Occupational Cancers

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Epidemiology and Prevention".

Deadline for manuscript submissions: closed (28 February 2023) | Viewed by 23070

Special Issue Editors


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Guest Editor
Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy
Interests: occupational and environmental epidemiology; cancer prevention and control; epidemiologic methods
Special Issues, Collections and Topics in MDPI journals

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Guest Editor
Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy
Interests: occupational medicine; cancer; occupational epidemiology; job-related diseases; cancer prevention; occupational oncology; occupational risk factors

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Guest Editor
Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy
Interests: epidemiology; job-related diseases; cancer prevention; occupational risk factors; infectious diseases; industrial hygiene

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Guest Editor
Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy
Interests: occupational medicine; occupational oncology; occupational epidemiology; oncology; toxicology; musculoskeletal diseases work-related

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Guest Editor
Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy
Interests: cancer epidemiology; gastric cancer; Helicobacter pylori; attributable fraction; cancer screening; cancer prevention; occupational epidemiology
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The main aim of this Special Issue is to focus on different aspects of occupational cancer and results from leaders in the field. Together, the intent is to emphasize the importance of a broad perspective: it is essential to understand the link between cancer and occupational risk factors, how they influence carcinogenetic development, and strategies for prevention. We can no longer take reductionist approaches that consider only the cancer and exposure assessment. Instead, we need to understand the role of genetic factors, lifestyle habits related to job titles, gender disparities, specific occupational tasks, environmental factors, socioeconomic conditions on carcinogenic processes, and how all these interact with each other. In order to do that, we will be collecting scientific contributions from expert international authors for each specific topic.

Prof. Dr. Paolo Boffetta
Dr. Federica Teglia
Dr. Giovanni Visci
Dr. Carlotta Zunarelli
Dr. Giulia Collatuzzo
Guest Editors

Manuscript Submission Information

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • occupational cancer epidemiology
  • exposure assessment
  • individual risk factors
  • environmental factors
  • socioeconomic conditions
  • multiple interaction
  • prevention
  • screening
  • biomarkers
  • gender disparities

Published Papers (12 papers)

