Adult survivors of childhood cancer and unemployment : a metaanalysis

We read with interest the report of de Boer et al1 describing the risk of unemployment of adult survivors of childhood cancer compared with healthy controls. We are currently evaluating the quality of life in survivors of bone tumors in the Pediatric Department at M. D. Anderson Cancer Center. Preliminary information on 250 patients reveals the following occupations in 15 long-term survivors: physicians (7), accountants (2), lawyers (2), banker (1), architect (1), travel agency manager (1), and radio disc jockey (1). While 1 swallow does not make a summer, it is important to emphasize that the outcome may not be as gloomy as perceived in the de Boer et al report and that such patients have the potential to become respected members of society. Of interest also is that 1 of the authors of this communication (G.O.) is a former patient and now a physician and has written articles describing the outcome and complications of her condition. An attempt was made to treat with chemotherapy only and to abrogate surgery, but the attempt was unsuccessful and she subsequently underwent several operative procedures that have been published. The above examples could be cited to patients and parents who are about to undergo treatment for bone tumors. Not only should the potential for cure and late effects of treatment be discussed, but also the finding that patients may successfully enter the workforce. It is also supportive of the findings of Eiser et al,4 who could not demonstrate increased deficits in measures of anxiety, depression, or self-esteem in long-term survivors when compared with matched controls.