Knowledge of Legal Protections and Employment-Related Resources Among Young Adults with Cancer

Abstract

Purpose:

Young adults (aged 18–39 years) who have received a cancer diagnosis can encounter significant barriers in their transition to employment. American young adults' familiarity with federal legislation and resources related to employment is unclear. The study questions included: (1) To what extent do young adults who have had a cancer diagnosis know about legal and programmatic supports that may help to address their employment-related needs and (2) What modes of receiving information about resources to address their employment-related concerns do young adults who have had a cancer diagnosis prefer?

Methods:

A cross-sectional online survey was conducted with a convenience sample composed of 203 young adults living in the United States, had a cancer diagnosis other than nonmelanoma skin cancer, and were between 18 and 39 years of age. Over half (57.6%) of respondents received a cancer diagnosis at age 24 years or older. The mean age at participation was 30.4.

Results:

More than half of the sample (57.0%) was familiar with the Americans with Disabilities Act yet many did not know that cancer was a covered condition. Almost 80% of the respondents were not familiar with other federal initiatives with employment protections for people with cancer. Participants preferred in-person trainings and resource fact sheets as the presentation channels, although sociodemographic factors such as employment status were related to preferred delivery methods.

Conclusion:

These young adults would benefit from additional outreach around federal guidelines concerning employment-related rights and services and programs applicable to young adult cancer survivors.

Introduction

About 60,000 young adults aged 20–39 years are diagnosed with cancer each year in the United States.¹ The majority of young survivors have issues and concerns related to life after diagnosis and treatment. Current conceptualizations and measures for survivorship and functioning may not match the lived experiences for many young cancer survivors because of the complex and interdependent outcome domains such as employment, education, and social connectedness.² Post-treatment, survivors' obstacles in daily living multiply and compound.³

Vocationally oriented programs and interventions for young adult cancer survivors are rare, let alone empirically tested.⁴ Young adults who have had cancer are more likely to have lower levels of career development skills and career readiness compared to noncancer populations.⁵ Treatment side effects and long-term late effects, including cognitive deficits and functional impairments due to treatment, may affect development of work-related skills or delay educational attainment, thereby altering one's career trajectory.

Consequently, many young adults who have had cancer face challenges in their transition to higher education and employment.^6,7 For example, individuals diagnosed with cancer before schooling, including higher education, has ended are less likely to graduate from college, which has been associated with lower levels of employment and wages averaging <$40,000 per year.⁸ Looking across various indicators of financial well-being, Landwehr et al.⁹ found that young adult survivors of cancer fared worse than their age-matched peers. While there are legal and vocational resources to ameliorate some of these challenges, they are underutilized and not robust.¹⁰ Young adults who have had cancer do not exhibit the same career readiness nor graduate from secondary, undergraduate, and graduate school at the same rate as their peers.^6,11

Despite the challenges encountered by cancer survivors, many are resilient and successful. For instance, one sample of long-term pediatric survivors of bone tumors who had serious physical disability involving the lower limb attained an educational level and annual net individual income that exceeded the U.S. general population.¹² Employment accomplishments vary widely across individuals and time.

To capture those multiple dimensions, Mehnert et al.¹⁰ developed a conceptual framework composed of three domains addressing the physical and mental barriers cancer survivors may face in the work place. First, there are individual and interpersonal factors.¹⁰ The second domain refers to the short-term effects of the cancer diagnosis and subsequent treatment such as fatigue. Finally, the long-term and late effects of cancer treatments and ongoing health care services affect quality of life and social reintegration.¹³ Barriers encountered in any one domain likely affect other domains.

Laws, support services, and resources are available to protect and support the employment of cancer survivors, such as the Americans with Disabilities Act (ADA), the Family and Medical Leave Act (FMLA), the Genetic Information Nondiscrimination Act (GINA), the Health Insurance Portability and Accountability Act (HIPAA), and provisions of the Consolidated Omnibus Budget Reconciliation Act (COBRA) that relate to health insurance. For example, the ADA, which was passed into law in 1990 and amended in 2008, prohibits employment discrimination on the basis of disability (42 U.S.C. § 12111-17). ADA lawmakers defined disability as an impairment that substantially limits major life activities, including working, interacting with others, and normal cell growth. Its employment regulations specifically acknowledge cancer as an impairment that substantially limits normal cell growth, including those that are in remission [29 C.F.R. §§ 1630.2(j)]. Table 1 outlines major legislation that can affect young adults with cancer.