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Research

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7 pages, 250 KiB  
Article
No Excess Cancer Risk among Veterinarians in Denmark, Finland, Iceland, Norway, and Sweden after the 1980s
by Laura Laakso, Pikka Jokelainen, Hans Houe, Eystein Skjerve, Johnni Hansen, Elsebeth Lynge, Jan-Ivar Martinsen, Ingrid Sivesind Mehlum, Jenny Selander, Jóhanna Eyrún Torfadóttir, Elisabete Weiderpass, Sanna Heikkinen and Eero Pukkala
Cancers 2023, 15(16), 4079; https://doi.org/10.3390/cancers15164079 - 13 Aug 2023
Cited by 1 | Viewed by 1320
Abstract
The cancer profile of veterinarians has received little research attention, despite the profession potentially being exposed to a wide range of known and suspected carcinogens. In this large-scale cohort study, we assessed cancer incidence in veterinarians in Denmark, Finland, Iceland, Norway, and Sweden, [...] Read more.
The cancer profile of veterinarians has received little research attention, despite the profession potentially being exposed to a wide range of known and suspected carcinogens. In this large-scale cohort study, we assessed cancer incidence in veterinarians in Denmark, Finland, Iceland, Norway, and Sweden, across more than 40 years (1961–2005). The cohort comprised 4708 veterinarians and 119,503 person-years at follow-up. The overall cancer incidence in veterinarians was close to the incidence in the total population in all countries and in all age groups. In male veterinarians, the standardized incidence ratios (SIR) in 1961–1990 were elevated for colon cancer (1.86, 95% confidence interval (CI) 1.39–2.44), prostate cancer (1.35, 95% CI 1.07–1.67), and especially skin melanoma (3.62, 95% CI 2.78–2.84), while there was no longer any statistically significant excess in the more recent follow-up period. Decreased SIRs were observed for lip cancer (0.11, 95% CI 0.00–0.62), laryngeal cancer (0.38, 95% CI 0.12–0.89), lung cancer (0.59, 95% CI 0.47–0.74), and stomach cancer (0.58, 95% CI 0.38–0.86), without a marked change in SIR over time. Non-significant excesses among male veterinarians were also observed in Hodgkin lymphoma (1961–1990 only), and leukaemia. This multi-country study indicates that there was an elevated incidence of several cancer types among male veterinarians before the 1990s but not after that. Some of the findings might rather be attributed to lifestyle factors and not directly to work conditions, but the excess risk of cancers of kidney and bladder, for example, might be related to work exposures. Full article
(This article belongs to the Special Issue Occupational Cancers)
16 pages, 346 KiB  
Article
Attributable Fraction of Cancer Related to Occupational Exposure in Italy
by Giulia Collatuzzo, Federica Turati, Matteo Malvezzi, Eva Negri, Carlo La Vecchia and Paolo Boffetta
Cancers 2023, 15(8), 2234; https://doi.org/10.3390/cancers15082234 - 10 Apr 2023
Cited by 1 | Viewed by 1960
Abstract
Background: Exposure to occupational carcinogens is an important and avoidable cause of cancer. We aimed to provide an evidence-based estimate of the burden of occupation-related cancers in Italy. Methods: The attributable fraction (AF) was calculated based on the counterfactual scenario of no occupational [...] Read more.
Background: Exposure to occupational carcinogens is an important and avoidable cause of cancer. We aimed to provide an evidence-based estimate of the burden of occupation-related cancers in Italy. Methods: The attributable fraction (AF) was calculated based on the counterfactual scenario of no occupational exposure to carcinogens. We included exposures classified as IARC group 1 and with reliable evidence of exposure in Italy. Relative risk estimates for selected cancers and prevalences of exposure were derived from large-scale studies. Except for mesothelioma, a 15–20-year latency period between exposure and cancer was considered. The data on cancer incidence in 2020 and mortality in 2017 in Italy were obtained from the Italian Association of Cancer Registries. Results: The most prevalent exposures were UV radiation (5.8%), diesel exhaust (4.3%), wood dust (2.3%) and silica dust (2.1%). Mesothelioma had the largest AF to occupational carcinogens (86.6%), followed by sinonasal cancer (11.8%) and lung cancer (3.8%). We estimated that 0.9% of cancer cases (N~3500) and 1.6% of cancer deaths (N~2800) were attributable to occupational carcinogens in Italy. Of these, about 60% were attributable to asbestos, 17.5% to diesel exhaust, followed by chromium and silica dust (7% and 5%). Conclusions: Our estimates provide up-to-date quantification of the low, but persistent, burden of occupational cancers in Italy. Full article
(This article belongs to the Special Issue Occupational Cancers)
13 pages, 1251 KiB  
Article
Risk and Status of Gastrointestinal Cancer According to the International Standard Industrial Classification in Korean Workers
by Soonsu Shin, Jun-Hyeok Choi, Kyung-Eun Lee, Jin-Ha Yoon and Wanhyung Lee
Cancers 2022, 14(20), 5164; https://doi.org/10.3390/cancers14205164 - 21 Oct 2022
Cited by 1 | Viewed by 1315
Abstract
To compare the risk of developing gastrointestinal (GI) cancer according to industrial groups, we performed a retrospective cohort study using the database of the Korea National Health Insurance Service (NHIS). We calculated the age-standardized incidence ratios (SIRs) and 95% confidence intervals (95% CIs) [...] Read more.
