ment status has obvious financial benefits and is often also necessary for health insurance coverage, self-esteem, and social support. Survivors of childhood cancer may have late effects that limit their initial entry into the workforce or restrict their employment options. In a recent study of over 10,000 members of the Childhood Cancer Survivor Study cohort, virtually all (95 percent) of the survivors had worked, but the likelihood of employment was lower as compared to their siblings (Pang et al., 2002). Similar findings emerged from an earlier survey of 219 childhood survivors who were treated between 1945 and 1975 and were at least 30 years old at the time of the survey. Childhood survivors, with the exception of survivors of CNS tumors, reported very similar employment histories as a matched control group. Members of the control group, however, reported somewhat higher annual incomes than did the survivors (Hays et al., 1992).

When employed, cancer survivors have often reported problems in the workplace, including dismissal, failure to hire, demotion, denial of promotion, undesirable transfer, denial of benefits, and hostility (Hoffman, 1996). Studies conducted prior to the passage of comprehensive employment discrimination laws suggest that survivors of childhood cancer encountered substantial employment obstacles:

  • 43 of 403 (11 percent) Hodgkin’s disease survivors treated at Stanford University experienced difficulties at work that they attributed to their cancer history (Fobair et al., 1986),

  • approximately 11 percent of adult survivors of childhood cancer reported some form of employment-related discrimination according to a study of 227 former pediatric cancer patients (Green et al., 1991),

  • 15 of 60 (25 percent) survivors of childhood cancer in another study reported job discrimination (10 persons were refused a job at least once, 3 were denied benefits, 3 experienced illness-related conflict with a supervisor, 4 reported job task problems, and 11 were rejected by the military) (Koocher and O’Malley, 1982),

  • 8 of the 40 (20 percent) survivors of childhood/adolescent Hodgkin’s disease reported job problems (Wasserman et al., 1987), and

  • younger cancer survivors who were either employed or active in the labor market were more concerned than older survivors about revealing their cancer history in searching for another job (Koocher and O’Malley, 1982).

Most employers treat cancer survivors fairly and legally. Some employers, however, erect unnecessary and sometimes illegal barriers to survivors’ job opportunities (Hoffman, 1996; Hoffman, 1999; Hoffman, 2002a). Most personnel decisions are driven by economic factors, not by charitable or personal consideration. Employers may be motivated to fire an em-

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