Table 1.

Select Federal Legislation Relevant for Young Adults with Cancer

The ADA protects cancer survivors from discrimination in the work place.

FMLA allows eligible employees to take up to 12 weeks of unpaid, job-protected leave in a 12-month period for certain family and medical reasons with continuation of group health insurance coverage.

COBRA requires group health plan to offer a continuation of coverage, on a temporary basis, to individuals and their families in cases where coverage would have ended.

HIPAA of 1996 protects and secures personal medical information.

GINA of 2008 protects individuals from health insurance companies or employers misusing genetic information.

The Rehabilitation Act of 1973 prohibits discrimination on the basis of disability in programs funded by the federal government.

ERISA of 1974 protects employees so they receive the benefits and pension as promised by their employers.

ADA, Americans with Disabilities Act; COBRA, Consolidated Omnibus Budget Reconciliation Act; ERISA, Employee Retirement Income Security Act; FMLA, Family and Medical Leave Act; GINA, Genetic Information Nondiscrimination Act; HIPAA, Health Insurance Portability and Accountability Act.

Studies of disability discrimination complaints filed with the Equal Employment Opportunity Commission clearly indicate that cancer survivors face very different types of discrimination in the workplace compared to other disability groups. Cancer survivors file greater numbers of complaints over job loss, terms and conditions of employment, wages, and demotion than other disability groups. These same studies also show that cancer survivors file fewer discrimination complaints than other disability groups and file few allegations over denials of reasonable accommodation, possibly because cancer survivors' lack awareness of their rights under disability nondiscrimination laws. These studies concluded that cancer survivors experience more actual discrimination than other groups.^3,14 Another study indicated that 70% of young adults with cancer specifically wanted help with understanding and access to insurance and disability options.¹⁵

At present, little is known about which interventions are the most effective at helping individuals who have had a cancer diagnosis participate in the labor force, particularly young adults who are developing their career readiness skills.¹⁶ With some exceptions, most resources relevant to employment focus either on young adults or individuals with cancer, but not young adults with a cancer related disability.^17,18

Cancer survivors' workplace related experiences may provide a strong foundation upon which to develop vocational psychology interventions. Toward that end, the following questions were explored: 1.

To what extent do young adults who have had a cancer diagnosis know about employment-related legal and programmatic supports?

How do young adults who have had a cancer diagnosis prefer to receive employment-related information?

Methods

A cross-sectional online survey was conducted. A convenience sample size of 210 participants was justified by a priori power analysis. The Southwest ADA Center (SWADA), housed within the Independent Living Research Utilization program at TIRR Memorial Hermann Hospital in Houston, Texas, led the study in partnership with collaborators at SEDL (formerly the Southwest Educational Development Laboratory), and the University of Texas MD Anderson Cancer Center (MDACC). [SEDL merged with the American Institutes for Research (AIR) in January 2015.] The Institutional Review Boards at the University of Texas Health Science Center and MDACC approved the study.

Participant recruitment

Participants who met the study selection criteria (N = 203) were young adults who lived in the United States, had a cancer diagnosis other than nonmelanoma skin cancer, and were between 18 and 39 years of age. Participants were offered a $20 gift card. AIR researchers recruited online through cancer advocacy and service organizations, invitations through social media, and publicizing the study in organizational newsletters. Researchers also sent a letter and follow-up flyer to respondents, requesting their help sharing the survey. MDACC conducted in-person recruitment, distributing information directing respondents to the online survey platform. MDACC recruitment populations included: (1) patients in active treatment in both the inpatient and ambulatory settings, post-treatment in primary and long-term follow-up clinics; (2) patient members of the institution's Young Adult Advisory Council; and (3) those attending locally sponsored health education conferences, fundraising events, and social support events.

Survey instrumentation

In 2011, SWADA and SEDL staff, in partnership with colleagues from MDACC, developed a survey about the employment-related effects of cancer. Some items were adapted from an existing British survey “Work and cancer: How cancer affects working lives,” developed by Cancer Backup (2005). This survey was adapted to fit a U.S. audience and piloted among 32 adult cancer survivors.²⁰

In 2015, SWADA and SEDL/AIR staff solicited feedback from over 15 national young adult cancer advocacy and service organizations on how to tailor an existing survey used by Murphy et al.²⁰ to be more applicable to young adults with cancer. Chief changes were to acknowledge that many young adults hold more than one job, may still be students and so have access to different sets of resources, and may still be financial dependents of their parents. In addition, questions pertaining to one's remission status were added by recommendation from a member of the research team who was a young adult with cancer.

