancer survivors”; “I am aware of specific career services resources available for college students who are cancer survivors”; “Career services resources specifically designed for college-aged cancer survivors would be useful”; and “If there was a resource available that specifically addressed the career services needs of cancer survivors, I would provide it to students who were cancer survivors.” All responses were on a 5-point Likert scale from 1 = strongly disagree to 5 = strongly agree. Principal components analysis with Varimax Rotation and Kaiser Normalization using pairwise deletion yielded two factors. The first four items were averaged together to create a measure of overall preparedness for working with AYA survivors, and the last two items were averaged together to create a measure of openness to resources for AYA survivors.
The survey also asked participants to indicate how many experiences they recalled working with a student who was a cancer survivor. For those who had at least one experience, we asked them to think about the most recent experience and answer two open-ended questions to assess: (1) what type of information the student was seeking and (2) what type of resources they provided to the student. We then asked how strongly they agreed with the statement, “I felt I was adequately equipped to address this student's needs” on the same 5-point Likert scale.
Finally, participants provided basic demographic information, including job title, number of years working in the career services profession, the number of career service employees at their university, gender, and age. After consulting with career service professionals before distributing the survey, and to maintain confidentiality, we did not ask participants' detailed information about their university or their personal cancer history. Participants could choose not to answer any question in the survey.
Results
Participants
From the 400 emails that were sent out, 40 career service professionals (10%) consented to participate and complete the survey.
The majority of participants were female (n = 35, male n = 5) and between the ages of 35–64 (18–24 n = 3, 25–34 n = 4, 35–49 n = 18, 50–64 n = 10, 65–79 n = 1, no answer n = 4). Participants identified their positions as directors or associate directors (n = 19), career counselors or coordinators (n = 13), program or administrative assistants (n = 6), and dean (n = 1) or associate dean (n = 1). Their experience in career services varied from a few weeks to 31 years, with an average of 9.62 years (SD = 1.29). The number of employees in the career services offices represented ranged from 1 to 33 with a mean of 6.44 employees (SD = 7.35).
Experience with AYA cancer survivors
Half of participants (n = 20) reported an experience working with a student who was a cancer survivor. Eleven reported 2–5 interactions with cancer survivors, 3 reported 6–10 interactions, and one participant reported 10 or more interactions with students who were cancer survivors. In an open-ended question about their most recent experience with a student who was a cancer survivor, many participants reported that the student was seeking general career-related advice. Some reported cancer-specific concerns, including flexibility related to internships, values and vocational goals, addressing cognitive deficits as a result of treatment, and switching to a career in health promotion and cancer prevention. In reporting resources provided, almost all participants reported providing survivors with general career advice and resources they would give to any other student. Two participants mentioned cancer-specific resources. One had provided links to scholarships for cancer survivors, and the other had advised on framing the cancer experience positively for prospective employers. Almost all somewhat or strongly agreed that they were adequately equipped to address this particular student's needs (n = 16 out of 20, Mean = 1.74, SD = 0.733).
Preparedness and openness to resources
Participants reported a lack of awareness to the specific career service needs and resources available for cancer survivors (Mean = 2.05 [0.79], Table 1). Only one participant reported any training on the potential career-related needs of cancer survivors. The majority said they were not aware of unique needs of cancer survivors (55%) or resources available for students who were survivors (85%). A third reported that they felt somewhat equipped to address these students' needs (32.5%), but no one felt strongly equipped, and the majority did not feel equipped (52.5%).
The majority of participants were open to receiving and distributing resources for this group (Mean = 4.21 [0.74]). Sixty-five percent agreed that career services resources specifically designed for college-aged cancer survivors would be useful, and 87.5% said that they would provide these resources to cancer survivors if available.
Age, gender, years of experience, job level (director, counselor, and administrator), and size of the career services office did not predict preparedness or openness to resources in unadjusted bivariate correlations or fully adjusted linear regression models.
Discussion
The present study examined university career service professionals' experience and awareness of career-related needs of AYA cancer survivors and receptivity to targeted resources for this population. Studies have looked at the role of school psychologists in transitioning younger cancer patients back to school,15–17 but to our knowledge, this is the first study to assess the role of universities in addressing AYA cancer survivors' career-related needs.
Half of all career service professionals surveyed for this study recalled at least one experience interacting with a student who was an AYA survivor. Most reported that they were able to adequately address students' needs, but many reported providing standard career-related resources. Career service professionals reported no training and little awareness of the unique needs of AYA cancer survivors. Although they may feel confident in their ability to help AYA survivors, perhaps because of experience in addressing the needs of students with complex situations or medical needs, there is the opportunity for specific outreach and resources about AYA survivor needs. Career service professionals reported a strong level of receptivity toward tailored resources if these were made available.
We did not find any demographic predictors of preparedness and openness to resources in the present study. This study is limited because we did not explore other factors such as university size and location that may predict more awareness or receptivity to resources. In addition, although we sought a random sample of United States colleges and universities, the sample size was small, and we are not able to assess the representativeness of our responses. We did not follow-up with additional outreach by phone or assess reasons for nonresponse. Additional studies should also address the AYA survivor perspective on career-related resources and their interaction with university career service professionals.
Future research should supplement these initial results with a mixed methods approach to understanding the experience of both career service professionals and AYA survivors using career services. AYA survivors age 20–29 are less likely to report using psychosocial resources. 18 Educational materials aimed toward career service professionals may be a start in reducing AYA survivors' career-related concerns. There are some existing resources that can fill the immediate need. Cancer and Careers (www.cancerandcareers.org) and Stupid Cancer (www.stupidcancer.org) provide career-related tools and advice to cancer survivors, with the latter aimed at AYA survivors. However, no resources are directed toward career service professionals and these results suggest that career service professionals are unaware of specific resources. Deeper understanding of the preferences of career service professionals and AYA survivors can help to develop targeted resources and identify approaches for implementing these during career counseling that fit with AYA-specific preferences. 19
Many AYA survivors are faced with transitioning to the workforce, in addition to transitioning from cancer patient to survivor. 20 They are making decisions about vocational pursuits and are concerned with career readiness. For many, this stage represents the first time they will apply and interview or adjust to a new workplace. AYA survivors may need to negotiate disease-related accommodations or make decisions about disease-status disclosure. They may have specific needs when comparing employee benefits packages, especially with healthcare reform changes. AYA survivors could benefit from career-related resources provided by career service professionals to establish vocational identity and increase career readiness. In addition, career service professionals should be aware that, although there are a number of concerns expressed by AYA survivors about career readiness and development, survivors may also search for a greater sense of purpose or meaning in their work as a result of their cancer experience. 21
University-based career services may prove a significant resource for many AYA survivors. Career service professionals acknowledge a lack of training and awareness of AYA survivors' specific needs and report a desire for targeted resources. Interventions should focus on providing tailored career service resources to both AYA survivors and career service professionals.
Footnotes
Acknowledgments
We thank the Bentley University Office of Career Services, in particular Colleen Murphy, for their guidance on surveying career service professionals. We acknowledge the support of the Bentley University Health Thought Leadership Network. We also thank the career service professionals who responded to our survey.
Author Disclosure Statement
The contents of this article have not been published elsewhere and both authors report no competing financial interests or other conflicts of interest to disclose.