1. Impact of Functioning on the Career Development of Young Adult CNS Survivors
David R. Strauser, Ph.D.

2. Study Partners Fong Chan-University of Wisconsin-Madison
Stacia Wagner-Children’s Brain Tumor Foundation
Timothy Tansey-University of Wisconsin-Madison
Kanako Iwanaga-University of Wisconsin-Madison

3. Importance of the Problem
Within cancer survivorship populations, survivors of central nervous system (CNS) tumors have been identified to be at greater risk for significant impairment in functioning, levels of independence, employment, and social competence when compared to survivors of non-CNS disease.
Difficulty transitioning to adulthood via education and work
5x more likely to be unemployed than their non-CNS counter parts

4. Career Development Perspective
Utilizing a vocational counseling framework, researchers have begun to identify potential areas in which survivors of young adult brain tumors can be categorized to better explain the challenges experienced around finding and maintaining employment.

5. Illinois Work and Well-Being Model
Recent work has suggested that the Illinois Work and Well-Being Model can be used to conceptualize how cancer related factors can impact the career development process and ultimately employment
Based on the ICF
Links career development to employment and overall participation in society
Three key Career Development Phases
Awareness
Acquisition
Maintenance

6. Illinois Work and Well-Being Model

7. Purpose of the Study
RQ1
Examine how physical and mental health self-management impacts the three phases of career development
RQ2
Examine how physical and mental functioning impacts the three phases of career development
RQ3
Does mental and physical functioning mediate the relationship between physical and mental health self-management and the three phases of career development
We should use terms in a consistent way

8. Methods

9. Procedures Survey first year college students who are CNS survivors
On-line survey
IRB approved-University of Illinois at Urbana-Champaign
Survey Packet- Demographics & Questionnaire

10. Instruments Questionnaire developed specifically for this study
ICF and Illinois Work and Disability Model Based
Areas
Career Development-3 domains
Physical/Mental Functioning
Physical/Mental health self-management

11. Career Development-3 domains
Awareness
I know how to obtain information that would assist me in making effective education and career decisions
I feel confident that I can make effective education and career decisions
People close to me (parents) provide me with the support and resources necessary to make effective education and career decisions.
People close to me (parents) believe it is important for me to work as an adult
Acquisition
I know how to go about looking for a job that meets my personal needs, skills, and abilities
Maintenance
I feel confident that I would have the ability to maintain employment if I would able to secure a job?

12. Physical/Mental Functioning
Physical functioning
Q: In the past 30 days how would you rate your physical health?
Excellent=4, Good=3, Fair=2, Poor=1
Mental functioning
Q: In the past 30 days how would you rate your emotional health?

13. Physical/Mental health self-management
Physical health self-management
Q: In the education and work environment I am confident that I can manage my physical related brain tumor symptoms (pain, fatigue, vision etc..)
Agree=4, Somewhat Agree=3, Somewhat Disagree=2, Disagree=1
Mental health self-management
Q: In the education and work environment I am confident about my ability to mange my emotional related brain tumor symptoms (depression, anxiety)

14. Data Analysis RQ1 Multiple linear regression RQ2 RQ3
Examine how physical and mental health self-management impacts the three phases of career development
RQ2
Examine how physical and mental functioning impacts the three phases of career development
RQ3
Does mental and physical functioning mediate the relationship between physical and mental health self-management and the three phases of career development
Multiple linear regression
We should use terms in a consistent way
Hierarchical regression analysis

15. Results

16. Participants 81 young adult survivors of childhood cancer
Age: Between 18 and 24 years old (M = 18.90, SD = .97)
Diagnosis
Astrocytoma
21%
Medulloblastoma brain tumor
17%
Craninopharyngioma 9%
Ependymoma
The age at diagnosis of the participants was between 0 and 17 years old
(M = 9.23, SD =4.72)

17. Participants Treatment Recurrence of cancer
The age at recurrence of cancer:
Between 4 and 23 years old
(M = 11.79, SD =6.38)

18. Job Awareness: RQ1 & 2 RQ1 RQ2 B SE B β .065 .070 .097 .309 .077
Examine how physical and mental health self-management impacts Job Awareness B
SE B β
Physical health self-management
.065
.070
.097
Mental health self-management
.309
.077
.421**
Note: R2=.211, p < F(2, 78) = , p < .001
R2 = 21%; BETA for mental health self-management is .421; if controlling for mental health functioning the R2 for mental health self-management becomes smaller (delta R2 and the mental health self-management beta becomes smaller or not significant, then mental health functioning is a partial mediator for the relationship between mental health self-management and job awareness. Mental health self-management  better mental health functioning better mental health functioning leads to better job awareness. Mental health functioning is a mediator.
RQ2
Examine how physical and mental functioning impacts Job Awareness B
SE B β
Physical functioning
.092
.057
.172
Mental functioning
.234
.055
.448**
Note: R2=.299, p < F(2, 78) = , p < .001

19. Job Awareness: RQ3
Physical and mental functioning as mediators for the relationship
between physical and mental health self-management and job awareness
At entry into model
Final model R2
ΔR2 B
SE B β
Step 1
.299
.299**
Physical functioning
.092
.057
.172
.093
.063
.173
Mental functioning
.234
.055
.448* *
.164
.065
.315*
Step 2
.342
.043
Physical health self-management
.017
.073
.025
Mental health self-management
.175
.085
.238*
After controlling for the effect of physical and mental health functioning, physical and mental health self-management added 4.3% of the variance; beta for mental health self-management reduced from .421 to Mental health functioning is definitely a mediator for the relationship between mental health self-management and job awareness. Better mental health self-management led to better mental health functioning, better mental health functioning led to better job awareness.
F(4, 76) = 9.872, p < .001 for the full model
Δ F(2, 78) = , p < .001 for Step 1; ΔF(2, 76) = 2.484, n.s. for Step 2.