The revised 2015 version of the survey, focusing on young adults, included a total of 49 possible questions. The survey took ∼25 minutes to complete and included skip logic so that respondents saw only pertinent questions. General content areas relevant to this study included: employment status and educational attainment; age of cancer onset and experiences with cancer treatment and remission; and familiarity with federal medical legislation.

Data analyses

The descriptive statistics as shown in Table 2 outlines the sample's key demographic features. Frequencies and cross-tabulations were performed to investigate the relationship between demographic features and knowledge around federal legislation and state rehabilitation services.

Table 2.

Demographics of Sample (N = 203)

	Frequency	Percent
Race
White	160	78.8
Black or African American	10	4.9
Asian	4	2.0
Other	6	3.0
Not reported	23	11.3
Spanish, Hispanic, or Latino/Latina
Yes	21	10.3
No	161	79.3
Gender
Male	41	20.2
Female	141	69.5
Not reported	21	10.3
Age at diagnosis
18 years or younger	41	20.2
19–23 years old	23	11.3
24 years old or older	117	57.6
Not reported	22	10.8
Cancer type
Breast	73	36.0
Colon and rectal	11	5.4
Endometrial	5	2.5
Leukemia	16	7.9
Lung	3	1.5
Skin (melanoma)	7	3.4
Non-Hodgkin lymphoma	9	4.4
Other	54	26.6
Did not report	25	12.3
Employment status
Unemployed, NOT actively looking for work, not retired	16	7.9
Employed, full-time (not self-employed)	101	49.8
Employed, part-time (not self-employed)	30	14.8
Employed, BUT currently on paid or unpaid medical leave	11	5.4
Self-employed	9	4.4
Unemployed, and actively looking for work	14	6.9
Retired AS A RESULT of cancer diagnosis	9	4.4
Never employed	12	5.9
Not reported	1	0.5
Annual household income
<$20,000 per year	27	13.3
$20,000–$39,999 per year	31	15.3
$40,000–$59,999 per year	24	11.8
$60,000–$79,999 per year	33	16.3
$80,000–$99,999 per year	16	7.9
$100,000 per year or more	40	19.7
Do not know	0	0.0
Not reported	32	15.8
Education
High school or lower	17	8.37
Finished technical/vocational school or completed some college	41	20.2
Finished an Associate's or Bachelor's degree	74	36.5
Finished some or all of a graduate degree (e.g., Master's degree or PhD)	48	23.7
Not reported	23	11.33

Findings

The current age of the respondent ranged from 18 to 39 years, with the mean age 30.4 and median age of 31. More than half 57.6% (117/203) received a cancer diagnosis at age 24 years or older. Breast cancer was the most frequent diagnosis (73/203, 36%). More than two-thirds of the respondents (141/203, 69.5%) were female, and almost half employed full-time (101/203, 49.8%). Most respondents were White (160/203 or 78.8%) and non-Hispanic/Latino (161/203, 79.3%), and about one-fourth (48/203, 23.7%) had gone to graduate school. Despite being disproportionately White and more highly educated than average, the income range was comparable to national income range. The 2016 U.S. median household income was $57,617²¹; the survey used ranges for responses so we cannot calculate a sample median, but 43.8% (89/203) came from households with incomes higher than $60,000.

Employment-related resources

As noted earlier, there are numerous federal resources that provide workplace and employment-related protections for people, including young adults, with cancer. Respondents were asked to quantify their familiarity with the stated resources or programs. Table 3 shows the total number of respondents for each item and the percentage of those who indicated the extent to which they were familiar with the legislation. Familiarity was established by a response of either agree or strongly agree.

Table 3.

Percentage of Respondents Familiar with Federal Legislation Related to Cancer

	% Strongly agree	% Agree	% Neither agree nor disagree	% Disagree	% Strongly disagree	Total (N)
ADA	20.3	36.7	16.4	13.6	13.0	177
COBRA of 1986	10.5	36.3	11.7	18.7	22.8	171
ERISA	6.0	15.0	13.2	31.7	34.1	167
FMLA	25.3	42.5	13.8	8.6	9.8	174
GINA	7.1	14.8	15.4	26.6	36.1	169
HIPAA	33.3	36.8	12.1	9.2	8.6	174
Rehabilitation Act of 1973	11.0	15.0	11.0	31.8	31.2	173

HIPAA and FMLA were known to most participants, 70.1% (122/174) and 67.8% (118/174), respectively. They were least familiar with Employee Retirement Income Security Act (21.0%, 35/167) and GINA (21.9%, 37/169). Most were familiar with ADA (57.0%, 101/177). COBRA was familiar to 46.8% (80/171). About one-fourth of the respondents (26.0%, 45/173) were familiar with the Rehabilitation Act of 1973.

