Jolene Harvey has a small voice and, at 4 feet 8, a small body. Although she has a medical assistant's degree, her employment record is spotty—it's mostly brief stints as a nanny—and right now she doesn't have a job. Her test scores and report cards have never been great, and today, at 35, she says, she "doesn't pick up a book unless it's a romance novel." She is not, in other words, the stuff of employers' dreams: a go-getter with a highly polished résumé. Neither is Kurt Zuhone, who is 24 and currently living on his dad's corn and soybean farm in rural Illinois. An aspiring record producer and recent college graduate, he sent out applications for entry-level jobs two months ago but hasn't heard back about any of them. When he finally does get an interview, he says, he expects to be asked about "things I've struggled with." He has a long list of those. He's bad at taking notes, and since the age of 9, teachers have been telling him he "isn't quick enough."

Still, he's not going to let anyone dismiss him easily. He's overcome obstacles before. And so has Harvey: both survived childhood leukemia. The disease left them with cognitive problems—they trace their disabilities to the intense radiation therapy they were given at ages 3 and 4—but it didn't win. They did, and they don't plan on giving up on anything now.

Childhood cancer is not the killer it once was. Seventy-five percent of kids diagnosed with it go on to have long lives. But survival comes at a cost: two thirds of patients suffer from lingering effects, sometimes from the disease but more often from the medicines that cured it. "Childhood therapy is often stronger than adult therapy," says Dr. Robert Hayashi, a pediatrician at St. Louis Children's Hospital. "That can wreak damage on a growing body." Radiation and chemotherapy may stunt physical and mental development. Survivors may find themselves unable to concentrate for more than a few minutes, or exhausted by the smallest tasks. Time is also known to work against them. "As these patients get older," says Hayashi, "they start to show symptoms that may have been silent for years."

Many of the earliest beneficiaries of strong radiation and chemo in the '70s and '80s are now entering the work force. Though they are covered by the Americans With Disabilities Act, they may find that their battle against cancer is not over, even if the disease itself is gone. Often less qualified for jobs than those who have been blessed with good health, they present employers with a dilemma. No one wants to penalize people for having been sick. At the same time, it's hard to justify hiring someone who can't always do the work. And no survivor wants to be given a job out of pity. According to a 2007 study in Pediatric Blood & Cancer, childhood cancer survivors are more than four times as likely to find no employment, compared with healthy people.

As a result, some try to hide their disabilities from potential employers; others admit to problems but don't explain why they have them. Both are bad strategies, says Hayashi. Ideally, what they need to do is admit to their disabilities and develop techniques to get around them as best they can. That is what Hayashi's Late Effects Program in St. Louis teaches. At the clinic, Zuhone has learned to work ahead of schedule, to get other people to take notes for him and to not let his pride get in the way; if he has to ask people to repeat themselves, he will. "Yes, I have a problem," he says. "But I have ways of overcoming it." Harvey, too, has learned a few tricks. She writes things down and tests herself on them. That seems to help her remember them, though she has had to stay up late into the night, working harder than most people. It's not all about strategy, however. Hayashi says cancer survivors have one advantage over everyone else: they are "inherently determined."

© 2008