Purpose: Adult survivors of childhood cancer experience difficulties in obtaining and maintaining employment. Employment-related challenges are associated with treatment-related health conditions and may also be related to vocational factors such as career readiness, skill acquisition, and work experience. Unfortunately, little is known about how treatment-, health-, and vocational-related factors interact to impact career development among childhood cancer survivors. Methods: Three hundred eighty-five adult survivors of childhood cancer (42.1 % male, median age 38 years (21–62)), participating in the St. Jude Lifetime Cohort Study, completed a work experiences survey that included measures of career readiness and vocational identity. Logistic regression was used to compare characteristics of survivors in the low career readiness category to those in the medium or high career readiness category, and structural equation modeling (SEM) was utilized to evaluate associations between career readiness, vocational identity, treatment intensity, and physical/emotional health. Results: Low career readiness was prevalent in 17.4 % of survivors. Univariate analysis did not identify any significant associations between cancer treatment-related factors and career readiness. Unemployed survivors (odds ratio (OR) 2.3, 95 % confidence interval (CI) 1.2–4.5), those who were not college graduates (OR 3.0, 95 % CI 1.6–5.6), and those who had no personal income (OR 5.9, 95 % CI 1.7–30.9) were at increased risk of low career readiness. SEM indicated that associations between treatment intensity, physical health, age at diagnosis, and career readiness were mediated by emotional health and vocational identity. Sixty-three, 35, and 10 % of the variance in career readiness, vocational identity, and emotional health, respectively, were explained by this theoretical model. Conclusions: The results of this study indicate that individuals who reported low levels of career readiness were more likely to be unemployed and earn less than US$40,000 per year and were less likely to graduate from high school. The final structural model indicates that vocational identity and emotional health accounted for the indirect effect of treatment intensity, age at diagnosis, and physical health on career readiness. Implications for Cancer Survivors: Addressing career readiness may be important to improve employment outcomes for adult survivors of childhood cancer.
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