When asked if, to their knowledge, the ADA covers people with cancer, respondents were about equally split between those who believed that cancer was a covered condition (48.0%, 85/177) and those who never heard of that particular ADA provision (45.2%, 80/177). Table 4 shows a cross tabulation between degree of familiarity with the ADA and knowledge of its cancer coverage. Respondents who endorsed familiarity with ADA were more likely to select Yes to ADA covers people with cancer than those who strongly disagreed or disagreed that they are familiar with ADA.

Table 4.

Familiarity with Americans with Disabilities Act (ADA) and Knowledge That ADA Covers Cancer

Familiar with ADA	Whether ADA covers people with cancer			N
Familiar with ADA	No	Yes	Never heard	N
Strongly agree	2.8%	75.0%	22.2%	36
Agree	4.6%	58.5%	36.9%	65
Neither agree nor disagree	13.8%	31.0%	55.2%	29
Disagree	8.3%	29.2%	62.5%	24
Strongly disagree	8.7%	17.4%	73.9%	23

Other sociodemographic factors correlated with knowledge of the ADA covering cancer as seen in Table 5. Of respondents that said that the ADA did not cover cancer, all were either employed in some capacity or retired. Those who were unemployed and actively looking for work were the most likely to know that the ADA covered cancer (61.5%, 8/13). Those with more formal education (some or completed graduate school) were more likely to know that the ADA covered cancer (60.1%, 29/48). All other education groups had <50% of respondents who knew the ADA's coverage. Those with household incomes above $60,000 were also more likely to know about the ADA and its coverage of cancer, with more than 50% of respondents in those groups indicating that they knew of the provision.

Table 5.

Sociodemographic Factors and Knowledge That Americans with Disabilities Act Covers Cancer

Sociodemographic factors	Whether ADA covers people with cancer			N
Sociodemographic factors	No	Yes	Never heard	N
Employment
Unemployed, NOT actively looking for work, not retired	0%	40.0%	60.0%	15
Employed, full-time (not self-employed)	8.8%	49.5%	41.8%	91
Employed, part-time (not self-employed)	0%	48.1%	51.9%	27
Employed, BUT currently on paid or unpaid medical leave	10.0%	40.0%	50.0%	10
Self-employed	25.0%	12.5%	62.5%	8
Unemployed, and actively looking for work	0%	53.3%	33.3%	15
Retired AS A RESULT of cancer diagnosis	12.5%	50.0%	37.5%	8
Never employed	0%	27.3%	72.7%	11
Education
High school or lower	5.8%	47.1%	47.1%	17
Finished technical/vocational school or completed some college	7.5%	42.5%	50.0%	40
Associate's or Bachelor's degree	4.1%	37.8%	58.1%	74
Finished some or all of a graduate degree	8.3%	60.4%	31.3%	48
Household income
<$20,000 per year	3.7%	29.6%	66.7%	27
$20,000–$39,999 per year	16.1%	45.2%	38.7%	31
$40,000–$59,999 per year	0%	37.5%	62.5%	24
$60,000–$79,999 per year	9.5%	42.9%	23.8%	42
$80,000–$99,999 per year	0%	56.3%	43.7%	16
$100,000 per year or more	2.5%	50.0%	47.5%	40

As shown in Table 6, more than half of the respondents (63.0%, 109/173) disagreed or strongly disagreed that they were familiar with state rehabilitation services. Not surprisingly, 70.5% (122/173) did not know or believed that state rehabilitation services could support people who had received a cancer diagnosis. The majority of respondents across income groups had never heard of the state rehabilitation services for people with cancer (Table 7). As shown in Table 7, the only group where the majority of the respondents knew that state rehabilitation services covered cancer were those who had a high school education or less. In this group, 64.7% (11/17) of the respondents knew about these services for those with cancer. Respondents who were self-employed were the least likely to know about the state rehabilitation services helping those with cancer, with 0% knowing about these services and 25% (2/8) mistakenly believing that rehabilitation services explicitly did not help people with cancer.

