Reasons given for non-vaccination and under-vaccination of children and adolescents in sub-Saharan Africa: A systematic review.

To achieve the full benefits of vaccination, it is key to understand the underlying causes of low vaccination by researching the barriers to vaccination at a local level. This systematic literature review aims to identify the reasons given by community members for the non-vaccination and under-vaccination of children and adolescents in sub-Saharan Africa. PubMed, Web of Science, PsycINFO, African Index Medicus, and African Journals Online databases were searched to identify articles published between 2010 and 2020. A total of 37 articles were included. As 17 studies did not report the reasons for non-vaccination and under-vaccination separately, we considered these two outcomes as "incomplete vaccination". The most common reasons for incomplete vaccination were related to caregiver's time constraints, lack of knowledge regarding vaccination, the unavailability of vaccines/personnel in healthcare facilities, missed opportunities for vaccination, caregiver's fear of minor side effects, poor access to vaccination services, and caregiver's vaccination beliefs.

The Economic, Medical and Psychosocial Consequences of Whole Genome Sequencing for the Genetic Diagnosis of Patients With Intellectual Disability: The DEFIDIAG Study Protocol.

Introduction: Like other countries, France has invested in a national medical genomics program. Among the four pilot research studies, the DEFIDIAG project focuses on the use of whole genome sequencing (WGS) for patients with intellectual disability (ID), a neurodevelopmental condition affecting 1-3% of the general population but due to a plethora of genes. However, the access to genomic analyses has many potential individual and societal issues in addition to the technical challenges. In order to help decision-makers optimally introduce genomic testing in France, there is a need to identify the socio-economic obstacles and leverages associated with the implementation of WGS. Methods and Analysis: This humanities and social sciences analysis is part of the DEFIDIAG study. The main goal of DEFIDIAG is to compare the percentage of causal genetic diagnoses obtained by trio WGS (including the patient and both parents) (WGST) to the percentage obtained using the minimal reference strategy currently used in France (Fragile-X testing, chromosomal microarray analysis, and gene panel strategy including 44 ID genes) for patients with ID having their first clinical genetics consultation. Additionally, four complementary studies will be conducted. First, a cost-effectiveness analysis will be undertaken in a subsample of 196 patients consulting for the first time for a genetic evaluation; in a blinded fashion, WGST and solo (index case, only) genomic analysis (WGSS) will be compared to the reference strategy. In addition, quantitative studies will be conducted: the first will estimate the cost of the diagnostic odyssey that could potentially be avoidable with first-line WGST in all patients previously investigated in the DEFIDIAG study; the second will estimate changes in follow-up of the patients in the year after the return of the WGST analysis compared to the period before inclusion. Finally, through semi-directive interviews, we will explore the expectations of 60 parents regarding genomic analyses. Discussion: Humanities and social sciences studies can be used to demonstrate the efficiency of WGS and assess the value that families associate with sequencing. These studies are thus expected to clarify trade-offs and to help optimize the implementation of genomic sequencing in France. Ethics Statement: The protocol was approved by the Ethics Committee Sud Méditerranée I (June 2019)-identification number: 2018-A00680-55 and the French data privacy commission (CNIL, authorization 919361). Clinical Trial Registration: (ClinicalTrials.gov), identifier (NCT04154891).

COVID-19-related attitudes, risk perceptions, preventive behaviours and economic impact in sub-Saharan African countries: implementing a longitudinal phone-based survey protocol in rural Senegalese households.

INTRODUCTION: Rural areas are considered safe havens against the increased spread of COVID-19 and associated restrictive measures, especially in contexts where public authorities are not in a position to systematically and substantially ease COVID-19-induced economic shocks. In the current sub-Saharan Africa context, still marked by uncertainty surrounding the spread of COVID-19, we present the protocol of an ongoing longitudinal study aimed at investigating COVID-19-related attitudes, risks perceptions, preventive behaviours and economic impact in rural areas in Senegal. METHODS AND ANALYSIS: A prospective randomised longitudinal study of 600 households located in three semiurban villages and nine randomly selected rural villages in the Niakhar area (located 135 km East of Dakar). Three ad hoc phone surveys are administered to 600 heads of households, their housewives in charge of managing the household and a relative living temporarily in the household, respectively. In addition to sharing identical sets of questions on several topics (risks perceptions, attitudes to curfew, attitudes to vaccines, beliefs about COVID-19 infection), the three separate survey questionnaires also include other topics (economic impact, local preventive strategies) whose related questions differ between questionnaires. As analysing evolutions is the study's primary focus, data on all the topics covered will be collected in three waves unless the spread of COVID-19 by mid-2021 justifies extending data collection. The present article presents the study protocol and details about the implementation of the first wave of data collection which started in July 2020. The decision to wait before presenting the protocol was based on the unprecedented context the COVID-19 pandemic. ETHICS AND DISSEMINATION: The survey's protocol was approved by the Senegalese National Ethical Committee for Research in Health (131/MSAS/CNERS/Sec) and received authorisation from both the Senegalese Ministry of Health (619/MSAS/DPRS/DR) and the French Commission on Information Technology and Liberties (CNIL 2220771).

