Workforce Entry and Employment Trajectories among Adolescent and Young Adult Hematopoietic Cell Transplant Survivors...

As survival after hematopoietic cell transplantation (HCT) improves, employment has emerged as a key survivorship outcome. However, little is known about employment attainment and sustainability among adolescent and young adult (AYA) survivors without prior work experience.

We conducted a nationwide cross-sectional survey of HCT survivors transplanted at ≤39 years of age, aged ≥20 years at survey, and without continuous employment before diagnosis. We evaluated employment attainment, timing of first employment, and subsequent outcomes, including leave of absence and resignation. Cumulative incidence was estimated using the Kaplan-Meier method, and associated factors were analyzed using Cox regression models.

Among 240 participants, 186 (78%) achieved employment after HCT. The cumulative incidence of employment reached 49% and 60% at 5 and 10 years, respectively. Median age at first employment was 22 years (range, 16-45), with all but one entering the workforce by their 20s. Among employed participants, 16% experienced leave of absence and 37% resigned, both occurring at a median of 2 years. Female sex and the presence of occupational healthcare staff were associated with higher incidence of leave, whereas occupational healthcare staff was associated with lower risk of resignation. Employment trajectories were dynamic with frequent transitions in status and type.

Although most AYA HCT survivors without prior work experience successfully entered the workforce, maintaining stable employment remained challenging. Employment attainment and employment sustainability appear to represent distinct survivorship outcomes, highlighting the need for longitudinal multidisciplinary support addressing both medical and developmental factors.