Table 6.

Familiarity with State Vocational Rehabilitation (VR) Services and Knowledge That VR Serves People with Cancer

Familiar with state VR services	Overall % familiar	Knowledge of state VR services for people with cancer			N
Familiar with state VR services	Overall % familiar	No	Yes	Never heard	N
Strongly agree	11.0%	0%	63.2%	36.8%	19
Agree	15.0%	3.8%	53.8%	42.3%	26
Neither agree nor disagree	11.0%	26.3%	26.3%	57.9%	19
Disagree	31.8%	7.3%	18.2%	74.5%	55
Strongly disagree	31.2%	3.7%	18.5%	77.8%	54

VR, vocational rehabilitation.

Table 7.

Sociodemographic Factors and Knowledge That Vocational Rehabilitation Serves People with Cancer

Sociodemographic factors	Knowledge of state VR services for people with cancer			N
Sociodemographic factors	No	Yes	Never heard	N
Employment
Unemployed, NOT actively looking for work, not retired	0%	26.7%	73.3%	15
Employed, full-time (not self-employed)	7.7%	28.6%	63.7%	91
Employed, part-time (not self-employed)	3.7%	37.0%	59.2%	27
Employed, BUT currently on paid or unpaid medical leave	10.0%	20.0%	70.0%	10
Self-employed	25.0%	0%	75.0%	8
Unemployed, and actively looking for work	0%	15.4%	84.6%	13
Retired AS A RESULT of cancer diagnosis	0%	50.0%	50.0%	8
Never employed	9.1%	45.5%	45.5%	11
Education
High school or lower	5.9%	64.7%	29.4%	17
Finished technical/vocational school or completed some college	12.5%	37.5%	50.0%	40
Associate's or Bachelor's degree	2.7%	18.9%	78.4%	74
Finished some or all of a graduate degree	6.3%	22.9%	70.8%	48
Household income
<$20,000 per year	3.7%	29.6%	66.7%	27
$20,000–$39,999 per year	16.1%	16.1%	67.7%	31
$40,000–$59,999 per year	4.2%	33.3%	62.5%	24
$60,000–$79,999 per year	6.3%	37.5%	56.3%	32
$80,000–$99,999 per year	0%	43.8%	56.2%	16
$100,000 per year or more	5.0%	20.0%	75.0%	40

Receiving information about resources

In terms of learning about federal and other resources to address employment-related concerns for young cancer survivors, the majority of respondents preferred in-person trainings (53.2%, 108/203) followed by fact sheets (46.8%, 95/203). About one-third favored webinars or printed brochures (36.5%, 74/203 and 34.5%, 70/203, respectively). About one-quarter of the respondents selected comprehensive manuals as the best format for training (26.5%, 54/203). Table 8 shows the percentage of respondents who selected the given format as a preferred way to receive information about their employment-related concerns. Respondents could choose more than one preferred delivery method.

Table 8.

Preferred Format for Trainings Around Employment-Related Concerns

Format preferred (N = 203)	% Yes
In-person training	53.2
Fact sheets	46.8
Webinars	36.5
Printed brochures	34.5
Comprehensive manuals	26.6
Other	4.4

Sociodemographic characteristics did display some trends in terms of preference between the top two delivery methods (Table 9). Those who were employed full-time and those on medical leave preferred fact sheets compared to in-person trainings. For example, of those who were employed 47.5% (48/101) preferred fact sheets compared to 39.6% (40/101) who preferred in person. More respondents in higher income brackets ($60,000 and above) preferred fact sheets as opposed to in person compared to those in $59,000 or lower, and more respondents who had graduate school education preferred fact sheets compared to in-person trainings.

Table 9.

