Next Article in Journal
Cervical Cancer Elimination Requires Systems, Trust, and Action
Previous Article in Journal
Health Effects of Ergonomics and Personal Protective Equipment on Chemotherapy Professionals
Previous Article in Special Issue
Parental Reports on Late Effects and Follow-Up Needs: A Single-Center Assessment of Childhood Cancer Survivorship Care in Kenya
 
 
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Article

Supporting Employment After Cancer: A Mixed-Methods Evaluation of a Vocational Integration Programme for Childhood, Adolescent, and Young Adult Cancer Survivors

by
Margherita Dionisi-Vici
1,2,
Anna Schneider-Kamp
3,
Ilenia Giacoppo
4,
Alessandro Godono
5,
Eleonora Biasin
4,5,
Antonella Varetto
1,
Emanuela Arvat
6,7,
Francesco Felicetti
6,7,
Giulia Zucchetti
4,* and
Franca Fagioli
4,5
1
Clinical Psychology Unit, Azienda Ospedaliero Universitaria Città della Salute e della Scienza Hospital, 10126 Turin, Italy
2
U.G.I. Association, Unione Genitori Italiani Contro Il Tumore dei Bambini, Corso Dante 101, 10126 Turin, Italy
3
Department of Business and Management, University of Southern Denmark, 5230 Odense, Denmark
4
Pediatric Oncology Division, Regina Margherita Children’s Hospital, Azienda Ospedaliero Universitaria Città della Salute e della Scienza Hospital, 10126 Turin, Italy
5
Department of Public Health and Pediatric Sciences, University of Turin, 10126 Turin, Italy
6
Oncological Endocrinology, Azienda Ospedaliero Universitaria Città della Salute e della Scienza Hospital, 10126 Turin, Italy
7
Department of Medical Sciences, University of Turin, 10126 Turin, Italy
*
Author to whom correspondence should be addressed.
Curr. Oncol. 2025, 32(10), 564; https://doi.org/10.3390/curroncol32100564
Submission received: 25 August 2025 / Revised: 20 September 2025 / Accepted: 7 October 2025 / Published: 8 October 2025

Abstract

Simple Summary

Childhood, adolescent, and young adult cancer (CAYAC) survivors often face difficulties entering the workforce, and this transition is frequently complicated by the long-term effects of illness and treatment. Although guidelines emphasise the importance of vocational support, few structured interventions have been developed and systematically evaluated for this population. This study explored a vocational integration programme specifically designed for CAYAC survivors in a tertiary cancer centre in Italy. The programme combined individualised career guidance, soft skills training, and a paid internship, delivered by a multidisciplinary team. A mixed-method approach was used to examine both feasibility and impact, providing a comprehensive understanding of how such interventions may respond to the complex needs of young cancer survivors. The study highlights the significance of tailored, socially supportive vocational programmes and offers insights that may inform future research, clinical practice, and policy development in the field of survivorship care.

Abstract

Childhood, adolescent, and young adult cancer (CAYAC) survivors often face challenges entering the workforce due to long-term physical, cognitive, and psychological late effects, defined as chronic health conditions resulting from cancer and its treatments. This study evaluated a vocational integration programme that addresses these barriers and promotes psychosocial well-being. The multidisciplinary intervention combined career guidance, soft-skills training, and a paid internship. Using a mixed-method design with questionnaires and semi-structured interviews, we assessed feasibility, satisfaction, and psychosocial outcomes. Thirteen participants (mean-age-at-diagnosis: 12.9 years, SD 5.2; mean-age-at-interview: 27.2 years, SD 5.3) reported over 40 late effects, mostly of moderate severity. Health-Related Quality of Life (HRQoL), measured by the SF-12, showed a Physical Component Score mean of 45.2 (SD 9.1) and a Mental Component Score mean of 43.5 (SD 11.2), indicating greater psychological impact. The programme received high satisfaction ratings (mean 8.3/10) and was described as motivating and valuable, enhancing self-confidence and career prospects. Social support emerged as a key facilitator, while participants noted the need for flexibility and individualised pacing. Despite a limited sample size and potential recruitment bias, this study provides preliminary insights into the feasibility and perceived value of tailored vocational programmes, emphasising the importance of adaptable, socially supportive interventions for CAYAC survivors.

1. Introduction

Recent improvements in therapeutic strategies for the treatment of childhood, adolescent, and young adult cancers (CAYAC) have significantly enhanced survival outcomes, with current 5-year survival rates reaching over 80% [1,2]. As a result, the distinctive population of CAYAC survivors continues to grow steadily, presenting a unique set of medical, psychological, and psychosocial needs [1,2,3,4,5,6].
Depending on the type of treatment received, CAYAC survivors are at increased risk of developing late effects (LE), a wide range of chronic or delayed health conditions that appear months or years after the completion of cancer therapies, requiring long-term monitoring through specialised and multidisciplinary follow-up care. Timely prevention and monitoring facilitate early detection and limit adverse outcomes [2,7,8]. These sequelae may include physical and neurocognitive impairments, mental health difficulties, psychosocial challenges, and an elevated risk of relapse or second primary tumours [9,10,11,12,13].
One critical concern during the transition of CAYAC survivors to adulthood is the impact of their medical history on social and occupational circumstance [14]. Educational achievements and employment outcomes are key indicators of social functioning and personal independence during adulthood [15]. However, compared with the general population, CAYAC survivors are at higher risk of unemployment, underemployment, health-related job absenteeism, and difficulties entering or maintaining full-time work, contributing to prolonged dependence and reduced financial autonomy [6,16,17,18,19,20,21].
Central nervous system (CNS) tumours, secondary disease or relapse, neurocognitive and sensory impairments, and treatment exposure such as cranial irradiation, neurosurgery, amputations, or specific chemotherapies (e.g., alkylating agents, vincristine) have been recognised as risk factors for poor occupational outcomes. Mental health vulnerability and socio-demographic factors, such as female gender and low educational attainment, could further increase this vulnerability [6,15,18,21,22,23,24].
Based on these findings, recent evidence-based guidelines [5,11,21,24,25,26] have emphasised the need to incorporate occupational monitoring and support within multidisciplinary follow-up care for CAYAC survivors. Specifically, vocational planning and employment surveillance should be initiated already in late adolescence, particularly during the transition from school to the workforce. A multidisciplinary team approach should be implemented, enabling the referral of survivors to specialised professionals when specific challenges are identified in the area of employment. Such professionals may include vocational counsellors, psychologists experienced with the CAYAC survivor’s population, or social workers. This approach allows for timely assessment and the implementation of tailored services to improve occupational outcomes and overall quality of life for CAYAC survivors.
Despite existing recommendations, practical interventions remain underreported in the literature [21,27]. Available studies are heterogeneous in aims and methodologies [28]. Some have focused on psychosocial support to improve well-being and coping skills [29,30,31], while others specifically address return-to-work (RTW) strategies for adult cancer survivors [32], typically involving workplace modifications. Only one intervention adopted an integrated care model, and very few targeted physical workload or work ability. Zegers et al. [33] highlighted the greater effectiveness of multidisciplinary, personalised support tailored to an individual’s state of motivation. However, these approaches are designed for adults returning to employment and may not apply directly to CAYAC survivors, who often face the challenge of entering the workforce for the first time. In Canada, a promising example of individualised support for childhood cancer survivors is the School and Work Transitions Program (SWTP), which used Goal Attainment Scaling to set and monitor personalised educational and vocational goals, demonstrating the value of tailored interventions in promoting first-time workforce integration [34].
Adapting such approaches may be particularly valuable for CAYAC survivors, supporting their first steps into employment through individualised, structured interventions aimed at autonomy and long-term integration, especially for those with significant functional or psychological limitations due to their prior illness [15,25].
The primary aim of this study is to describe the experience of implementing such recommendations through a multidisciplinary work placement intervention, designed for CAYACs who have survived paediatric cancer and based in Turin, Italy.
Using a mixed-methods follow-up study combining a validated questionnaire with qualitative semi-structured interviews, the study explores participants’ perceptions of the intervention’s effectiveness and impact, with particular regard to perceived barriers and facilitators to employment integration and long-term occupational outcomes.

