This is a retrospective cross-sectional study examining the association between unemployment, cancer type, treatment and total body fat percentage of childhood cancer survivors recruited at St. Anne's University Hospital in Brno, Czech Republic. A total of 55 survivors aged 18-49 who were in remission of cancer and fulfilled the criteria for body composition measurements by the BIA and completed questionnaires investigating their socioeconomic status, employment status, and history. There was a significant relationship between the employment status and central nervous system-directed treatment (c2(1) = 7.53, p = 0.006, Cramér's V = 0.38) and between the type of cancer and employment status (c2(3) = 7.83, p = 0.049, Cramér's V = 0.38), the highest unemployment rate was recorded for brain and spine survivors (72.7%) compared to survivors with other diagnosis (35.7%) (uLR(1) = 4.91, p = 0.027; OR = 4.80, 95% CI:1.10-20.86, p = 0.036); these survivors did not have a significantly different body fat percentage compared to survivors with other diagnoses (t(53) = 1.29, p = 0.202, Cohen's d = 0.41) Interestingly, the survivors reporting having a partner also had a significantly higher percentage of body fat (t(53) = 2.90, p = 0.005, Cohen's d = 0.81). A linear regression model was used to model the percentage of body fat in relation to a set of selected variables and the we observed a significant effect of sex (female vs male: b = 6.37, 95% CI: 1.82-10.93, p = 0.007), partnership status (yes vs no: b = 5.65, 95% CI: 0.67-10.62, p = 0.027) and category of diagnosis (Brain and spinal column tumors vs Other solid tumors: b = 12.40, 95% CI: 0.59-24.21, p = 0.040; Brain and spinal column tumors vs Lymphoma: b = 14.02, 95% CI: 2.06-25.97, p = 0.023). Employment status and risk of adiposity in childhood cancer survivors depends on the type of treatment and diagnosis group, which may significantly impact their lifestyle and overall quality of life after treatment. Trial registration: This study was registered on July 29, 2022, at ClinicalTrials.gov (NCT05481229).

Department of Food Technology Mendel University Brno Czech Republic

Department of Paediatric Oncology University Hospital Brno Masaryk University Brno Czech Republic

Department of Pathological Physiology Faculty of Medicine Masaryk University Brno Czech Republic

Department of Physical Activities and Health Sciences Faculty of Sports Studies Masaryk University Brno Czech Republic

International Clinical Research Center St Anne's University Hospital Brno Brno Czech Republic

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Kirchhoff AC, Krull KR, Ness KK, Park ER, Oeffinger KC, et al.. Occupational outcomes of adult childhood cancer survivors: A report from the childhood cancer survivor study. Cancer. 2011. Jul 1; 117(13), 3033–3044. doi: 10.1002/cncr.25867 Epub 2011 Jan 18. PubMed DOI PMC

Kaatsch P. Epidemiology of childhood cancer. Cancer Treatment Reviews. 2010. Jun; 36(4), 277–285. doi: 10.1016/j.ctrv.2010.02.003: Epub 2010 Mar 15. PubMed DOI

Karlage RE, Wilson CL, Zhang N, Kaste S, Green DM, Amstrong GT, et al.. Validity of anthropometric measurements for characterizing obesity among adult survivors of childhood cancer: A report from the St. Jude Lifetime Cohort Study. Cancer. 2015, 121(12), 2036–2043. doi: 10.1002/cncr.29300 Epub 2015 Feb 27. . PubMed DOI PMC

Zhang FF, Rodday AM, Kelly MJ, Must A, MacPherson C, Roberts SB, et al.. Predictors of being overweight or obese in survivors of pediatric acute lymphoblastic leukemia (ALL). Pediatr Blood Cancer. 2014. Jul;61(7): 1263–9. doi: 10.1002/pbc.24960 Epub 2014 Jan 30. . PubMed DOI PMC

Zhang FF, Kelly MJ, Saltzman E, Must A, Roberts SB, Parsons SK. Obesity in pediatric ALL survivors: a meta-analysis. Pediatrics. 2014, 133(3), e704–715. doi: 10.1542/peds.2013-3332 PubMed DOI PMC