Top Two Delivery Methods by Sociodemographic Factors

Sociodemographic factors	Preferred delivery method
Sociodemographic factors	% Fact sheets (N)	% In-person trainings (N)
Employment
Unemployed, NOT actively looking for work, not retired	37.5 (6/16)	75.0 (12/16)
Employed, full-time (not self-employed)	47.5 (48/101)	39.6 (40/101)
Employed, part-time (not self-employed)	53.3 (16/30)	70.0 (21/30)
Employed, BUT currently on paid or unpaid medical leave	72.7 (8/11)	36.4 (4/11)
Self-employed	33.3 (3/9)	77.8 (7/9)
Unemployed, and actively looking for work	42.9 (6/14)	64.3 (9/14)
Retired AS A RESULT of cancer diagnosis	55.6 (5/9)	66.7 (6/9)
Never employed	25.0 (3/12)	75.0 (9/12)
Household income
<$20,000 per year	51.9 (14/27)	74.0 (20/27)
$20,000–$39,999 per year	51.6 (16/31)	80.6 (25/31)
$40,000–$59,999 per year	37.5 (9/24)	45.8 (11/24)
$60,000–$79,999 per year	48.5 (16/33)	45.5 (15/33)
$80,000–$99,999 per year	62.5 (10/16)	43.8 (7/16)
$100,000 per year or more	52.5 (21/40)	50.0 (20/40)
Education level
High school or lower	41.2 (7/17)	64.7 (11/17)
Finished technical/vocational school or completed some college	39.0 (16/41)	53.7 (22/41)
Associate's or Bachelor's degree	52.7 (39/74)	67.6 (50/74)
Finished some or all of a graduate degree	62.5 (30/48)	47.9 (23/48)

Discussion of Findings

For many, cancer is a survivable illness, although the associated burdens may increase survivors' vulnerability to poverty and unemployment. Maturational delays are associated with lengthy illness and treatments. The physical, social, and emotional burdens may be long lived. Survivors commonly suffer chronic fatigue and general aches and pains; cognitive dysfunction; and physical activity restrictions. Academic and workplace accommodations are oftentimes necessary.

Findings from this study show that there are several employment and workplace-related resources for young cancer survivors with which they are not familiar. Results also suggest that young cancer survivors may benefit from additional education specifically around ADA coverage related to cancer and its side effects. That said, it is important to note that over a quarter of respondents were not familiar with the ADA at all, which suggests that outreach and educational activities need to both increase the broad familiarity with ADA, as well as specific provisions related to cancer.

Some groups were more aware than others that cancer was considered a disability under the ADA. Unemployed respondents who were actively on the job market were the most familiar with ADA's provision about cancer, while those who were employed full time were the least knowledgeable. This suggests that outreach about the ADA may need to include employers or human resource departments. Other resources for young adults with cancer, such as state rehabilitation services, were not generally known across groups. Given that young adults are in the earlier stages of their career, increasing their knowledge about these resources may help their long-term employment outcomes.

When asked about training preferences around employment-related concerns, respondents preferred in-person trainings and fact sheets. Comprehensive manuals were the least popular, preferred by 26.6%. Importantly, certain sociodemographic factors appear related to delivery preferences. The data suggest that those who are employed, have household incomes above $60,000, and have a graduate education prefer fact sheets over in-person trainings. Given the need to increase awareness of ADA and its coverage of cancer, these findings point to the importance of disseminating information about employment-related resources for young adults with cancer and the ways in which the information may best be received.

Limitations

While informative, this study has limitations. Cross-sectional data, convenience sampling, and language homogeneity impact generalizability. The cancer diagnosis was self-reported for those recruited online so medical conditions were not verified for all respondents. Some respondents may have participated in vocational psychology and career oriented interventions that affected their employment-related knowledge and status. Likewise, cancer related risk factors, such as illness (e.g., brain tumor) and treatment type (e.g., radiation, chemotherapy, and surgery), were not reported. Respondents' physical, neurocognitive, and mental status were not captured, nor was time post-treatment.

Implications of research

Future research opportunities are vast. Strauser⁵ argued the need for interventions to improve childhood cancer survivors' employment outcomes. The evaluation and remediation of physical and psychological health issues should include survivors' career development and work place well-being. Strauser's⁵ argument holds true for young adults with a cancer history as well. However, evidence based information remains scarce.

The impact of legislation and resource awareness on career well-being is unclear. Developing and testing information dissemination models is another aspect of vocational rehabilitation research to be explored.

Likewise, researchers may want to explore what entities—HR departments, health care providers, and state rehabilitation specialists—are best to deliver these trainings. By recognizing that many young adults with cancer are not aware of federal and state resources available to them, we can begin to improve ways to increase knowledge about their rights they can exercise and services they can obtain.