2. Materials and Methods

2.1. The Intervention

In Turin (Italy), since 1980 [35], the Italian association Parents’ Union Against Childhood Cancer (Unione Genitori Italiani contro il Tumore dei Bambini, UGI) has collaborated with the Paediatric Hemato-Oncology Department of the Regina Margherita Children’s Hospital, and later also with the Transition Unit for Paediatric Cancer Survivors, promoting initiatives aimed at supporting the well-being of paediatric oncology patients both during and after their illness.
Since 2021, among other initiatives, the UGI association has implemented targeted actions to support the employment of young adults treated for childhood cancer. These projects are carried out in collaboration with Patchanka [36], a social cooperative and employment agency (accredited by the Piedmont Region), which offers support to unemployed individuals—particularly those facing disadvantage—through career guidance and vocational redevelopment services.
This partnership has enabled the development of specialised pathways for beneficiaries who have been left with temporary or permanent disabilities following cancer treatment, applying specific ‘Place and Train’ methodologies in which Patchanka staff are trained.
Each year, approximately 4–5 CAYAC survivors join the project. They are engaged in a personalised pathway lasting around 12 months and comprising several phases: orientation, a paid internship of approximately six months in a company, and subsequent support either for direct employment or further job searches.
The team is composed of a psychologist specialised in CAYAC survivorship, a UGI representative, and Patchanka job placement specialists. When necessary, consultation with an occupational physician may also be requested for assessments or certifications.
Participants are identified through various channels: personal requests, follow-up medical visits, rehabilitation sessions, or via association volunteers. No strict exclusion criteria are applied—any unemployed adult CAYAC survivor experiencing employment-related difficulties connected to previous cancer is eligible for enrolment on the project and, subsequently, the follow-up study. The intervention consists of five phases, which are illustrated in Figure 1.
  • Initial referral and Intake: The beneficiary is connected with the multidisciplinary team and referred to the designated Patchanka project manager.
  • Vocational profiling and functional assessment: An initial assessment phase is conducted, involving individualised vocational guidance, curriculum vitae development, functional and disability evaluations, and mapping of skills, interests, and employment-related barriers.
  • Soft-skills training: A subset of beneficiaries engages in group sessions through theatrical techniques via the JobAct® Method, aimed at enhancing soft skills such as communication, emotional regulation, and workplace self-efficacy [37].
  • Internship Placement and Workplace Integration: Patchanka employment specialists identify host companies compatible with the physical, cognitive, and professional profiles of participants. They provide structured support throughout workplace integration, including onboarding facilitation and interpersonal mediation. The internship is remunerated and fully funded by UGI. Participants proceed autonomously while retaining access to the project manager for case-specific support.
  • Outcome Evaluation and Employment Transition: Upon completion of the internship, outcome evaluations are performed. These may lead to an extension of the placement, direct employment, or the initiation of new job-matching procedures.

2.2. The Mixed-Methods Follow-Up Study

The sampling frame for the follow-up study are CAYAC survivors in Turin that participated in a project/intervention aimed at workplace integration and/or increasing employability. Given this inherently limited sampling frame and the expected diversity and complexity of the experiences and perceptions of the participants, we opted for a non-sequential predominantly qualitative [38] mixed-methods design combining a validated questionnaire with qualitative semi-structured interviews.
Participants were recruited through telephone calls by either the project psychologist or members of the Patchanka team. After explaining the objectives of the study and ensuring participants’ understanding, written informed consent was obtained prior to participation. The interviews were conducted via video calls between May and July 2025.
The purpose of the questionnaire is to assess the self-reported health status of the participants (Health related quality of life, HRQoL). To this end, we employ the validated and well-established SF-12 (12-Item Short Form Health Survey) questionnaire [39], which provides two composite indices: the Physical Component Summary (PCS) and the Mental Component Summary (MCS). Both scores are standardised, with values > 50 indicating better-than-average physical or mental health, and scores < 50 suggesting poorer health status.
For the qualitative semi-structured interviews, we followed state-of-the-art best practices [40] and developed a thematic interview guide covering the themes of interview and participant information, orientation phase participation, internship experience, integration and professional support, accessibility and physical suitability, current employment situation, and personal impact and social support.
The participants were sampled purposely for maximum variation from the participants of several initiatives aiming at integrating childhood cancer survivors into workplace settings and increasing their downstream employability. Within the confines of the limited sampling frame, we strove for representing a variety of diagnoses and age groups (both age-at-diagnosis and age-at-interview). We iteratively and continuously analysed the interviews, measuring the degree of data saturation based on the extent to which the most recent interview supported rather than extended existing categorisations.
All interviews were described verbatim in Italian and subsequently translated equivalently and adequately to English for analysis. We employed reflexive thematic analysis [41] relying on an inductive approach, starting with open codes, collecting these into categories, and connecting and condensing these categories into themes. Accordingly, we used a collaborative co-constructive coding approach, reflecting on and discussing codes, categories, and themes among the co-investigators until consensus was reached.
As part of the semi-structured qualitative interviews, participants were also asked to rate their overall experience off the intervention on a scale from 0 to 10, where 0 indicated a completely negative experience and 10 a completely positive one. Furthermore, we also asked each participant to reflect upon their experience of the intervention/project and describe it using exactly three words. These words were coded openly and then merged into categories. The participants’ clinical data and SF-12 and rating scores were summarised using absolute and relative frequency. Descriptive statistics analyses were reported as absolute frequencies and percentages for categorical variables and as means and standard deviations (SDs) for continuous variables.
LE have been grouped in categories of system-based chronic and late medical health events (CLME), using the St Jude Lifetime Cohort Study (SJLIFE) modified version of the National Cancer Institute’s Common Terminology Criteria for Adverse Events (CTCAE) version 4.03. LE’ severity has been classified as mild (grade 1), moderate (grade 2), severe or disabling (grade 3), life-threatening (grade 4), or death (grade 5) [9].