To compare the risk of developing gastrointestinal (GI) cancer according to industrial groups, we performed a retrospective cohort study using the database of the Korea National Health Insurance Service (NHIS). We calculated the age-standardized incidence ratios (SIRs) and 95% confidence intervals (95% CIs) for the types of GI cancers according to the Korean Standard Industrial Classification (KSIC) compared with the whole employee population. The highest SIR for all GI cancer was found in the “Mining and quarrying” section (SIR, 1.30; 95% CI, 1.14–1.47), followed by the “Transportation and storage” section (SIR, 1.27; 95% CI, 1.24–1.30). Miners and quarriers had the highest risk of developing gastric cancer (SIR, 1.29; 95% CI, 1.06–1.55) and cancer of the liver and intrahepatic bile ducts (SIR, 1.48; 95% CI, 1.17–1.86). Transportation workers had the highest SIR of cancer of the lip, oral cavity, and pharynx (SIR, 1.27; 95% CI, 1.13–1.43) and cancers of the rectum, anus, and anal canal (SIR, 1.27; 95% CI, 1.19–1.35). There were distinct GI cancers with an elevated risk in each industry group. Our findings imply that distinct cancer prevention programs should be developed for each industrial sector. Full article
(This article belongs to the Special Issue Occupational Cancers)
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16 pages, 338 KiB  
Article
Paternal Occupational Exposure to Heavy Metals and Welding Fumes and Testicular Germ Cell Tumours in Sons in France
by Shukrullah Ahmadi, Margot Guth, Astrid Coste, Liacine Bouaoun, Aurélie Danjou, Marie Lefevre, Brigitte Dananché, Delphine Praud, Martie Van Tongeren, Louis Bujan, Olivia Pérol, Joachim Schüz, Barbara Charbotel, Béatrice Fervers, Ann Olsson and the TESTIS Study Group
Cancers 2022, 14(19), 4962; https://doi.org/10.3390/cancers14194962 - 10 Oct 2022
Cited by 5 | Viewed by 1953
Abstract
Testicular cancer is the most common cancer in young men. Its causes are largely unknown, although prenatal occupational and environmental exposures have been suggested. We investigated paternal occupational exposure to heavy metals and welding fumes and the risk of testicular germ cell tumors [...] Read more.
Testicular cancer is the most common cancer in young men. Its causes are largely unknown, although prenatal occupational and environmental exposures have been suggested. We investigated paternal occupational exposure to heavy metals and welding fumes and the risk of testicular germ cell tumors (TGCT) in their offspring. A total of 454 cases and 670 controls were included from a French nationwide case–control study. The INTEROCC job exposure matrix was used to assign occupational exposures (cadmium, chromium, iron, nickel, lead, and welding fumes) to the fathers’ jobs. Odds ratios (ORs) for TGCT were estimated using conditional logistic regression models for frequency-matched sets. Three complementary analytical approaches were used: (1) single-agent analysis, (2) analysis by groups, and (3) principal component analysis (PCA). The proportion of paternal exposure to different heavy metals and welding fumes ranged from 0.7% (cadmium) to 11.3% (lead). Based on PCA, three principal components explained 93.5% of the cumulative variance. No associations were found between heavy metals or welding fumes and TGCT. In this study, paternal occupational exposure to heavy metals or welding fumes was not associated with TGCT development in their sons. Full article
(This article belongs to the Special Issue Occupational Cancers)
11 pages, 916 KiB  
Article
Work Placement and Job Satisfaction in Long-Term Childhood Cancer Survivors: The Impact of Late Effects
by Margherita Dionisi-Vici, Alessandro Godono, Anna Castiglione, Filippo Gatti, Nicoletta Fortunati, Marco Clari, Alessio Conti, Giulia Zucchetti, Eleonora Biasin, Antonella Varetto, Enrico Pira, Franca Fagioli, Enrico Brignardello and Francesco Felicetti
Cancers 2022, 14(16), 3984; https://doi.org/10.3390/cancers14163984 - 18 Aug 2022
Cited by 1 | Viewed by 1293
Abstract
Late effects of cancer and its treatments during childhood or adolescence can impact work placement and increase the risk of unemployment. The aim of this study is to describe the work placement and the perceived job and economic satisfaction of long-term childhood cancer [...] Read more.
Late effects of cancer and its treatments during childhood or adolescence can impact work placement and increase the risk of unemployment. The aim of this study is to describe the work placement and the perceived job and economic satisfaction of long-term childhood cancer survivors (CCS). Jobs have been categorized according to the International Standard Classification of Occupations version 08 (ISCO-08), and satisfaction has been evaluated through the Satisfaction Profile (SAT-P). Out of 240 CCS (female = 98) included: 53 were students, 46 were unemployed and 141 were employed. Within unemployed survivors, 89.13% were affected by late effects (n = 41). The presence of at least one severe late effect was significantly associated with the probability of unemployment (OR 3.21; 95% CI 1.13–9.12, p < 0.050), and having any late effect was inversely related to the level of satisfaction of the financial situation of unemployed CCS (b −35.47; 95% CI −59.19, −11.74, p = 0.004). Our results showed that being a survivor with severe comorbidities has a significantly negative impact on occupation and worsens the perception of satisfaction of economic situations. Routinary follow-up care of CCS should include the surveillance of socioeconomic development and provide interventions, helping them to reach jobs suitable for their health. Full article