Beliefs and Risk Perceptions About COVID-19: Evidence From Two Successive French Representative Surveys During Lockdown.

BACKGROUND: The outbreak of COVID-19 has been a major interrupting event, challenging how societies and individuals deal with risk. An essential determinant of the virus' spread is a series of individual decisions, such as wearing face masks in public space. Those decisions depend on trade-offs between costs (or benefits) and risks, and beliefs are key to explain these. METHODS: We elicit beliefs about the COVID-19 pandemic during lockdown in France by means of surveys asking French citizens about their belief of the infection fatality ratio (IFR) for COVID-19, own risk to catch the disease, risk as perceived by others, and expected prevalence rate. Those self-assessments were measured twice during lockdown: about 2 weeks after lockdown started and about 2 weeks before lockdown ended. We also measured the quality of these beliefs with respect to available evidence at the time of the surveys, allowing us to assess the calibration of beliefs based on risk-related socio-demographics. Finally, comparing own risk to expected prevalence rates in the two successive surveys provides a dynamic view of comparative optimism with respect to the disease. RESULTS: The risk perceptions are rather high in absolute terms and they increased between the two surveys. We found no evidence for an impact of personal experience with COVID-19 on beliefs and lower risk perceptions of the IFR when someone in the respondent's family has been diagnosed with a disease. Answers to survey 1 confirmed this pattern with a clear indication that respondents were optimistic about their chances to catch COVID-19. However, in survey 2, respondents revealed comparative pessimism. CONCLUSION: The results show that respondents overestimated the probabilities to catch or die from COVID-19, which is not unusual and does not necessarily reflect a strong deviation from rational behavior. While a rational model explains why the own risk to catch COVID-19 rose between the two surveys, it does not explain why the subjective assessment of the IFR remained stable. The comparative pessimism in survey 2 was likely due to a concomitant increase in the respondents' perceived chances to catch the disease and a decreased expected prevalence rate.

Genome Sequencing for Genetics Diagnosis of Patients With Intellectual Disability: The DEFIDIAG Study.

Introduction: Intellectual Disability (ID) is the most common cause of referral to pediatric genetic centers, as it affects around 1-3% of the general population and is characterized by a wide genetic heterogeneity. The Genome Sequencing (GS) approach is expected to achieve a higher diagnostic yield than exome sequencing given its wider and more homogenous coverage, and, since theoretically, it can more accurately detect variations in regions traditionally not well captured and identify structural variants, or intergenic/deep intronic putatively pathological events. The decreasing cost of sequencing, the progress in data-management and bioinformatics, prompted us to assess GS efficiency as the first line procedure to identify the molecular diagnosis in patients without obvious ID etiology. This work is being carried out in the framework of the national French initiative for genomic medicine (Plan France Médecine Génomique 2025). Methods and Analysis: This multidisciplinary, prospective diagnostic study will compare the diagnostic yield of GS trio analysis (index case, father, mother) with the French core minimal reference strategy (Fragile-X testing, chromosomal microarray analysis and Gene Panel Strategy of 44 selected ID genes). Both strategies are applied in a blinded fashion, in parallel, in the same population of 1275 ID index cases with no obvious diagnosis (50% not previously investigated). Among them, a subgroup of 196 patients are randomized to undergo GS proband analysis in addition to GS trio analysis plus the French core minimal reference strategy, in order to compare their efficiency. The study also aims to identify the most appropriate strategy according to the clinical presentation of the patients, to evaluate the impact of deployment of GS on the families' diagnostic odyssey and the modification of their care, and to identify the advantages/difficulties for the patients and their families. Ethics Statement: The protocol was approved by the Ethics Committee Sud Méditerranée I and the French data privacy commission (CNIL, authorization 919361). Trial Registration: ClinicalTrials.gov identifier NCT04154891 (07/11/2019).