3. Results

3.1. Quantitative Findings

Between January 2021 and January 2025, a total of 23 CAYAC survivors took part in the projects developed by UGI and Patchanka. Of these, 4 participants (17.4%) declined to participate in the follow-up study, 4 (17.4%) could not be contacted, 1 (7.7%) had not yet started the internship at the time of data collection, and 1 participant (7.7%) passed away due to complications related to late effects. The final sample therefore consisted of 13 participants.
The mean age-at-diagnosis was 12.94 years (SD 5,19; range 1–20) while the mean age-at-interview was 27.19 years (SD 5.29; range 21–40). Participants represented different diagnoses: Acute Leukaemia (Myeloid or lymphoblastic) (n = 5), Central Nervous System (CNS) Tumours (n = 4) (Medulloblastoma n = 2, Ependymoma, CNS Germ Cell Tumour), supplemented with singular cases of Ewing Sarcoma, Nasopharyngeal Rhabdomyosarcoma, Immature Teratoma, and Epstein–Barr Virus-Associated Hemophagocytic Lymphohistiocytosis.
A total of 40 late effects (LEs) were present, distributed, across all participants. Of these, 7 were grade 1 (17.5%), 25 were grade 2 (62.5%), and 8 were grade 3 (20%). Twelve out of thirteen patients (92.3%) experienced at least one LE, and the majority (9 out of 13) presented with multiple events, sometimes of different severity grades (Table 1).
The SF-12 results showed a mean PCS score of 45.2 (SD 9.1 range 33.7–64.3) and a mean MCS score of 43.5 (SD 11.2 range 26.3–63.1). Whereas, the average score on the 0–10 ranking reported by participants in their evaluation of the experience was 8.3 (SD 2.0 range 5.0–10.0) (Table 2).

3.2. Overall Experience and Three-Words Reflection Task

The participants rated their overall experience quite highly with a mean of 8.3 (SD: 2.0; min: 5, median: 9, max: 10) on a scale of 0 to 10, with only two participants rating it as 5 and the remaining rating it from 8 to 10. This rating is well-aligned with the analysis of results of the three-words reflection task.
We obtained a total of seven codes from all the words of the reflection task. These seven codes were then merged into three categories (rewarding, stimulating, challenging) as illustrated in Table 3.
The analysis of these three categories indicates that most of the participants experienced and perceived the intervention/project as rewarding (11 out of 13) and stimulating (10 out of 13). A minority (4 out of 13) described the intervention/project with words that indicate demanding (3 out 13) or limiting (1 out of 13) experiences. The distribution of the three categories from Table 3 regarding the number of participants that used included words, is visualised in Figure 2.

3.3. Results of the Thematic Analysis

The thematic analysis of our interview data gave rise to 20 categories, grouped into 8 themes, which we present in the following subsections. This presentation is accompanied by Table 4, which presents sample quotes for all the categories of each theme.
  • Theme 1: Motivations and initial expectations
Most participants reported having no specific expectations regarding the outcomes and trajectory of the project. Nonetheless, many were motivated to participate out of a desire for autonomy and financial independence (Category 1.1). Participants often approached the intervention with a strong desire to pursue employment and personal development (Category 1.2). However, many were facing their first work experience and expressed uncertainty about how to start or navigate the job market, especially given their physical impairments and medical history.
  • Theme 2: The impact of cancer on workability
Participants report that previous cancer—along with its related physical and psychological sequelae—has an impact on occupational choices (Category 2.1), influencing career goals and self-perceived workability. Physical impairments not only can decrease ability to work but, in some cases, can even lead to the loss of employment (Category 2.2). Moreover, previous cancer also modulates emotional well-being in professional settings (Category 2.3).
  • Theme 3: Accessibility and task adequacy
Some participants had previously undertaken job experiences independently, which were unfortunately not appropriate given their physical conditions and perceived as too challenging (Category 3.1). In contrast, the individualised approach of the intervention seems to facilitate the identification of workplaces that were both aligned with participants’ skills and compatible with their physical limitations (Category 3.2). This alignment was perceived to promote job stability. When asked whether the tasks assigned during the internship were appropriate for their physical conditions, the majority of participants responded with a strong affirmation: “Absolutely.”
  • Theme 4: The importance of building self-esteem and self-efficacy
Participants want to learn, build skills, be helpful, and feel integrated. The intervention experience appears to have influenced participants’ self-perception, fostering personal growth and enhanced self-awareness. This growth increases the participants’ self-esteem (Category 4.1), leaving them more confident. What is more, for most participants, the intervention also enhances self-efficacy (Category 4.2), allowing participants to gain the skills to operate more independently and self-reliantly. Several participants also experienced the intervention as helping them to move from pathology toward normality. As for many of the other participants, normality is associated with successful integration into a work environment, i.e., with occupational embeddedness (Category 4.3). Particularly the opportunity for some participants to have their internships extended or to be hired has helped enhance their self-perception.
  • Theme 5: The value of vocational support
Several participants highlighted the importance of individualised career assessment, particularly when aimed at enhancing general job skills (Category 5.1) such as the development of a curriculum vitae (CV). This process was often described as beneficial and, in many cases, as an experience never previously conducted with qualified professional coaching. The support through the intervention was perceived as impactful (Category 5.2) not only in identifying employment aligned with personal aspirations but also in discovering suitable yet engaging opportunities. The theatre and training phase was perceived by those who participated as particularly effective in enhancing professional and interpersonal skills, providing a focus on personal growth (Category 5.3).
  • Theme 6: The power of relationships: social support and workplace integration
Relational aspects of the work environment emerged as a key factor in participants’ positive experiences and successful integration, often through enhancing social interactions (Category 6.1). Support from tutors, colleagues, and customers not only enhanced participants’ self-efficacy and autonomy but also fostered a sense of belonging and motivation (Category 6.2). The intervention facilitated interaction with supervisors or managers at work and also with peers, which in some cases led to the formation of friendships, thereby promoting an expanded social network able to provide feedback and support (Category 6.3).
  • Theme 7: The double-edged impact of peer and family support
Participants frequently reported receiving consistent and encouraging support from family members, which positively influenced their engagement in project activities and daily routines (Category 7.1). However, this support is sometimes accompanied by a pattern of overprotection or persistent concern that CAYAC survivors may experience excessive fatigue, struggle to manage work responsibilities, or fear to fail coping independently (Category 7.2).
  • Theme 8: Critical aspects and the role of social support
While many participants reported positive outcomes, some expressed critical reflections on the professional impact of the intervention (Category 8.1). One key factor influencing the success of the intervention appeared to be the presence—or absence—of social support (Category 8.2). Participants who experienced stronger relational support reported greater clarity and confidence in their work integration process. In contrast, others struggled due to a lack of structured guidance. Notably, participant P1 had one of the least successful experiences in the programme, underscoring how insufficient support can hinder the development of self-efficacy and limit the collaborative, relational benefits that the intervention aims to foster.