Pietilä S, Mäkipernaa A, Sievänen H, Koivisto AM, Wiegren T, Lenko HL. Obesity and metabolic changes are common in young childhood brain tumor survivors. Pediatric Blood & Cancer [online]. 2009, 52(7), 853–859. doi: 10.1002/pbc.21936 PubMed DOI

Oeffinger KC, Adams-Huet B, Victor RG, Church TS, Snell PG, Dunn AL, et al.. Insulin resistance and risk factors for cardiovascular disease in young adult survivors of childhood acute lymphoblastic leukemia. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology. 2009, 27(22), 3698–3704. doi: 10.1200/JCO.2008.19.7251 PubMed DOI PMC

Latoch E, Muszynska-Roslan K, Panas A, Panasiuk A, Sawicka-Zukowska M, Zelazowska-Rutkowska B, et al.. Adipokines and Insulin Resistance in Young Adult Survivors of Childhood Cancer. International Journal of Endocrinology [online]. 2016;2016, 6349134. doi: 10.1155/2016/6349134 PubMed DOI PMC

Friedman DN, Tonorezos ES, Cohen P. Diabetes and Metabolic Syndrome in Survivors of Childhood Cancer. Hormone Research in Paediatrics. 2019, 91(2), 118–127. doi: 10.1159/000495698 PubMed DOI PMC

Miller TL, Lipsitz SR, Lopez-Mitnik G, Hinkle AS, Constine LS, Adams MJ, et al.. Characteristics and determinants of adiposity in pediatric cancer survivors. Cancer Epidemiology, Biomarkers & Prevention: A Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology. 2010, 19(8), 2013–2022. doi: 10.1158/1055-9965.EPI-10-0163 PubMed DOI PMC

Garmey EG, Liu Q, Sklar CA, Meacham LR, Mertens AC, Stovall MA, et al.. Longitudinal changes in obesity and body mass index among adult survivors of childhood acute lymphoblastic leukemia: a report from the Childhood Cancer Survivor Study. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology. 2008, 26(28), 4639–4645. doi: 10.1200/JCO.2008.16.3527 PubMed DOI PMC

Suh E, Stratton KL, Leisenring WM, Nathan PC, Ford JS, Freyer DR, et al.. Late mortality and chronic health conditions in long-term survivors of early-adolescent and young adult cancers: a retrospective cohort analysis from the Childhood Cancer Survivor Study. The Lancet. Oncology [online]. 2020, 21(3), 421–435. doi: 10.1016/S1470-2045(19)30800-9 PubMed DOI PMC

Mulhern RK, Merchant TE, Gajjar A, Reddick WE, Kun LE. Late neurocognitive sequelae in survivors of brain tumours in childhood. The Lancet. Oncology [online]. 2004, 5(7), 399–408. ISSN 1470-2045. doi: 10.1016/S1470-2045(04)01507-4 PubMed DOI

WINNING Adrien M., MOSCATO Emily L., LEHMANN Vicky, KEIM Madelaine C., RAUSCH Joseph R., LIPAK Keagan G., et al.. Impact of central nervous system-directed treatment on competence and adjustment among children in early cancer survivorship. Pediatric Blood & Cancer [online]. 2021, 68(9), e29220. ISSN 1545-5017. doi: 10.1002/pbc.29220 PubMed DOI

STAVINOHA Peter L., ASKINS Martha A., POWELL Stephanie K., PILLAY Natasha SMILEY a ROBERT Rhonda S. Neurocognitive and Psychosocial Outcomes in Pediatric Brain Tumor Survivors. Bioengineering (Basel, Switzerland) [online]. 2018, 5(3), E73. ISSN 2306-5354. doi: 10.3390/bioengineering5030073 PubMed DOI PMC

HOWELL Carrie R., WILSON Carmen L., YASUI Yutaka, SRIVASTAVA Deo K., Wei LU, BJORNARD Kari L., et al.. Neighborhood effect and obesity in adult survivors of pediatric cancer: A report from the St. Jude lifetime cohort study. International Journal of Cancer [online]. 2020, 147(2), 338–349. ISSN 1097-0215. doi: 10.1002/ijc.32725 PubMed DOI PMC