(This article belongs to the Special Issue Occupational Cancers)
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14 pages, 1477 KiB  
Article
Burden of Lung Cancer Attributable to Occupational Carcinogens from 1990 to 2019 and Projections until 2044 in China
by Yaguang Fan, Yong Jiang, Xin Li, Xuebing Li, Yang Li, Heng Wu, Hongli Pan, Ying Wang, Zhaowei Meng, Qinghua Zhou and Youlin Qiao
Cancers 2022, 14(16), 3883; https://doi.org/10.3390/cancers14163883 - 11 Aug 2022
Cited by 7 | Viewed by 2209
Abstract
Background: Little is known about trends in the lung cancer burden from the disease that can be attributed to occupational carcinogens in China. Methods: Data regarding the lung cancer burden that can be attributed to occupational carcinogens in China were extracted from the [...] Read more.
Background: Little is known about trends in the lung cancer burden from the disease that can be attributed to occupational carcinogens in China. Methods: Data regarding the lung cancer burden that can be attributed to occupational carcinogens in China were extracted from the Global Burden of Disease (GBD) study in 2019. Joinpoint regression analysis and an age-period-cohort (APC) analysis were conducted to estimate the trend of lung cancer burden as a result of occupational carcinogens from 1990 to 2019. A Bayesian APC model was used to predict the disease burden until 2044. Results: The average annual percentage changes of age-standardized summary exposure values (SEVs) of occupational lung carcinogens, as well as the age-standardized population attributable fraction (PAF) of lung cancer due to occupational carcinogens, were 0.5% (95% confidence interval (CI): 0.4–0.5%) and 0.1% (95% CI: 0–0.2%), respectively. In addition, both the joinpoint regression analysis and APC analysis demonstrated significantly increased trends of age-standardized lung cancer mortality (ASMR) and age-standardized disability-adjusted life years (ASDR) as a result of occupational carcinogens. Asbestos and silica accounted for the two most important occupational lung carcinogens in China. The absolute burden is expected to increase, mainly due to population aging and the age-specific rate of illness. Conclusions: The lung cancer burden that could be attributed to occupational carcinogens significantly increased from 1990 to 2019 in China, and the absolute burden will continue to increase in the next 25 years. Full article
(This article belongs to the Special Issue Occupational Cancers)
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11 pages, 657 KiB  
Article
The Proportion of Occupationally Related Cholangiocarcinoma: A Tertiary Hospital Study in Northeastern Thailand
by Anantapat Seeherunwong, Naesinee Chaiear, Narong Khuntikeo and Chatchai Ekpanyaskul
Cancers 2022, 14(10), 2386; https://doi.org/10.3390/cancers14102386 - 12 May 2022
Cited by 1 | Viewed by 1404
Abstract
Northeastern Thailand registers the highest worldwide incidence of cholangiocarcinoma (CCA). Most of the cases are associated with liver flukes, while unknown causes comprise approximately 10–30% of cases, and these could be due to occupational exposures. Our aim was to determine the magnitude of [...] Read more.
Northeastern Thailand registers the highest worldwide incidence of cholangiocarcinoma (CCA). Most of the cases are associated with liver flukes, while unknown causes comprise approximately 10–30% of cases, and these could be due to occupational exposures. Our aim was to determine the magnitude of occupational causes of CCA in a tertiary hospital in northeastern Thailand. We conducted a cross-sectional study with a sample of 220 patients between March and November 2021. Descriptive statistics were used to analyze the findings. Clinical information and telephone interviews were used to explore significant occupational histories. An occupational consensus meeting was held with two occupational physicians, an industrial hygienist, and a hepatobiliary surgeon to decide on the final diagnosis. The response rate was 90.9% (200/220). Based on the medical records and telephone interviews, researchers found that 11 participants had significant exposure. After occupational consensus, it was agreed that the eleven had possible occupational causes, 5.5% (11/200)–54.5% (6/11) being due to asbestos fibers, 45.5% (5/11) due to dichloromethane, and 9.1% (1/11) due to 1,2-dichloropropane. Only 4% (8/200) had occupational histories collected by their treating physicians. Taken together, occupationally related CCA appears to have been underestimated, so improving occupational history taking is needed to properly identify and classify work-related CCA—both for patient treatment and occupational hazard prevention. Full article
(This article belongs to the Special Issue Occupational Cancers)
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Review