4. Discussion

CAYAC survivors face significant challenges when entering the workforce, especially if they are affected by long-term physical LE or burdened by psychological issues. These factors affect not only their overall work ability, but also the capacity to perform specific tasks, whether physically demanding or cognitively complex. Also, participants’ health issues affect their approach to work, interactions with colleagues, and self-perception.
The job placement intervention described in this study has been developed in accordance with current survivorship care guidelines [7,21,24,26] and supported by recent evidence [3,11,15,18,20,34]. Participants were already enrolled in an integrated and multidisciplinary follow-up programme, where educational and occupational needs are routinely monitored alongside medical care [42,43]. The tailored approach where the intervention was implemented by a multidisciplinary team with vocational specialists playing a central role, effectively addressed a key challenge identified in the semi-structured interviews: the difficulty not only in finding work but in identifying suitable and accessible job opportunities. Many participants were at the beginning of their professional journey or facing their first real work experience, a stage that can be particularly complex for survivors due to health-related barriers and limited prior exposure to the labour market [3,34]. By providing personalised counselling and practical experience, the intervention helped survivors overcome employment barriers and access meaningful work. This approach is consistent with the findings of Pole et al. [34], who demonstrated that individualised goal-setting within vocational counselling enhances motivation, tracks progress, and facilitates successful workforce integration.
Clinical complexity was high across participants. Twelve out of 13 (92.3%) survivors reported at least one LE, most of moderate severity. Moreover, 9 out of 13 participants were officially recognised as having a physical, cognitive, or psychological disability according to the criteria defined by the Italian legal framework [44,45] (Law 104/1992; Law 68/1999). In Italy, disability certification is issued by public medical committees and based on documented impairments and functional limitations, and serves to guarantee access to social, educational, and occupational support [46]. Although country-specific, the classification broadly reflects the biopsychosocial model outlined by the World Health Organization’s International Classification of Functioning, Disability and Health [47].
Despite the complex medical history, HRQoL scores remained generally within normative ranges, indicating a certain level of functional adjustment. However, in the SF-12 questionnaire the lower average Mental Component Score (MCS = 43.5) compared to the Physical Component Score (PCS = 45.2) may indicate that psychological and emotional issues are more impactful than physical limitations. Many participants expressed anxiety and concerns in interviews about how their health limitations might interfere with their ability to work. This pattern is consistent with prior studies documenting the long-term psychosocial impact in adolescent and young adult cancer survivors [48].
Notably, several participants emphasised that their current difficulties were not primarily linked to their oncological history but to ongoing physical constraints that hinder access to employment opportunities matching their true capabilities. Our findings are consistent with the evidence that the cumulative burden of chronic health conditions—particularly neurologic and sensory impairments—can be linked to unemployment and can further compromise employment stability. Given the early onset of multiple morbidities, targeted clinical and vocational support is essential to reduce long-term workforce exclusion [25]. Other studies [3,25,49,50] similarly observed that physical and mental impairments related to cancer and its treatment affected cancer survivors’ work ability, the capacity to keep up with work demands, and employment status. To address these challenges and support long-term functioning, adopting more flexible working conditions (e.g., adjusted schedules, opportunities for remote engagement, and guidance from occupational health specialists) may play a key role in improving quality of life among survivors [3,15,51]. In our sample, several participants reported benefiting from tasks that were well aligned with their functional needs, and the flexibility offered by internship programmes facilitated engagement and reduced strain.
The primary motivation for joining the programme was the desire for greater independence, particularly financial autonomy, a universal goal at this life stage, that can be particularly challenging. This finding is consistent with existing literature [17,19,25,33], which highlights financial independence as a central concern for young adult cancer survivors navigating the transition to adulthood.
The intervention was generally well appreciated, with participants reporting high overall satisfaction (mean score 8.3/10). Most of them described the experience as rewarding and stimulating, indicating that it was both meaningful and empowering. However, a few participants also found it demanding or limiting, suggesting the need for flexibility and individualised pacing to accommodate different capacities and expectations. Moreover, the time restricted duration of internships may represent a significant limiting factor, especially for individuals whose contracts are not renewed. Such employment discontinuity contributes to long-term economic instability [25].
One of the most important resources reported was social support, provided by family, tutors, and colleagues. Social support may reduce the risk of work withdrawal or early retirement by enhancing self-efficacy, which has been shown to mediate this relationship [52]. While social support can be a key protective factor [14,27,33], it may also present challenges. Overprotection, particularly from parents, can hinder the development of autonomy and self-efficacy [4] unless balanced with appropriate encouragement and expectations. Many participants noted this ambivalence, highlighting the need to educate families about promoting independence in survivors, even when health concerns persist. This balance between emotional support and autonomy becomes even more delicate in the presence of complexities or disabilities, as observed in the analysed sample, where survivors may require additional assistance but still need opportunities to foster self-reliance and personal growth.
Finally, the intervention had a positive impact on participants’ self-perception, enhancing their sense of competence, responsibility, and confidence in managing tasks such as internships and contract renewals, all of which represent core elements of adult identity and workforce integration. These findings are consistent with those reported by Maas et al. [13], who demonstrated that individual perceptions, illness-related beliefs, self-esteem, and social support significantly influence long-term emotional, social, cognitive, and physical well-being in survivors. Their study showed that these psychosocial factors have a greater impact on psychosocial functioning than socio-demographic or medical characteristics alone. Together, these results highlight the value of targeted interventions aimed at fostering self-acceptance, strengthening self-esteem and social support. They also address feelings of helplessness and negative self-perception, with the ultimate goal of improving survivors’ overall quality of life.
This study has several limitations that should be acknowledged. The limited sample size, clinical heterogeneity, and single-centre design restrict the generalisability of the findings and limit the possibility of conducting robust statistical analyses. Additionally, the variability in internship experiences among participants complicates the identification of specific factors driving the observed outcomes. When evaluating social outcomes such as unemployment, it is crucial to consider the Italian cultural and socio-economic context (REF), where youth unemployment rates and the structure of labour and welfare systems may have influenced both participation and perceived benefits. Furthermore the sustainability and potential cost-effectiveness of this type of structured, multidisciplinary intervention were not assessed and should be addressed in future studies, as resource requirements may affect feasibility in routine survivorship care.
Nonetheless, there is a paucity of research investigating structured vocational interventions within this population. Most existing studies focus primarily on occupational challenges and associated risk or protective factors without evaluating the effectiveness of targeted support programmes. Despite its limitations, this study contributes preliminary evidence supporting the feasibility and potential benefits of individualised vocational interventions that can be closely integrated into cancer survivorship programmes. The transferal of our experience out of the Italian context, based on a tailored and specialist-guided approach, may require a deep effort in adapting interventions to different socio-cultural and economic contexts. Designing and conducting studies exploring the feasibility of this approach across other countries might generally represent a challenge for health care providers and stakeholders involved in survivorship care programmes. The subsequent dissemination and critical revision of these practices and experiences may further contribute to optimise their applicability in different health care systems.