BRAVEMAN Paula A., Catherine CUBBIN, EGERTER Susan, Sekai CHIDEYA, MARCHI Kristen S., METZLER Marilyn, et al.. Socioeconomic status in health research: one size does not fit all. JAMA [online]. 2005, 294(22), 2879–2888. ISSN 1538-3598. doi: 10.1001/jama.294.22.2879 PubMed DOI

GUPTA Sumit, Marta WILEJTO, POLE Jason D., GUTTMANN Astrid a SUNG Lillian. Low socioeconomic status is associated with worse survival in children with cancer: a systematic review. PloS One [online]. 2014, 9(2), e89482. ISSN 1932-6203. doi: 10.1371/journal.pone.0089482 PubMed DOI PMC

JANLERT Urban, WINEFIELD Anthony H. a HAMMARSTRÖM Anne. Length of unemployment and health-related outcomes: a life-course analysis. European Journal of Public Health [online]. 2015, 25(4), 662–667. ISSN 1464-360X. doi: 10.1093/eurpub/cku186 PubMed DOI

DE BOER Anna G. E. M., VERBEEK Jozef H. A. M. a VAN DIJK Franciscus J. H. Adult survivors of childhood cancer and unemployment: A metaanalysis. Cancer [online]. 2006, 107(1), 1–11. ISSN 0008-543X. doi: 10.1002/cncr.21974 PubMed DOI

MADER Luzius, MICHEL Gisela a ROSER Katharina. Unemployment Following Childhood Cancer. Deutsches Arzteblatt International [online]. 2017, 114(47), 805–812. ISSN 1866-0452. doi: 10.3238/arztebl.2017.0805 PubMed DOI PMC

BRINKMAN Tara M., RECKLITIS Christopher J., Gisela MICHEL, GROOTENHUIS Martha A. a KLOSKY James L. Psychological Symptoms, Social Outcomes, Socioeconomic Attainment, and Health Behaviors Among Survivors of Childhood Cancer: Current State of the Literature. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology [online]. 2018, 36(21), 2190–2197. ISSN 1527-7755. doi: 10.1200/JCO.2017.76.5552 PubMed DOI PMC

ULLRICH Nicole J. a EMBRY Leanne. Neurocognitive dysfunction in survivors of childhood brain tumors. Seminars in Pediatric Neurology [online]. 2012, 19(1), 35–42. ISSN 1558-0776. doi: 10.1016/j.spen.2012.02.014 PubMed DOI

VOLACO Alexei, CAVALCANTI Ana Maria, FILHO Roberto Pecoits a PRÉCOMA Dalton Bertolim. Socioeconomic Status: The Missing Link Between Obesity and Diabetes Mellitus? Current Diabetes Reviews [online]. 2018, 14(4), 321–326. ISSN 1875-6417. doi: 10.2174/1573399813666170621123227 PubMed DOI

AMIRI Sohrab. Unemployment associated with major depression disorder and depressive symptoms: a systematic review and meta-analysis. International journal of occupational safety and ergonomics: JOSE [online]. 2022, 28(4), 2080–2092. ISSN 2376-9130. doi: 10.1080/10803548.2021.1954793 PubMed DOI

InBody UK–Healthier [online]. [2023-04–24]. https://uk.inbody.com/

CHUMLEA N. C. a KUCZMARSKI R. J. Using a bony landmark to measure waist circumference. Journal of the American Dietetic Association [online]. 1995, 95(1), 12. ISSN 0002-8223. doi: 10.1016/s0002-8223(95)00003-8 PubMed DOI

Waist circumference and waist-hip ratio: report of a WHO expert consultation [online]. [2023-03-08]. https://www.who.int/publications-detail-redirect/9789241501491

R CORE TEAM. R: A language and environment for statistical computing [online]. B.m.: R Foundation for Statistical Computing, Vienna, Austria.https://www.R-project.org

Obesity Guidelines for Clinicians | 2021 Obesity Algorithm E-Book [online]. [2023-04-24]. https://obesitymedicine.org/obesity-algorithm/

ZHANG Fang Fang a PARSONS Susan K. Obesity in Childhood Cancer Survivors: Call for Early Weight Management. Advances in Nutrition (Bethesda, Md.) [online]. 2015, 6(5), 611–619. ISSN 2156-5376. doi: 10.3945/an.115.008946 PubMed DOI PMC