Attitudes about COVID-19 Lockdown among General Population, France, March 2020.

Because the effectiveness of a coronavirus disease lockdown in curbing coronavirus disease spread depends on public support, acquiring real-time information about the way populations reacted to the lockdown is crucial. In France, such public support remained fragile among low-income persons, probably because the lockdown exacerbated preexisting social inequalities and conflicts.

Physicians' decision processes about the HPV vaccine: A qualitative study.

BACKGROUND: The contemporary crisis of trust in vaccines has severely impaired acceptance of the HPV vaccine, especially in France, where its uptake culminated at 23.7% in 2018 (complete course at age 16). Physicians' recommendations strongly influence its acceptance/refusal. Our study sought to understand the decision processes leading physicians to recommend this vaccine (or not). METHODS: Qualitative interviews of French physicians (general practitioners, gynecologists, and pediatricians). We first randomly selected doctors in a national register of medical professionals and then resorted to snowballing to build a convenience sample. We coded the interviews in a thematic analysis built both inductively and deductively from our research questions and data. RESULTS: Two thirds of the participants (19/28) were favorable to HPV vaccination, some (4) opposed it, while the others were hesitant about recommending it. In explaining their opinions, most participants mentioned that they trusted the stakeholders within the vaccination system: the less trust they had, the more critical they were of the vaccine and the more importance they attributed to patients' opinions. We identified three different ways they interacted with patients on this topic: informing and convincing; adapting to patients' opinions; refusing compromise about vaccination. Crossing these various themes, we found 5 types of physicians: dissidents (mistrustful of the healthcare system and HPV vaccine), hesitant (finding it difficult to make up their minds about this vaccination), laissez-faire (letting patients decide by themselves, but very favorable to HPV vaccination), educator (very favorable), and uncompromising vaccinators (refusing debate). Pediatricians were overrepresented among the latter two types. CONCLUSIONS: Physicians' judgment was influenced by their trust in the stakeholders involved in designing and implementing the HPV vaccination strategy. In this sense, doctors did not differ substantially from laypeople. They were, nonetheless, strongly influenced by their professional style and ethos.

Regional variations of childhood immunisations in Senegal: a multilevel analysis.

OBJECTIVES: To estimate geographical variations of child immunisation at the regional level in Senegal, to identify individual and contextual factors that could explain these regional discrepancies, and to measure their effects. METHODS: Data come from the 2015, 2016 and 2017 Senegalese Demographic and Health Survey, a national survey targeting women aged 15-49, with a questionnaire focusing on health and reproductive issues including their children's immunisation status. We restricted the analysis to children aged 12-23 months (n = 4955) and conducted a multilevel logistic regression to assess individual and contextual factors associated with complete immunisation coverage. RESULTS: The complete immunisation coverage rate of children was estimated at 68% and ranged from 41% in the region of Kedougou to 83% in the region of Dakar. The inter-regional variance was significantly different from zero (P = 0.006) in the empty multilevel model. It decreased by more than half (57 %) after adjusting for individual factors but remained significantly different from zero (P = 0.010). Regional variations of complete immunisation rates drastically decreased and were no longer statistically significant (P = 0.343) after adjusting for the following regional factors: population density, density of hospitals, literacy rate and proportion of health facilities with an antenatal care service. CONCLUSIONS: Regarding health policies designed to improve childhood immunisation and to reduce related inequalities, our results highlight the need to take into account both individual and contextual factors, with a focus on rural and deprived areas where children are at higher risk of incomplete immunisation.