20. Job Acquisition: RQ1 & 2 RQ1 RQ2 B SE B β .292 .121 .248* .478 .133
Physical health self-management
.292
.121
.248*
Mental health self-management
.478
.133
.368**
Note: R2=.251, p < F(2, 78) = , p < .001
RQ2
R2 = 25%; BETA for mental health self-management is .368; if controlling for mental health functioning the R2 for mental health self-management becomes smaller (delta R2 and the mental health self-management beta becomes smaller or not significant, then mental health functioning is a partial mediator for the relationship between mental health self-management and job acquisition. Mental health self-management  better mental health functioning better mental health functioning leads to better job acquisition. Mental health functioning is a mediator. B
SE B β
Physical functioning
.207
.104
.218*
Mental functioning
.339
.101
.367**
Note: R2=.254, p < F(2, 78) = , p < .001

21. Job Acquisition: RQ3
Physical and mental functioning as mediators for the relationship
between physical and mental health self-management and Job Acquisition
At entry into model
Final model R2
ΔR2 B
SE B β
Step 1
.254
.254**
Physical functioning
.207
.104
.218
.135
.111
.143
Mental functioning
.339
.101
.367**
.232
.115
.251*
Step 2
. 337
.082*
Physical health self-management
.222
.129
.189
Mental health self-management
.288
.152
After controlling for the effect of physical and mental health functioning, physical and mental health self-management added 8.2% of the variance in job acquisition (vs. 36.8% without controlling for the effect of physical and mental health functioning; beta for mental health self-management reduced from .368 to .222 and not significant. Mental health functioning is definitely a mediator for the relationship between mental health self-management and job acquisition.
F(4, 76) = 9.640, p < .001 for the full model
Δ F(2, 78) = , p < .001 for Step 1; ΔF(2, 76) = 4.717, p < .05 for Step 2.

22. Job Maintenance : RQ1 & 2 RQ1 RQ2 B SE B β .550 .101 .545** -.041 .111
Physical health self-management
.550
.101
.545**
Mental health self-management
-.041
.111
-.037
Note: R2=.286, p < F(2, 78) = , p < .001
RQ2
R2 = 29%; BETA for physical health self-management is .550; if controlling for physical health functioning, the R2 for physical health self-management becomes smaller (delta R2 and the physical health self-management beta becomes smaller or not significant, then physical health functioning is a partial mediator for the relationship between physical health self-management and job maintenance. Physical health self-management  better physical health functioning better physical health functioning leads to better job awareness. Physical health functioning is a mediator. B
SE B β
Physical functioning
.395
.090
.486**
Mental functioning
-.011
.088
-.013
Note: R2=.230, p < F(2, 78) = , p < .001

23. Job Maintenance: RQ3
Physical and mental functioning as mediators for the relationship
between physical and mental health self-management and Job Maintenance
At entry into model
Final model R2
ΔR2 B
SE B β
Step 1
.230
.230**
Physical functioning
.395
.090
.486**
.093
.283*
Mental functioning
-.011
.088
-.013
.047
.097
.059
Step 2
.364
.134**
Physical health self-management
.431
.108
.426**
.426* *
Mental health self- management
-.101
.127
-.090
After controlling for the effect of physical and mental health functioning, physical and mental health self-management added 13.4% of the variance; beta for physicl health self-management reduced from .550 to Physical health functioning is definitely a partial mediator for the relationship between physical health self-management and job awareness. Better physical health self-management led to better physical health functioning, better physicL health functioning led to better job maintenance.
F(4, 76) = , p < .001 for the full model
Δ F(2, 78) = , p < .001 for Step 1; ΔF(2, 76) = 8.016, p < .001 for Step 2.

24. Discussion

25. Limitations Cross-sectional study Well educated sample
Limited psychometrics regarding the instruments
Predominately female and Caucasian sample

26. Discussion
Facilitating education and employment via career development, it is important to address perceived physical and mental functioning
Improving management of functioning may also be warranted
Target functioning based on phase of career development

27. Discussion
Improving perception of functioning appears to strengthen ability to manage late effects in the education and work environment
Incorporating career development into young adult CNS psychosocial treatment appears to be important.
Interventions should be targeted based on career development activities

28. Contact Information
David R. Strauser, Ph.D. Work and Disability Lab Department of Kinesiology and Community Health 213A Huff Hall, MC South Fourth Street Champaign, IL