Association of Employment Disruptions and Financial Hardship Among Individuals Diagnosed with Cancer in the United States: Findings from a Nationally Representative Study

Abstract

Financial hardship (FH), defined as adverse patient effects due to cancer costs, is experienced by approximately half of individuals diagnosed with cancer. Many individuals diagnosed with cancer also experience disruptions with their employment. This study examines associations of employment disruptions and FH among a nationally representative sample of individuals diagnosed with cancer in the United States. We utilized 2016/2017 Medical Expenditure Panel Survey Experiences with Cancer data from individuals who worked for pay following cancer diagnosis. Employment disruption included taking extended paid time off work; switching to part-time/less demanding jobs; and/or retiring early due to cancer diagnosis/treatment. FH domains included: material (e.g., borrowing money/financial sacrifices); psychologic (e.g., worrying about medical bills/income); and behavioral (delaying/forgoing healthcare services because of cost). Multivariable logistic regression analyses determined associations of employment disruption and FH. Among 732 individuals with a cancer history, 47.4% experienced employment disruptions; 55.9% experienced any FH. Any FH was significantly more common among individuals with versus without employment disruptions across multiple measures and domains (68.7% vs. 44.5%; P value of difference <0.0001). Individuals with employment disruptions were more likely to have any FH [OR, 2.38; 95% confidence interval (CI), 1.62–3.52] and more FHs (OR, 2.76; 95% CI, 1.96–3.89]. This study highlights that employment disruptions are common and significantly associated with multiple domains of FH among individuals with a cancer history. Employer workplace accommodation, physician discussions regarding potential impacts of cancer care on employment, and other policies to minimize employment disruptions among individuals diagnosed with cancer may reduce FH in this vulnerable population. Significance: Individuals diagnosed with cancer may have employment disruptions; they may also develop FHs. People with cancer who have employment changes are more likely to also have FHs. Physicians and employers can help individuals with cancer through advancing planning, workplace assistance, and improved medical leave and insurance policies.

Racial and Ethnic Inequities in Cancer Care Continuity During the COVID-19 Pandemic Among Those With SARS-CoV-2

“…Second, given how closely tied employment is with insurance status in the United States, an important limitation of our study is that we did not have details on patient’s insurance type or whether patients were uninsured. The pandemic or a diagnosis of cancer may have led to disruptions in employment and associated insurance, which disproportionately impacts racially and ethnically minoritized populations . In the context of cancer treatment delays during the pandemic, it is important to consider insurance status as health care access factor to disentangle impacts of a COVID-19 diagnosis or employment loss on treatment disruptions.…”

“…The pandemic or a diagnosis of cancer may have led to disruptions in employment and associated insurance, which disproportionately impacts racially and ethnically minoritized populations. 48 In the context of cancer treatment delays during the pandemic, it is important to consider insurance status as health care access factor to disentangle impacts of a COVID-19 diagnosis or employment loss on treatment disruptions. Third, among those who received drug-based therapy, we were unable to evaluate different types of therapy, such as intravenous (IV) chemotherapy vs oral chemotherapy, which is important in the context of treatment delays given the need for physical visits to obtain IV chemotherapy.…”

Cancer diagnosis and treatment in working‐age adults: Implications for employment, health insurance coverage, and financial hardship in the United States

“…About 47% of adults with a cancer history report that they made changes to their regular employment after their diagnosis, 39 including extended leave (35.6%) and changes to schedules, roles, or career trajectory (15.9%), such as switching to a flexible schedule, or from full-time to part-time work, or to a less demanding job, declining a promotion, or even retiring earlier than planned (27.2%). 39,40 Some made multiple changes to their regular employment after cancer diagnosis. 40 Employed patients with cancer who do not have access to workplace accommodations, such as flexible schedules and work locations, are less likely to maintain employment during treatment and return to full-time work.…”

“…39,40 Some made multiple changes to their regular employment after cancer diagnosis. 40 Employed patients with cancer who do not have access to workplace accommodations, such as flexible schedules and work locations, are less likely to maintain employment during treatment and return to full-time work. 41,42 In addition to the consequences for patients and families, productivity losses because of employment disability can have adverse consequences for society.…”