HUDSON Melissa M., NESS Kirsten K., GURNEY James G., MULROONEY Daniel A., CHEMAITILLY Wassim, KRULL Kevin R., et al.. Clinical ascertainment of health outcomes among adults treated for childhood cancer. JAMA [online]. 2013, 309(22), 2371–2381. ISSN 1538-3598. doi: 10.1001/jama.2013.6296 PubMed DOI PMC

ACHAMRAH Najate, COLANGE Guillaume, DELAY Julie, RIMBERT Agnès, FOLOPE Vanessa, PETIT André, et al.. Comparison of body composition assessment by DXA and BIA according to the body mass index: A retrospective study on 3655 measures. PloS One [online]. 2018, 13(7), e0200465. ISSN 1932-6203. doi: 10.1371/journal.pone.0200465 PubMed DOI PMC

ERDMANN Friederike, FREDERIKSEN Line Elmerdahl, MOGENSEN Hanna, PEDERSEN Camilla, MADER Luzius, TALBÄCK Mats, et al.. Cohort Profile: The Socioeconomic Consequences in Adult Life After Childhood Cancer in Scandinavia (SALiCCS) Research Programme. Frontiers in Oncology [online]. 2021, 11, 752948. ISSN 2234-943X. doi: 10.3389/fonc.2021.752948 PubMed DOI PMC

FREDERIKSEN Line Elmerdahl, PEDERSEN Camilla, MOGENSEN Hanna, MADER Luzius, BAUTZ Andrea, TALBÄCK Mats, et al.. Employment status and occupational positions of childhood cancer survivors from Denmark, Finland and Sweden: A Nordic register-based cohort study from the SALiCCS research programme. The Lancet Regional Health. Europe [online]. 2022, 12, 100258. ISSN 2666-7762. doi: 10.1016/j.lanepe.2021.100258 PubMed DOI PMC

KIRCHHOFF Anne C., LEISENRING Wendy, KRULL Kevin R, NESS Kirsten K., FRIEDMAN Debra L., ARMSTRONG Gregory T., et al.. Unemployment among adult survivors of childhood cancer: a report from the childhood cancer survivor study. Medical Care [online]. 2010, 48(11), 1015–1025. ISSN 1537-1948. doi: 10.1097/MLR.0b013e3181eaf880 PubMed DOI PMC

WENGENROTH L., RUEEGG C. S., MICHEL G., ESSIG S., AMMANN R. A., BERGSTRAESSER E., et al.. Life partnerships in childhood cancer survivors, their siblings, and the general population. Pediatric Blood & Cancer [online]. 2014, 61(3), 538–545. ISSN 1545-5017. doi: 10.1002/pbc.24821 PubMed DOI PMC

LEE Seon Yeong a Dympna GALLAGHER. Assessment methods in human body composition. Current Opinion in Clinical Nutrition and Metabolic Care [online]. 2008, 11(5), 566–572. ISSN 1363-1950. doi: 10.1097/MCO.0b013e32830b5f23 PubMed DOI PMC

MARINI Elisabetta, Francesco CAMPA Roberto BUFFA, STAGI Silvia MATIAS Catarina N., Stefania TOSELLI, et al.. Phase angle and bioelectrical impedance vector analysis in the evaluation of body composition in athletes. Clinical Nutrition (Edinburgh, Scotland) [online]. 2020, 39(2), 447–454. ISSN 1532-1983. doi: 10.1016/j.clnu.2019.02.016 PubMed DOI

GONZALEZ Maria Cristina, BARBOSA-SILVA Thiago G., BIELEMANN Renata M., GALLAGHER Dympna a HEYMSFIELD Steven B. Phase angle and its determinants in healthy subjects: influence of body composition. The American Journal of Clinical Nutrition [online]. 2016, 103(3), 712–716. ISSN 1938-3207. doi: 10.3945/ajcn.115.116772 PubMed DOI PMC

KYLE Ursula G., Ingvar BOSAEUS, DE LORENZO Antonio D., Paul DEURENBERG, Marinos ELIA, GÓMEZ José Manuel, et al.. Bioelectrical impedance analysis—part I: review of principles and methods. Clinical Nutrition (Edinburgh, Scotland) [online]. 2004, 23(5), 1226–1243. ISSN 0261-5614. doi: 10.1016/j.clnu.2004.06.004 PubMed DOI