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17 pages, 647 KiB  
Review
Cancer and Potential Prevention with Lifestyle among Career Firefighters: A Narrative Review
by Amalia Sidossis, Fan-Yun Lan, Maria S. Hershey, Kishor Hadkhale and Stefanos N. Kales
Cancers 2023, 15(9), 2442; https://doi.org/10.3390/cancers15092442 - 24 Apr 2023
Cited by 3 | Viewed by 2261
Abstract
Career firefighters are at considerable risk for chronic diseases, including an increased risk of various cancers, compared to the general population. Over the last two decades, several systematic reviews and large cohort studies have demonstrated that firefighters have statistically significant increases in overall [...] Read more.
Career firefighters are at considerable risk for chronic diseases, including an increased risk of various cancers, compared to the general population. Over the last two decades, several systematic reviews and large cohort studies have demonstrated that firefighters have statistically significant increases in overall and site-specific cancer incidence and site-specific cancer mortality compared to the general population. Exposure assessment and other studies have documented exposures to a variety of carcinogens in fire smoke and within the fire station. Other occupational factors such as shift work, sedentary behavior, and the fire service food culture may also contribute to this working population’s increased cancer risk. Furthermore, obesity and other lifestyle behaviors such as tobacco use, excessive alcohol consumption, poor diet, inadequate physical activity, and short sleep duration have also been associated with an increased risk of certain firefighting-associated cancers. Putative prevention strategies are proposed based on suspected occupational and lifestyle risk factors. Full article
(This article belongs to the Special Issue Occupational Cancers)
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15 pages, 317 KiB  
Review
Occupational Cancers among Employed Women: A Narrative Review
by Federica Teglia, Giulia Collatuzzo and Paolo Boffetta
Cancers 2023, 15(4), 1334; https://doi.org/10.3390/cancers15041334 - 20 Feb 2023
Cited by 2 | Viewed by 1874
Abstract
The facts that occupational cancer in women is under-investigated, with few in-depth analyses are well known. In recent decades the workforce has changed, with an increasing number of women employed. Therefore, the inclusion of women in occupational cancer studies has become more urgent [...] Read more.
The facts that occupational cancer in women is under-investigated, with few in-depth analyses are well known. In recent decades the workforce has changed, with an increasing number of women employed. Therefore, the inclusion of women in occupational cancer studies has become more urgent and feasible than in the past decades. The difficulties to evaluate occupational causes of female gynecologic tumors in most past cohorts and the potential variation in outcome responses between men and women must be taken into consideration. This narrative review discusses women’s occupational cancer as a current area of research, focusing on three groups of workers characterized by peculiar exposure to occupational carcinogens and where women are often employed: beauticians and hairdressers; farmers; and healthcare workers. We discuss the most relevant cancers in each working category, with a particular focus on female breast cancer. In the three industries reviewed in detail, there are some risk factors which may affect primarily women, inducing breast cancer and cervical cancer, as well as risk factors that are carcinogenic in both genders, but whose effects are less well known in women. Full article
(This article belongs to the Special Issue Occupational Cancers)
15 pages, 291 KiB  
Review
Role of Occupation in Shaping Cancer Disparities
by Giulia Collatuzzo, Federica Teglia and Paolo Boffetta
Cancers 2022, 14(17), 4259; https://doi.org/10.3390/cancers14174259 - 31 Aug 2022
Cited by 5 | Viewed by 1724
Abstract
Cancer occurrence is characterized globally by profound socioeconomic differences. Occupation is a fundamental component of socioeconomic status. In this review, we discuss the role of occupation as a determinant of cancer disparities. First, we address the issue of participation in cancer screening programs [...] Read more.
Cancer occurrence is characterized globally by profound socioeconomic differences. Occupation is a fundamental component of socioeconomic status. In this review, we discuss the role of occupation as a determinant of cancer disparities. First, we address the issue of participation in cancer screening programs based on income, health insurance, occupational status and job title. Second, we review the role of occupation in contributing to disparities by acting as a mediator between cancer and (i) education and (ii) race/ethnicity. Lastly, we analyze data from a multicenter case−control study of lung cancer to calculate the mediating role of occupational exposure to diesel exhaust, silica and welding fumes in the association between education and lung cancer. By addressing the complex paths from occupation to cancer inequalities from multiple points of view, we provide evidence that occupational-related characteristics, such as income, health insurance, unemployment and hazardous exposures impinge on cancer control and outcomes. The increasing awareness of these aspects is fundamental and should lead to public health interventions to avoid inequalities rising from occupational factors. Full article
(This article belongs to the Special Issue Occupational Cancers)
13 pages, 297 KiB  
Review
Balancing Work and Cancer Care: Challenges Faced by Employed Informal Caregivers
by Ellen Xiang, Patricia Guzman, Martha Mims and Hoda Badr
Cancers 2022, 14(17), 4146; https://doi.org/10.3390/cancers14174146 - 27 Aug 2022
Cited by 12 | Viewed by 2612
Abstract
Individuals with cancer commonly rely on their informal caregivers (e.g., spouse/partner, family member, close friend) to help them manage the demands of the disease and its treatment. Caregiving, including helping with patient care, performing household chores, and providing emotional and practical support, can [...] Read more.
Individuals with cancer commonly rely on their informal caregivers (e.g., spouse/partner, family member, close friend) to help them manage the demands of the disease and its treatment. Caregiving, including helping with patient care, performing household chores, and providing emotional and practical support, can be particularly demanding for employed caregivers, who must juggle their work responsibilities while providing care. Although a burgeoning literature describes the toll that balancing these oft-competing demands can exact, few resources exist to support employed cancer caregivers. To address this gap, we conducted a narrative review of the impacts of cancer on employed caregivers. We found that employed caregivers experience significant financial impacts in terms of lost time and income. They also experience a variety of work-related (e.g., reduced productivity, absenteeism) and mental health (e.g., stress, burden) impacts. Going forward, prospective studies are needed to characterize changes in caregiver support needs and preferences at different time points along the cancer care continuum (e.g., at diagnosis, during treatment, end-of-life) so that appropriate workplace accommodations can be provided. More population-based studies are also needed to develop models for identifying caregivers who are at increased risk for poor employment or mental health outcomes so that more targeted support programs can be developed. Ultimately, a multipronged effort on behalf of employers, healthcare, and community-based organizations may be needed to support and empower this vulnerable subgroup. Full article
(This article belongs to the Special Issue Occupational Cancers)