5. Conclusions

This pilot study provides preliminary insights into the feasibility and perceived value of a tailored vocational intervention for CAYAC survivors. The findings suggest that structured, multidisciplinary approaches may support the transition to employment and merit further exploration. Larger and more diverse samples, together with longitudinal designs, are needed to evaluate the efficacy of vocation programmes in addressing the employment needs of young cancer survivors.

Author Contributions

Conceptualization, M.D.-V., A.S.-K., A.G. and G.Z.; methodology, A.S.-K., M.D.-V., G.Z. and A.G.; formal analysis, A.S.-K.; investigation, M.D.-V., I.G., F.F. (Francesco Felicetti) and E.B.; data curation, M.D.-V., A.S.-K. and I.G.; writing—original draft preparation, M.D.-V., A.S.-K., F.F. (Francesco Felicetti) and A.G.; writing—review and editing, M.D.-V., A.S.-K., A.G., F.F. (Francesco Felicetti), G.Z., E.A. and A.V.; supervision, A.V., E.B., F.F. (Francesco Felicetti) and F.F. (Franca Fagioli). All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki, and approved by the Ethics Committee of Regina Margherita Children’s Hospital, AOU Città Della Salute e Della Scienza Turin, Italy (Protocol number: 0018330, dated 20 February 2018).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

The data presented in this study are available on request from the corresponding author.

Acknowledgments

The authors would like to acknowledge the UGI Association (Unione Genitori Italiani contro il tumore dei bambini ODV) for the ongoing support to their clinical and research activities and the team of Patchanka-Cooperativa Sociale. We are grateful to all the participants whose voices and willingness to share their experiences made this study possible.

Conflicts of Interest

The authors declare no conflicts of interest.

Abbreviations

The following abbreviations are used in this manuscript:
CAYACChildhood, adolescent, and young adult cancers
CNSCentral nervous system
RTWReturn to work
SWTPSchool and Work Transitions Program
HRQoLHealth related quality of life
SF-1212-Item Short Form Health Survey
PCSPhysical Component Summary
MCSMental Component Summary
LELate effect
CLMEChronic and late medical health events
CTCAENational Cancer Institute’s Common Terminology Criteria for Adverse Events
CVCurriculum Vitae
WHOWorld Health Organization
ICFInternational Classification of Functioning, Disability and Health