Footnotes

Acknowledgments

The contents of this article were developed under subcontract to Southwest Educational Development Laboratory, an affiliate of American Institutes of Research, from Southwest ADA Center (SWADA). The SWADA is a program of Independent Living Research Utilization, at TIRR Memorial Hermann in Houston, Texas. The SWADA work was funded by grants (Nos. H133A060091 and H133A110027) from the Department of Education's National Institute on Disability and Rehabilitation Research and then by grant number 90DP0022 and 90DP0092, from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this presentation do not necessarily represent the policy of NIDILRR, ACL, and HHS, and you should not assume endorsement by the Federal Government.

Author Disclosure Statement

No competing financial interests exist.

References

Cancer in Young Adults. American Cancer Society Web site. April 2018. Accessed December 10, 2018 from: http://www.cancer.org/acs/groups/cid/documents/webcontent/acspc-042002-pdf.pdf

Zebrack

, Santacroce

, Patterson

, Gubin

Adolescents and young adults with cancer: a biopsychosocial approach. In: Abrams

, Muriel

, Wiener

, (Eds). Pediatric psychosocial oncology: Textbook for multidisciplinary care. Switzerland: Springer International Publishing; 2016; pp. 199–217.

Feuerstein

, Luff

, Harrington

, Olsen

. Pattern of workplace disputes in cancer survivors: a population study of ADA claims. J Cancer Surviv. 2007; 1:185–92.

Strauser

, Jones

, Chiu

, et al. Career development of young adult cancer survivors: a conceptual framework. J Vocat Rehabil. 2015; 42(2);167–76.

Strauser

Career readiness and vocational outcomes in a group of young adult cancer survivors: implications for vocational rehabilitation. NARRTC conference presentation, Alexandria, VA, 2013.

Strauser

, Wagner

, Wong

, O'Sullivan

. Career readiness, developmental work personality and age of onset in young adult central nervous system survivors. Disabil Rehabil. 2013; 35(7):543–50.

Cheatham

, Smith

, Elliott

, Friedline

. Family assets, postsecondary education, and students with disabilities: building on progress and overcoming challenges. Child Youth Serv Rev. 2013; 35:1078–86.

Nathan

, Hayes-Lattin

, Sisler

, Hudson

. Critical issues in transition and survivorship for adolescents and young adults with cancers. Cancer. 2011; 117:2335–41.

Landwehr

, Watson

, Macpherson

, et al. The cost of cancer: a retrospective analysis of the financial impact of cancer on young adults. Cancer Med. 2016; 5(5):863–70.

10.

Mehnert

, de Boer

, Feuerstein

. Employment challenges for cancer survivors. Cancer. 2013; 119:2154.

11.

Ghaderi

, Engeland

, Gunnes

, et al. Educational attainment among long-term survivors of cancer in childhood and adolescence: a Norwegian population-based cohort study. J Cancer Surviv. 2016; 10(1):87–95.

12.

Ottaviani

, Robert

, Huh

, Palla

, Jaffe

Sociooccupational and physical outcomes more than 20 years after the diagnosis of osteosarcoma in children and adolescents: limb salvage versus amputation. Cancer, 119(20):3727–36.

13.

McKenna

, Fabian

, Hurley

, et al. Workplace discrimination and cancer. Work. 2007; 29(4):313–22.

14.

The 2020 Federal Youth Transition Plan: A Federal Interagency Strategy. Federal Partners in Transition Workgroup. February 2015. Accessed October 13, 2016 from: http://youth.gov/docs/508_EDITED_RC_FEB26-accessible.pdf

15.

Donovan

Correlates of psychosocial service use in AYA cancer patients. Psychooncology. 2017; 26:30.

16.

Warner

, Kent

, Trevino

, et al. Social well-being among adolescents and young adults with cancer: a systematic review. Cancer. 2016; 122(7):1029–37.

17.

Strauser

, Feuerstein

, Chan

, et al. Vocational services associated with competitive employment in 18–25 year old cancer survivors. J Cancer Surviv. 2010; 4:179–86.

18.

Zebrack

, Mathews-Bradshaw

, Siegel

. Quality cancer care for adolescents and young adults: a position statement. J Clin Oncol. 2010; 28:4862–7.

19.

Cancer Backup. Work and Cancer: How Cancer Affects Working Lives. London: Cancer Backup; 2005.

20.

Murphy

, Markle

, Nguyen

, et al. Addressing the employment-related needs of cancer survivors. Work. 2013; 46:423–32.

21.

Guzman

. Household Income: 2016. Accessed April 11, 2019 from: https://www.census.gov/content/dam/Census/library/publications/2017/acs/acsbr16-02.pdf