Other

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20 pages, 1407 KiB  
Systematic Review
Employment among Childhood Cancer Survivors: A Systematic Review and Meta-Analysis
by Alessandro Godono, Francesco Felicetti, Alessio Conti, Marco Clari, Margherita Dionisi-Vici, Filippo Gatti, Catalina Ciocan, Tommaso Pinto, Emanuela Arvat, Enrico Brignardello, Franca Fagioli and Enrico Pira
Cancers 2022, 14(19), 4586; https://doi.org/10.3390/cancers14194586 - 22 Sep 2022
Cited by 7 | Viewed by 1757
Abstract
To date, there are heterogeneous studies related to childhood cancer survivors’ (CCS) employment rates. Given the importance of this topic, we aimed to perform a systematic review and meta-analysis to investigate the prevalence of employment among CCS and to examine its association with [...] Read more.
To date, there are heterogeneous studies related to childhood cancer survivors’ (CCS) employment rates. Given the importance of this topic, we aimed to perform a systematic review and meta-analysis to investigate the prevalence of employment among CCS and to examine its association with socio-demographic and clinical factors. We followed the PRISMA guidelines to search for pertinent articles in relevant electronic databases. Eighty-nine articles comprising 93 cohorts were included. The overall prevalence of employment was 66% (CI: 95% 0.63–0.69). Subgroup meta-analyses showed that lower rates were found for central nervous system tumor survivors (51%, CI: 95% 0.43–0.59), and for CCS treated with cranial-radiotherapy (53%, CI: 95% 0.42–0.64) or haematopoietic stem-cell transplantation (56%, CI: 95% 0.46–0.65). The studies conducted in Asia highlighted employment rates of 47% (CI: 95%, 0.34–0.60). Univariate meta-regressions identified the following socio-demographic factors associated with higher rates of employment: a female gender (p = 0.046), a higher mean age at the time of investigation (p = 0.00), a longer time since diagnosis (p = 0.00), a higher educational level (p = 0.03), and a married status (p = 0.00). In conclusion, this systematic review and meta-analysis provides evidence that two-thirds of CCS are employed worldwide. Identifying vulnerable groups of CCS may allow for the design of multidisciplinary support strategies and interventions to promote employment in this population. Full article
(This article belongs to the Special Issue Occupational Cancers)
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