References

  1. Suh, E.; Stratton, K.L. 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. Lancet Oncol. 2020, 21, 421–435. [Google Scholar] [CrossRef] [PubMed]
  2. van Kalsbeek, R.J.; van der Pal, H.J.H. European PanCareFollowUp Recommendations for surveillance of late effects of childhood, adolescent, and young adult cancer. Eur. J. Cancer 2021, 154, 316–328. [Google Scholar] [CrossRef] [PubMed]
  3. Braun, I.; Friedrich, M. Changes, challenges and support in work, education and finances of adolescent and young adult (AYA) cancer survivors: A qualitative study. Eur. J. Oncol. Nurs. Off. J. Eur. Oncol. Nurs. Soc. 2023, 64, 102329. [Google Scholar] [CrossRef] [PubMed]
  4. Winzig, J.; Inhestern, L. And what about today? Burden and support needs of adolescent childhood cancer survivors in long-term follow-up care—A qualitative content analysis. Child Care Health Dev. 2024, 50, e13207. [Google Scholar] [CrossRef]
  5. Rudolf von Rohr, L.; Battanta, N. The Requirements for Setting Up a Dedicated Structure for Adolescents and Young Adults with Cancer—A Systematic Review. Curr. Oncol. 2025, 32, 101. [Google Scholar] [CrossRef]
  6. Egger-Heidrich, K.; Wolters, F. Long-term surveillance recommendations for young adult cancer survivors. Cancer Treat. Rev. 2025, 139, 102992. [Google Scholar] [CrossRef]
  7. Michel, G.; Mulder, R.L. Evidence-based recommendations for the organization of long-term follow-up care for childhood and adolescent cancer survivors: A report from the PanCareSurFup Guidelines Working Group. J. Cancer Surviv. Res. Pract. 2019, 13, 759–772. [Google Scholar] [CrossRef]
  8. Buehlmann, L.; Otth, M. Longitudinal needs and cancer knowledge in Swiss childhood cancer survivors transitioning from pediatric to adult follow-up care: Results from the ACCS project. Discov. Oncol. 2024, 15, 450. [Google Scholar] [CrossRef]
  9. Hudson, M.M.; Ehrhardt, M.J. Approach for Classification and Severity Grading of Long-term and Late-Onset Health Events among Childhood Cancer Survivors in the St. Jude Lifetime Cohort. Cancer Epidemiol. Biomark. Prev. 2017, 26, 666–674. [Google Scholar] [CrossRef]
  10. DeVine, A.; Landier, W. The Children’s Oncology Group Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers: A Review. JAMA Oncol. 2025, 11, 544–553. [Google Scholar] [CrossRef]
  11. Lown, E.A.; Phillips, F. Psychosocial Follow-Up in Survivorship as a Standard of Care in Pediatric Oncology. Pediatr. Blood Cancer 2015, 62 (Suppl. S5), S514–S584. [Google Scholar] [CrossRef] [PubMed]
  12. Demoor-Goldschmidt, C.; Porro, B. Editorial: Young adults or adults who are survivors of childhood cancer: Psychosocial side effects, education, and employment. Front. Psychol. 2024, 15, 1510822. [Google Scholar] [CrossRef] [PubMed]
  13. Maas, A.; Maurice-Stam, H.; Feijen, E.A.M.; Teepen, J.C.; Delden, A.M.v.d.A.; Streefkerk, N.; Broeder, E.v.D.; Tissing, W.J.E.; Loonen, J.J.; van der Pal, H.J.H.; et al. Risk and Protective Factors of Psychosocial Functioning in Survivors of Childhood Cancer: Results of the DCCSS-LATER Study. Psycho-Oncology 2024, 33, e9313. [Google Scholar] [CrossRef] [PubMed]
  14. Miyagishima, K.; Ichie, K. The process of becoming independent while balancing health management and social life in adolescent and young adult childhood cancer survivors. Jpn. J. Nurs. Sci. 2023, 20, e12527. [Google Scholar] [CrossRef]
  15. Altherr, A.; Bolliger, C. Education, Employment, and Financial Outcomes in Adolescent and Young Adult Cancer Survivors—A Systematic Review. Curr. Oncol. 2023, 30, 8720–8762. [Google Scholar] [CrossRef]
  16. Kirchhoff, A.C.; Leisenring, W. Unemployment Among Adult Survivors of Childhood Cancer. Med Care 2010, 48, 1015–1025. [Google Scholar] [CrossRef]
  17. Gunnes, M.W.; Lie, R.T. Economic independence in survivors of cancer diagnosed at a young age: A Norwegian national cohort study. Cancer 2016, 122, 3873–3882. [Google Scholar] [CrossRef]
  18. Frederiksen, L.E.; Pedersen, C. 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. Lancet Reg. Health Eur. 2021, 12, 100258. [Google Scholar] [CrossRef]
  19. Dionisi-Vici, M.; Godono, A. Work Placement and Job Satisfaction in Long-Term Childhood Cancer Survivors: The Impact of Late Effects. Cancers 2022, 14, 3984. [Google Scholar] [CrossRef]
  20. Godono, A.; Felicetti, F. Employment among Childhood Cancer Survivors: A Systematic Review and Meta-Analysis. Cancers 2022, 14, 4586. [Google Scholar] [CrossRef]
  21. Devine, K.A.; Christen, S. Recommendations for the surveillance of education and employment outcomes in survivors of childhood, adolescent, and young adult cancer: A report from the International Late Effects of Childhood Cancer Guideline Harmonization Group. Cancer 2022, 128, 2405–2419. [Google Scholar] [CrossRef]
  22. Dumas, A.; Berger, C. Educational and occupational outcomes of childhood cancer survivors 30 years after diagnosis: A French cohort study. Br. J. Cancer 2016, 114, 1060–1068. [Google Scholar] [CrossRef] [PubMed]
  23. Otth, M.; Michel, G. On Behalf Of The Swiss Pediatric Oncology Group Spog. Educational Attainment and Employment Outcome of Survivors of Pediatric CNS Tumors in Switzerland—A Report from the Swiss Childhood Cancer Survivor Study. Children 2022, 9, 411. [Google Scholar] [CrossRef] [PubMed]
  24. L’Hotta, A.J.; Randolph, S.B. Clinical practice guideline and expert consensus recommendations for rehabilitation among children with cancer: A systematic review. CA Cancer J. Clin. 2023, 73, 524–545. [Google Scholar] [CrossRef] [PubMed]
  25. Bhatt, N.S.; Goodman, P. Chronic Health Conditions and Longitudinal Employment in Survivors of Childhood Cancer. JAMA Netw. Open 2024, 7, e2410731. [Google Scholar] [CrossRef]
  26. Signorelli, C.; Hart, N.H.; Mullen, L.; Nekhlyudov, L.; Travado, L.; Lam, W.W.T.; Henry, M.; Dégi, C.L.; Haywood, D.; Jefford, M. Aligning the World Health Organization’s (WHO) package of interventions for rehabilitation for cancer with the mission of the International Psycho-Oncology Society’s: Promoting psychosocial care for all people affected by cancer. J. Psychosoc. Oncol. Res. Pract. 2024, 6, 144. [Google Scholar] [CrossRef]
  27. Dionisi-Vici, M.; Giacoppo, I. Childhood, adolescent and young adult cancer survivors: Health promotion and wellbeing interventions. Curr. Opin. Epidemiol. Public Health 2025, 4, 1–6. [Google Scholar] [CrossRef]
  28. de Boer, A.G.; Taskila, T.K.; Tamminga, S.J.; Feuerstein, M.; Frings-Dresen, M.H.W.; Verbeek, J.H. Interventions to enhance return-to-work for cancer patients. Cochrane Database Syst. Rev. 2011, 16, 1343. [Google Scholar]
  29. Arpaci, T.; Altay, N. Psychosocial interventions for childhood cancer survivors: Systematic review and meta-analysis of randomized control trials. Eur. J. Oncol. Nurs. Off. J. Eur. Oncol. Nurs. Soc. 2024, 69, 102541. [Google Scholar] [CrossRef]
  30. Peikert, M.L.; Inhestern, L. Psychosocial interventions for rehabilitation and reintegration into daily life of pediatric cancer survivors and their families: A systematic review. PLoS ONE 2018, 13, e0196151. [Google Scholar] [CrossRef]
  31. Bradford, N.K.; Chan, R.J. Health promotion and psychological interventions for adolescent and young adult cancer survivors: A systematic literature review. Cancer Treat Rev. 2017, 55, 57–70. [Google Scholar] [CrossRef] [PubMed]
  32. Tamminga, S.J.; de Boer, A.G. Return-to-work interventions integrated into cancer care: A systematic review. Occup. Environ. Med. 2010, 67, 639–648. [Google Scholar] [CrossRef] [PubMed]
  33. Zegers, A.D.; Coenen, P. Tailoring work participation support for cancer survivors using the stages of change: Perspectives of (health care) professionals and survivors. J. Cancer Surviv. Res. Pract. 2023, 17, 706–719. [Google Scholar] [CrossRef] [PubMed]
  34. Pole, J.D.; Williams, B. Measuring what gets done: Using goal attainment scaling in a vocational counseling program for survivors of childhood cancer. Cancer Med. 2023, 12, 8676–8689. [Google Scholar] [CrossRef]
  35. UGI. Unione Genitori Italiani Contro il Tumore dei Bambini. Available online: https://ugi-torino.it/ (accessed on 20 August 2025).
  36. Patchanka. Available online: https://cooperativapatchanka.org/ (accessed on 20 August 2025).
  37. JobACT. Available online: https://www.projektfabrik.org/index.php/about-jobact.html (accessed on 18 July 2025).
  38. Hammarberg, K.; Kirkman, M. Qualitative research methods: When to use them and how to judge them. Hum. Reprod. 2016, 31, 498–501. [Google Scholar] [CrossRef]
  39. Ware, J., Jr.; Kosinski, M. A 12-Item Short-Form Health Survey: Construction of scales and preliminary tests of reliability and validity. Med. Care 1996, 34, 220–233. [Google Scholar] [CrossRef]
  40. Kallio, H.; Pietilä, A.M. Systematic methodological review: Developing a framework for a qualitative semi-structured interview guide. J. Adv. Nurs. 2016, 72, 2954–2965. [Google Scholar] [CrossRef]
  41. Braun, V.; Clarke, V. Reflecting on reflexive thematic analysis. Qual. Res. Sport Exerc. Health 2019, 11, 589–597. [Google Scholar] [CrossRef]
  42. Brignardello, E.; Felicetti, F. Endocrine health conditions in adult survivors of childhood cancer: The need for specialized adult-focused follow-up clinics. Eur. J. Endocrinol. 2013, 168, 465–472. [Google Scholar] [CrossRef]
  43. Zucchetti, G.; Ciappina, S. The Creation of a Transition Protocol Survey for Childhood, Adolescent, and Young Adult Cancer Survivors in Transition from Pediatric to Adult Health Care in Italy. J. Adolesc. Young Adult Oncol. 2022, 11, 202–210. [Google Scholar] [CrossRef]
  44. Legge 104/1992; Legge-quadro per l’assistenza, l’integrazione sociale e i diritti delle persone handicappate. Gazzetta Ufficiale della Repubblica Italiana: Rome, Italy, 1992. Available online: https://www.gazzettaufficiale.it/eli/id/1992/02/17/092G0108/s (accessed on 18 July 2025).
  45. Legge 68/1999; Norme per il diritto al lavoro dei disabili. Gazzetta Ufficiale della Repubblica Italiana: Rome, Italy, 1999. Available online: https://www.gazzettaufficiale.it/eli/id/1999/03/23/099G0123/s (accessed on 18 July 2025).
  46. Ministero della Salute. Invalidità civile e riconoscimento dello stato di handicap. Available online: https://www.salute.gov.it/new/it/faq/faq-esenzioni-invalidita/?utm_source=chatgpt.com (accessed on 18 July 2025).
  47. World Health Organization. International Classification of Functioning, Disability and Health (ICF). 2001. Available online: https://www.who.int/standards/classifications/international-classification-of-functioning-disability-and-health (accessed on 18 July 2025).
  48. Dionisi-Vici, M.; Felicetti, F. The impact of infertility and physical late effects on psycho-social well-being of long-term childhood cancer survivors: A cross-sectional study. EJC Paediatr. Oncol. 2023, 2, 100025. [Google Scholar] [CrossRef]
  49. Ketterl, T.G.; Syrjala, K.L. Lasting effects of cancer and its treatment on employment and finances in adolescent and young adult cancer survivors. Cancer 2019, 125, 1908–1917. [Google Scholar] [CrossRef]
  50. Brock, H.; Friedrich, M. Work ability and cognitive impairments in young adult cancer patients: Associated factors and changes over time-results from the AYA-Leipzig study. J. Cancer Surviv. Res. Pract. 2022, 16, 771–780. [Google Scholar] [CrossRef]
  51. Goto, S.; Itani, Y. Impact of work-related changes on health related quality of life in adolescent and young adult cancer survivors. J. Psychosoc. Oncol. Res. Pract. 2024, 6, 126. [Google Scholar] [CrossRef]