OBJECTIFS: Estimer les variations géographiques de la vaccination des enfants au niveau régional au Sénégal, identifier les facteurs individuels et contextuels qui pourraient expliquer ces écarts régionaux et mesurer leurs effets. MÉTHODES: Les données proviennent de l'enquête démographique et la santé du Sénégal de 2015, 2016 et 2017, une enquête nationale ciblant les femmes âgées de 15 à 49 ans, avec un questionnaire axé sur les problèmes de santé et de reproduction, y compris le statut vaccinal de leurs enfants. Nous avons limité l'analyse aux enfants âgés de 12 à 23 mois (n = 4.955) et avons effectué une régression logistique à plusieurs niveaux pour évaluer les facteurs individuels et contextuels associés à une couverture vaccinale complète. RÉSULTATS: Le taux de couverture vaccinale complète des enfants était estimé à 68% et variait de 41% dans la région de Kédougou à 83% dans la région de Dakar. La variance interrégionale était significativement différente de zéro (P = 0,006) dans le modèle vide à plusieurs niveaux. Il diminuait de plus de la moitié (57%) après ajustement pour les facteurs individuels mais est restait significativement différent de zéro (P = 0,010). Les variations régionales des taux de vaccination complète ont considérablement diminué et n'étaient plus statistiquement significatives (P = 0,343) après ajustement pour les facteurs régionaux suivants: densité de population, densité des hôpitaux, taux d'alphabétisation et proportion d'établissements de santé disposant d'un service de soins prénatals. CONCLUSIONS: En ce qui concerne les politiques de santé conçues pour améliorer la vaccination des enfants et réduire les inégalités associées, nos résultats soulignent la nécessité de prendre en compte les facteurs individuels et contextuels, en mettant l'accent sur les zones rurales et défavorisées où les enfants sont plus à risque de vaccination incomplète.

Vaccination card availability and childhood immunization in Senegal.

BACKGROUND: The World Health Organization recommends recording vaccination status according to maternal recall in countries where administrative reporting systems are insufficiently reliable, as maternal recall in developing countries has been shown to be quite reliable compared with data from vaccination cards. This study aimed to investigate childhood vaccination coverage and its determinants according to the mothers' presentation of vaccination cards. METHODS: The data come from the 2017 Senegalese Demographic and Health Survey, a nationally representative household survey of women aged 15-49 years, with a questionnaire focusing on children's health. This analysis was restricted to children aged 12-35 months (n = 4032) and it assessed vaccination coverage and associated sociodemographic factors with weighted multivariate logistic regressions. Stratified multivariate logistic regressions were also performed to investigate factors associated with routine childhood immunization uptake of the Bacillus Calmette-Guérin (BCG) vaccine, recommended for administration shortly after birth, as well as of the vaccines against yellow fever and measles (recommended at 9 months). RESULTS: Comparison of vaccination coverage estimates according to the vaccination card or parental recall resulted in a 5-10% difference in estimated coverage for the BCG, pentavalent, measles, and yellow fever vaccines, but a huge difference for the polio vaccine (93.0% with the card, 32.0% without it). Presentation of the vaccination card was correlated with mothers' attendance at health facilities (suggesting it serves as a concrete manifestation of a bond between mothers and the healthcare system) and their region of residence, but it was not correlated with usually strong predictors of childhood vaccination, such as maternal education level. Factors associated with vaccinations differed depending on whether they were administered shortly after birth or later on. CONCLUSIONS: Maternal recall was found to be quite reliable except for oral polio vaccination, which raises the possibility that complete immunization coverage rates could have been significantly underestimated due to potential confusion between injection and vaccination. Considering the ability to present vaccination cards as the materialization of a bond with the healthcare system, the decision path leading to vaccination among those who lack such a bond appears longer and more likely to be driven by supply-side effects.

Asymmetric participation of defenders and critics of vaccines to debates on French-speaking Twitter.

For more than a decade, doubt about vaccines has become an increasingly important global issue. Polarization of opinions on this matter, especially through social media, has been repeatedly observed, but details about the balance of forces are left unclear. In this paper, we analyse the flow of information on vaccines on the French-speaking realm of Twitter between 2016 and 2017. Two major asymmetries appear. Rather than opposing themselves on each vaccine, defenders and critics focus on different vaccines and vaccine-related topics. Pro-vaccine accounts focus on hopes for new groundbreaking vaccines and on ongoing outbreaks of vaccine-preventable illnesses. Vaccine critics concentrate their posts on a limited number of "controversial" vaccines and adjuvants. Furthermore, vaccine-critical accounts display greater craft and energy, using a wider variety of sources, and a more coordinated set of hashtags. This double asymmetry can have serious consequences. Despite the presence of a large number of pro-vaccine accounts, some arguments raised by efficiently organized and very active vaccine-critical activists are left unanswered.

Determinants of childhood immunizations in Senegal: Adding previous shots to sociodemographic background.