ELLEGÅRD L., BERTZ F., WINKVIST A., BOSAEUS a H I. BREKKE K. Body composition in overweight and obese women postpartum: bioimpedance methods validated by dual energy X-ray absorptiometry and doubly labeled water. European Journal of Clinical Nutrition [online]. 2016, 70(10), 1181–1188. ISSN 1476-5640. doi: 10.1038/ejcn.2016.50 PubMed DOI

BOSAEUS Marja, Therese KARLSSON, Agneta HOLMÄNG a Lars ELLEGÅRD. Accuracy of quantitative magnetic resonance and eight-electrode bioelectrical impedance analysis in normal weight and obese women. Clinical Nutrition (Edinburgh, Scotland) [online]. 2014, 33(3), 471–477. ISSN 1532-1983. doi: 10.1016/j.clnu.2013.06.017 PubMed DOI

HINTON Benjamin J., Bo FAN, Bennett K. NG a SHEPHERD John A. Dual energy X-ray absorptiometry body composition reference values of limbs and trunk from NHANES 1999–2004 with additional visualization methods. PloS One [online]. 2017, 12(3), e0174180. ISSN 1932-6203. doi: 10.1371/journal.pone.0174180 PubMed DOI PMC

KULLBERG J., BRANDBERG J., ANGELHED J.-E., FRIMMEL H., BERGELIN E., STRID L., et al.. Whole-body adipose tissue analysis: comparison of MRI, CT and dual energy X-ray absorptiometry. The British Journal of Radiology [online]. 2009, 82(974), 123–130. ISSN 1748-880X. doi: 10.1259/bjr/80083156 PubMed DOI

ANDREOLI A., SCALZO G., MASALA S., TARANTINO U. a GUGLIELMI G. Body composition assessment by dual-energy X-ray absorptiometry (DXA). La Radiologia Medica [online]. 2009, 114(2), 286–300. ISSN 0033-8362. doi: 10.1007/s11547-009-0369-7 PubMed DOI

LAHAV Yair, Nir GOLDSTEIN a Yftach GEPNER. Comparison of body composition assessment across body mass index categories by two multifrequency bioelectrical impedance analysis devices and dual-energy X-ray absorptiometry in clinical settings. European Journal of Clinical Nutrition [online]. 2021, 75(8), 1275–1282. ISSN 1476-5640. doi: 10.1038/s41430-020-00839-5 PubMed DOI

SHEPHERD John, Bennett NG, Markus SOMMER a HEYMSFIELD Steven B. Body Composition by DXA. Bone [online]. 2017, 104, 101–105. ISSN 8756-3282. doi: 10.1016/j.bone.2017.06.010 PubMed DOI PMC

KENDLER David L., BORGES Joao L. C., FIELDING Roger A., Akira ITABASHI, Diane KRUEGER, Kathleen MULLIGAN, et al.. The Official Positions of the International Society for Clinical Densitometry: Indications of Use and Reporting of DXA for Body Composition. Journal of Clinical Densitometry: The Official Journal of the International Society for Clinical Densitometry [online]. 2013, 16(4), 496–507. ISSN 1094-6950. doi: 10.1016/j.jocd.2013.08.020 PubMed DOI

BELLE Fabiën N., Annette WEISS, Matthias SCHINDLER, Myrofora GOUTAKI, Murielle BOCHUD, Karin ZIMMERMANN, et al.. Overweight in childhood cancer survivors: the Swiss Childhood Cancer Survivor Study. The American Journal of Clinical Nutrition [online]. 2018, 107(1), 3–11. ISSN 1938-3207. doi: 10.1093/ajcn/nqx006 PubMed DOI

Ulf SEIFART a Jan SCHMIELAU. Return to Work of Cancer Survivors. Oncology Research and Treatment [online]. 2017, 40(12), 760–763. ISSN 2296-5262. doi: 10.1159/000485079 PubMed DOI