  52. Zhong, J.; Shao, L. The mediating role of self-efficacy in the relationship between social support and work withdrawal behavior: A cross-sectional study among young lung cancer survivors. Asia Pac. J. Oncol. Nurs. 2023, 10, 100207. [Google Scholar] [CrossRef]
Figure 1. The five phases of the vocational intervention for CAYAC survivors: enrolment, assessment, orientation, training, and internship.
Figure 1. The five phases of the vocational intervention for CAYAC survivors: enrolment, assessment, orientation, training, and internship.
Curroncol 32 00564 g001
Figure 2. Distribution of categories to participants for the three-words reflection task.
Figure 2. Distribution of categories to participants for the three-words reflection task.
Curroncol 32 00564 g002
Table 1. Socio-demographic and medical characteristics of participants.
Table 1. Socio-demographic and medical characteristics of participants.
No.%
Sex
Female646.2
Male753.8
Age at diagnosis
0–4215.4
5–900.0
10–14646.2
≥15538.4
Age at the interview
20–24538.4
25–29646.2
30–3417.7
≥3517.7
Off-therapy
<200017.7
2000–2009215.4
2010–2014430.8
≥2015646.2
Education
Middle school430.8
High school861.5
University17.7
Diagnosis
Acute Leukaemia (Myeloid or lymphoblastic)538.4
CNS Tumours430.8
Others *430.8
Chemotherapy1292.3
Radiotherapy646.2
Neurosurgery430.8
Hematopoietic stem cell transplantation215.4
Disease Relapse17.7
Late effects **
Patients with ≥ 1 LE1292.3
Grade 1717.5
Grade 22562.5
Grade 3820.0
Second Neoplasm215.4
* Ewing Sarcoma, Immature Teratoma, Nasopharyngeal Rhabdomyosarcoma, and Epstein–Barr Virus-Associated Hemophagocytic Lymphohistiocytosis. ** According to the National Cancer Institute’s Common Terminology Criteria for Adverse Events (CTCAE) version 4.03.
Table 2. SF-12 physical and mental health scores and 0–10 self-reported ratings of perceived satisfaction with the intervention.
Table 2. SF-12 physical and mental health scores and 0–10 self-reported ratings of perceived satisfaction with the intervention.
MSDRange
SF-12
PCS45.29.133.7–64.3
MCS43.511.226.3–63.1
0–10 rating8.32.05.0–10.0
Table 3. Codebook of the three-words reflection task.
Table 3. Codebook of the three-words reflection task.
CodesBeneficialSatisfyingRelationalEducationalStimulatingLimitingDemanding
Categoriesrewardingstimulatingchallenging
Table 4. Sample quotes for all 20 categories grouped by the 8 themes.
Table 4. Sample quotes for all 20 categories grouped by the 8 themes.
Theme 1: Motivations and Expectations
Category 1.1:
Desire for autonomy and financial independence
Hoping to get hired and have a salary. (P1)
The desire to leave my home and feel more independent (P2; P9)—to be useful to others. (P2)
I wanted to be independent, to stop asking my parents for money. I wanted to work! (P3)
Category 1.2:
Desire for employment and personal development
I didn’t have expectations about what I’d like to do, but they formed over time through these experiences. (P4)
I made mistakes. Since it was my first real job, I didn’t behave at my best. (P6)
I didn’t even know where to start looking for a job. (P6; P8)
I was willing to do anything, within my limits. (P8)
The desire to work, grow, learn new things, and to feel normal in a way. After being in the hospital context, doing heavy jobs isn’t ideal. (P12)
Theme 2: The impact of cancer on workability
Category 2.1:
Physical constraints on occupational choice
My career goals have changed a little bit. The doctor told me that certain jobs would be too demanding for me and my health, and suggested that office work would be better for me. (P2)
I realized that the problems I had in the past are still affecting me: fatigue and physical health issues. I’ve always avoided and denied being limited by my illness, but then I realized I do have limitations. I’m cancer free, but I get tired very easily. (P3)
I would have loved to attend a sports-focused high school, since I was really passionate about sports. Unfortunately, due to my physical conditions, I was told it wasn’t possible. (P5)
I do have eye-related issues, and I think that it would affect any job. (P13)
Category 2.2:
Employment loss due to physical impairments
Some jobs are hard if you are not healthy. I had to stop [a previous job] because of severe shoulder pain. They needed someone who could function every day. (P3)
I had to stop [my internship] due to a surgery that kept me in the hospital for a month. After that they weren’t able to keep me on. (P5)
Category 2.3:
Impact on emotional well-being
I always have anxiety about feeling unwell at work. (P3)
A lot of us have our own struggles. (P7)
Most things I’ve faced aren’t comparable to what I went through in the hospital—nothing was harder than that! (P12)
Theme 3: Accessibility and task adequacy
Category 3.1:
Previous work-related challenges
I found a job on my own as a construction worker for about a year, but it was very hard. Even though I earned money, I chose to quit because I wasn’t well. (P10)
The shift working hours can be tough for someone with a medical past, even if it’s not physically demanding. I’d already worked in physically demanding jobs before, so I wanted to change the environment a bit. (P12)
Category 3.2:
Successful alignment with workability
They did their best to arrange the internship. (P3)
They had informed me that I’d be working at the register due to my physical limitations. Occasionally, I took on other tasks, but nothing too physically demanding. (P5)
[The intervention] helped me find something more stable [work]. (P7).
Now I sit at a desk and don’t have to exert myself physically. (P13)
Theme 4: The importance of building self-esteem and self-efficacy
Category 4.1:
Increasing self-esteem
I suffer a lot from anxiety—especially when I’m around people, or when I have to talk to many people at once, or juggle a lot of tasks. This job helped me manage that. (P5)
Before, I saw everything negatively—like I wasn’t good at anything. Now, even if a [job] interview doesn’t go well, I treat it as experience and not as failure. (P8)
[The intervention] was short, so I’m not sure about a full self-esteem shift, but it gave me more confidence to try things on my own. (P9)
I didn’t imagine myself wearing a shirt every day. It’s a formal environment. My mindset has really changed. (P12)
Category 4.2:
Enhancing self-efficacy
Now, that I’ve had a serious experience, I understand how the work world operates—how to behave with colleagues, how to collaborate with them and with managers. (P2)
Now, I see my future in a more positive and autonomous way. I am definitely more autonomous in terms of work tasks. (P4)
I’ve built up my skills, I feel confident and independent. I no longer need assistance. I developed skills, learning how to adapt different situations. (P5)
I’ve changed for the better. Now I enjoy working, I’m active, my days are fuller, and I have a daily routine. (P10)
Category 4.3:
Occupational embeddedness
I am very happy because they asked me to stay. Now I also work night shifts. It’s more demanding and I have more responsibilities. (P5)
My supervisor wants to offer me a one-year contract. (P6)
Especially now that they’ve offered me a contract, I know that a company might actually want me. (P13)
Theme 5: The value of vocational support
Category 5.1:
Enhancing general job skills
The CV writing session was really helpful—mine needed a lot of work—and [the career coaches] helped me in improving it. (P7)
It was my first time. They help you to understand and guide you in what you might want to do, your options, the pros and cons. They helped me think about other paths, other possibilities through my CV. (P12)
I’d written a CV before, but something was missing, so they helped me to structure it better. (P13)
Category 5.2:
Perceived impact of the intervention
The project helped by connecting me with the right people and finding options that suited me. (P8)
The tasks of the internship were aligned with what we had discussed during the individual interview. During the second interview, I got the chance to do an internship—that made it feel more concrete. The project helped me narrow things down and find what to specialize in. (P9)
Category 5.3:
Focus on personal growth
It was definitely a stimulating experience. It helped me work through the anxiety I feel when speaking in front of others, facing large audiences, and juggling several tasks simultaneously. (P5)
Theme 6: The power of relationships: social support and workplace integration
Category 6.1:
Growth through social interactions
Interacting with customers helped me break out of my shell. I used to be shy and awkward, but I really came to enjoy those interactions. Now, I’m much more confident in conversations with people. (P8)
The most pleasant moment was when they trusted me enough to leave me in charge of the structure. Working with people and being in contact with them, it’s fulfilling. (P12)
Category 6.2:
Sense of belonging and motivation
My tutor used to stop by the office every morning and say that even if there was nothing to sign, she wanted to see my smile—it made her day better. (P2)
I got along even better with my last manager than the previous one. She really taught me a lot, and I became very patient. (P3)
One colleague in particular still offers help—even now that I’m working night shifts, I know I can rely on her if anything comes up. (P5)
I felt supported and comfortable whenever I needed help. I think that finding good people at work makes a huge difference. One of the girls from Patchanka advocated for me, and that helped get my contract extended. (P7)
My tutor is very kind and helpful, but she lets me handle things independently, too. She gives me general guidance and says ‘Go ahead, and I’ll review it.’ (P13)
Category 6.3:
Peer feedback and support
I also made friends during the project, and I still keep in touch with them. I met a girl who became my best friend. (P5)
Also, group activities taught me a lot about myself. I picked up on things I hadn’t noticed before, especially through feedback from others and moments shared during group work. I became especially close with my tutor. I also learned tailoring from a colleague, and we’re still friends. (P8)
Theme 7: The double-edged impact of family support
Category 7.1:
Family support as a facilitator
[Family support] helped very much. They were happy because they saw I was happy, too. (P2)
I used to complain a lot, and my family encouraged me to join. They were very supportive. (P8)
My family supported me, both emotionally and practically, like giving me rides when they can. They supported and motivated me throughout. (P9)
Yes, my family has always supported me in general and also encouraged me to continue with these projects. Even during the tough times, my mother gave me strength. From when I got sick until now, she’s always stayed close to me. (P11)
Category 7.2:
Family support as a barrier
They weren’t against it, but when I wasn’t feeling well, they advised me to stop if I wasn’t okay. (P3)
My mom always worries I might be too tired, so I try to reassure her. Previous jobs were short and poorly paid. My brother wasn’t thrilled, but for me it was nevertheless a way to get out of my home. (P7)
Theme 8: Critical aspects and the role of social support
Category 8.1:
Critical reflections
I thought it would be more helpful in finding a job. It was useful as a personal experience—but not professionally. (P11)
Category 8.2:
Importance of social support at the workplace
There wasn’t a specific person explaining things, so I asked different people in the stores. (P1)
What truly made a difference was having someone help me at the beginning to understand what I needed to do. (P2)
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