Introduction. Today, in Sub-Saharan Africa, vaccine-preventable diseases still contribute heavily to high child mortality. Maintaining high coverage rates for childhood vaccines and reducing related social inequalities are public health priorities in Senegal. Our aim was to investigate the determinants of childhood vaccination, including sociodemographic factors and previous vaccine-related decision-making.Methods. Data come from the 2016 Senegalese Demographic and Health Survey, a nationally representative household survey targeting women aged 15-49, with a questionnaire focusing on health and reproductive issues, including their children's health. We restricted the analysis to children aged 12-23 months (n = 1,143). We used bivariate and multivariate analyses for investigating the determinants of several childhood vaccinations (Bacillus Calmette-Guérin, pentavalent, polio, measles and yellow fever vaccines), including sociodemographic factors and previous shots.Results. We identified two main sociodemographic predictors of childhood vaccination in Senegal: the mother's education level, which was strongly and positively correlated to every vaccination considered, except from the BCG vaccination, and the region of residence, with higher vaccination coverage rates in the Centre and West of Senegal. Moreover, previous shots were also strongly predictive of subsequent shots.Conclusion. The positive impact of mother's education on child vaccination illustrates the wide-ranging benefits of educating girls, while the regional variability of immunization rates requires more research to be better understood. Previous shots are probably a proxy variable for unobservable factors strongly correlated to vaccinations, but beyond this 'proxy effect', they may also have their own specific effect on following shots. We believe this topic deserves further research.

The cost-effectiveness of neonatal versus prenatal screening for congenital toxoplasmosis.

BACKGROUND: Congenital Toxoplasmosis (CT) can have severe consequences. France, Austria, and Slovenia have prenatal screening programs whereas some other countries are considering universal screening to reduce congenital transmission and severity of infection in children. The efficiency of such programs is debated increasingly as seroprevalence among pregnant women and incidence of congenital toxoplasmosis show a steady decrease. In addition, uncertainty remains regarding the effectiveness of pre- and postnatal treatments. METHOD: To identify cost-effective strategies, prenatal and neonatal screenings were compared using a decision-analytic model based on French guidelines and current knowledge of long-term evolution of the disease in treated children. Epidemiological data were extracted from the scientific literature and clinical data from the French Lyon cohort. Strategies were compared at one year of age, when infection can be definitively evaluated, and at 15 years of age, after which validated outcome data become scarce. The analysis was performed from the French Health Insurance System perspective and included direct medical costs for pregnant women and their children. RESULTS: The 1-year Incremental Cost-Effectiveness Ratio showed that prenatal screening would require investing €14,826 to avoid one adverse event (liveborn with CT, fetal loss, neonatal death or pregnancy termination) compared to neonatal screening. Extra investment increased up to €21,472 when considering the 15-year endpoint. CONCLUSIONS: Prenatal screening is cost-effective as compared to neonatal screening in moderate prevalence areas with predominant Type II strains. In addition, prenatal screening, by providing closer follow-up of women at risk increases the number of occasions for education avoiding toxoplasmosis.

Women's Attitudes Toward Invasive and Noninvasive Testing When Facing a High Risk of Fetal Down Syndrome.

Importance: Noninvasive prenatal testing (NIPT) using cell-free DNA in maternal blood is increasingly common compared with invasive testing (IT) in routine antenatal detection of Down syndrome (DS). Objective: To assess attitudes and decision making in pregnant women facing a risk of fetal DS greater than 1 in 250 as established by combined first trimester screening at 11 to 14 weeks of gestation. Design, Setting, and Participants: Survey study in which data were collected from pregnant women at high risk of fetal DS participating in a randomized clinical trial. Data were collected from April 8, 2014, to April 7, 2016, in 57 prenatal diagnosis centers in France. Data were analyzed in 2018. Interventions: Data on attitudes were collected prior to offering randomization between NIPT and IT, whereas data on decision making and test results were collected as part of the clinical trial. Main Outcome and Measures: The primary outcome related to attitudes. A hierarchical cluster analysis was conducted to identify clusters with contrasting attitudes. Logistic regression analyses were used to identify factors associated with attitudes. Results: All 2436 consecutive women to whom the study was proposed (mean [SD] age, 36.3 [5.0] years) answered the questionnaire: 515 (21.1%) expressed preference toward IT with complete karyotyping, whereas 1843 (75.7%) favored NIPT with almost certain but limited information. Hierarchical cluster analysis yielded 4 different clusters that mainly differed in attitudes toward risk taking and extent of information seeking. Factors likely associated with attitudes driven by risk aversion were mostly age and religious beliefs (adjusted odds ratio [aOR], 1.03; 95% CI, 1.00-1.05; P = .03 and aOR, 1.62; 95% CI, 1.29-2.04; P < .001, respectively), whereas higher nuchal translucency measurements by ultrasonography were associated with attitudes driven by ambiguity aversion (aOR, 1.67; 95% CI, 1.27-2.20; P < .001). For attitudes involving both risk and ambiguity aversion at different extents, lower education was associated with highly valuing all possibilities of getting information on pregnancy, whereas higher education was associated with highly valuing information on fetal DS as a primary concern (aOR, 0.54; 95% CI, 0.44-0.67; P < .001 and aOR, 1.44; 95% CI, 1.20-1.74; P < .001, respectively). In all, decision making was in line with attitudes. Conclusions and Relevance: Aversion to risk of fetal loss related to IT and aversion to ambiguity generated by incomplete information from NIPT played a major role in shaping attitudes and decision making. Informed decision making should require pregnant women at high risk of DS to receive extensive information on targeted abnormalities by both tests.