ZELLER Bernward, LOGE Jon H., Adriani KANELLOPOULOS, Hanne HAMRE, WYLLER Vegard B. a Ellen RUUD. Chronic fatigue in long-term survivors of childhood lymphomas and leukemia: persistence and associated clinical factors. Journal of Pediatric Hematology/Oncology [online]. 2014, 36(6), 438–444. ISSN 1536-3678. doi: 10.1097/MPH.0000000000000051 PubMed DOI

COHEN Jennifer E., WAKEFIELD Claire E. a COHN Richard J. Nutritional interventions for survivors of childhood cancer. The Cochrane Database of Systematic Reviews [online]. 2016, (8), CD009678. ISSN 1469-493X. doi: 10.1002/14651858.CD009678.pub2 PubMed DOI PMC

BRAAM Katja I., VAN DER TORRE Patrick, TAKKEN Tim, VEENING Margreet A., VAN DULMEN-DEN BROEDER Eline a Gertjan J. L. KASPERS. Physical exercise training interventions for children and young adults during and after treatment for childhood cancer. The Cochrane Database of Systematic Reviews [online]. 2013, (4), CD008796. ISSN 1469-493X. doi: 10.1002/14651858.CD008796.pub2 PubMed DOI

BURDEN Sorrel, JONES Debra J., SREMANAKOVA Jana, SOWERBUTTS Anne Marie, Simon LAL, Mark PILLING, et al.. Dietary interventions for adult cancer survivors. The Cochrane Database of Systematic Reviews [online]. 2019, 2019(11). ISSN 1469-493X. doi: 10.1002/14651858.CD011287.pub2 PubMed DOI PMC

DIELI-CONWRIGHT Christina M., COURNEYA Kerry S., DEMARK-WAHNEFRIED Wendy SAMI Nathalie, LEE Kyuwan, SWEENEY Frank C., et al.. Aerobic and resistance exercise improves physical fitness, bone health, and quality of life in overweight and obese breast cancer survivors: a randomized controlled trial. Breast cancer research: BCR [online]. 2018, 20(1), 124. ISSN 1465-542X. doi: 10.1186/s13058-018-1051-6 PubMed DOI PMC

ZHANG Fang Fang, KELLY Michael J. a MUST Aviva. Early Nutrition and Physical Activity Interventions in Childhood Cancer Survivors. Current Obesity Reports [online]. 2017, 6(2), 168–177. ISSN 2162-4968. doi: 10.1007/s13679-017-0260-0 PubMed DOI PMC

GANCE-CLEVELAND Bonnie, Anna LINTON Jaron ARBET, STILLER Debra a SYLVAIN Genevieve Predictors of Overweight and Obesity in Childhood Cancer Survivors. Journal of Pediatric Oncology Nursing: Official Journal of the Association of Pediatric Oncology Nurses [online]. 2020, 37(3), 154–162. ISSN 1532-8457. doi: 10.1177/1043454219897102 PubMed DOI

RAMSEY William A., HEIDELBERG Rebecca Elyse, GILBERT Alexandra M., HENEGHAN Mallorie B., BADAWY Sherif M., ALBERTS Nicole M. eHealth and mHealth interventions in pediatric cancer: A systematic review of interventions across the cancer continuum. Psycho-Oncology [online]. 2020, 29(1), 17–37. ISSN 1099-1611. doi: 10.1002/pon.5280 PubMed DOI

Cristina OANCEA, S., BRINKMAN Tara M., NESS Kirsten K., KRULL Kevin R., SMITH Webb A., SRIVASTAVA D. Kumar, et al.. Emotional distress among adult survivors of childhood cancer. Journal of cancer survivorship: research and practice [online]. 2014, 8(2), 293–303. ISSN 1932-2259. doi: 10.1007/s11764-013-0336-0 PubMed DOI PMC

DANIEL Lauren C., WANG Mingjuan, MULROONEY Daniel A., SRIVASTAVA Deo Kumar, SCHWARTZ Lisa A., EDELSTEIN Kim, et al.. Sleep, emotional distress, and physical health in survivors of childhood cancer: A report from the Childhood Cancer Survivor Study. Psycho-Oncology [online]. 2019, 28(4), 903–912. ISSN 1099-1611. doi: 10.1002/pon.5040 PubMed DOI PMC

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