Share and Cite

MDPI and ACS Style

Dionisi-Vici, M.; Schneider-Kamp, A.; Giacoppo, I.; Godono, A.; Biasin, E.; Varetto, A.; Arvat, E.; Felicetti, F.; Zucchetti, G.; Fagioli, F. Supporting Employment After Cancer: A Mixed-Methods Evaluation of a Vocational Integration Programme for Childhood, Adolescent, and Young Adult Cancer Survivors. Curr. Oncol. 2025, 32, 564. https://doi.org/10.3390/curroncol32100564

AMA Style

Dionisi-Vici M, Schneider-Kamp A, Giacoppo I, Godono A, Biasin E, Varetto A, Arvat E, Felicetti F, Zucchetti G, Fagioli F. Supporting Employment After Cancer: A Mixed-Methods Evaluation of a Vocational Integration Programme for Childhood, Adolescent, and Young Adult Cancer Survivors. Current Oncology. 2025; 32(10):564. https://doi.org/10.3390/curroncol32100564

Chicago/Turabian Style

Dionisi-Vici, Margherita, Anna Schneider-Kamp, Ilenia Giacoppo, Alessandro Godono, Eleonora Biasin, Antonella Varetto, Emanuela Arvat, Francesco Felicetti, Giulia Zucchetti, and Franca Fagioli. 2025. "Supporting Employment After Cancer: A Mixed-Methods Evaluation of a Vocational Integration Programme for Childhood, Adolescent, and Young Adult Cancer Survivors" Current Oncology 32, no. 10: 564. https://doi.org/10.3390/curroncol32100564

APA Style

Dionisi-Vici, M., Schneider-Kamp, A., Giacoppo, I., Godono, A., Biasin, E., Varetto, A., Arvat, E., Felicetti, F., Zucchetti, G., & Fagioli, F. (2025). Supporting Employment After Cancer: A Mixed-Methods Evaluation of a Vocational Integration Programme for Childhood, Adolescent, and Young Adult Cancer Survivors. Current Oncology, 32(10), 564. https://doi.org/10.3390/curroncol32100564

Article Metrics

Article metric data becomes available approximately 24 hours after publication online.
Back to TopTop