France's citizen consultation on vaccination and the challenges of participatory democracy in health.

BACKGROUND: Confronted with a rise in vaccine hesitancy, public health officials increasingly try to involve the public in the policy decision-making process to foster consensus and public acceptability. In public debates and citizen consultations tensions can arise between the principles of science and of democracy. To illustrate this, we analyzed the 2016 citizen consultation on vaccination organized in France. This consultation led to the decision to extend mandatory vaccination. METHODS: The analysis combines qualitative and quantitative methods. We analyze the organization of the consultation and its reception using the documents provided by its organizing committee, articles of newsmedia and the contents of 299 vaccine-critical websites. Using methods from computational linguistics, we investigate the 10435 public comments posted to the consultation's official website. RESULTS: The combination of a narrow framing of debates (how to restore trust in vaccination and raise vaccination coverages) and a specific organization (latitude was given to the orientation committee with a strong presence of medical experts) was successful in avoiding legitimizing vaccine critical arguments. But these choices have been at the expense of a real reflection on the acceptability of mandatory vaccination and it did not quell vaccine-critical mobilizations. CONCLUSIONS: Public health officials must be aware that when trying to increase democratic participation into their decision-making process, how they balance inputs from the various actors and how they frame the discussion determine whether this initiative will provide meaningful information and democratic legitimacy.

Discounting health and money: New evidence using a more robust method.

This study compares discounting for money and health in a field study. We applied the direct method, which measures discounting independent of utility, in a representative French sample, interviewed at home by professional interviewers. We found more discounting for money than for health. The median discount rates (6.5% for money and 2.2% for health) were close to market interest rates, suggesting that at the aggregate level the direct method solves the puzzle of unrealistically high discount rates typically observed in applied economics. Constant discounting fitted the data better than the hyperbolic discounting models that we considered. The substantial individual heterogeneity in discounting was correlated with age and occupation.

Chronic neuropathic pain negatively associated with employment retention of cancer survivors: evidence from a national French survey.

PURPOSE: Chronic neuropathic pain (CNP) is more prevalent among cancer survivors than among the general population. This study aims to investigate the role of CNP on job retention among cancer survivors, 5 years after diagnosis. METHODS: In 2015, 2009 individuals diagnosed with cancer in 2010 were interviewed in the French national survey VIe après le CANcer. Logistic regression investigated the relationship between CNP-measured using the seven-item Douleur Neuropathique 4 (DN4) questionnaire-and employment. RESULTS: Nine hundred sixty-nine individuals were aged 18-54 and employed at diagnosis and therefore were included. Eighty-two percent were still employed in 2015, 26% had fewer working hours than before diagnosis, and 55% had the same working hours. Thirty percent reported CNP 5 years after diagnosis. These cancer survivors were less likely to be employed in 2015 than those without CNP and, if employed, were more likely to work fewer hours. After adjustment for gender, medical variables (adverse cancer event, prognosis, chemotherapy, and comorbidities) were found to still significantly affect employment retention in cancer survivors, as well as reporting CNP. CONCLUSION: Improving CNP screening and management is necessary to reduce its impact on cancer survivors' professional lives. IMPLICATIONS FOR CANCER SURVIVORS: Healthcare policy and medical cancer survivor's follow-up must take into account the importance of the substantial impact of CNP on cancer survivors' daily lives. Therefore, in order to ensure greater employment retention for cancer survivors, raising awareness of care providers about diagnosis and management of CNP is needed.