Insurance Coverage, Employment Status, and Financial Well-Being of Young Women Diagnosed with Breast Cancer

Abstract

Background: The economic cost of breast cancer is a major personal and public health problem in the United States. This study aims to evaluate the insurance, employment, and financial experiences of young female breast cancer survivors and to assess factors associated with financial decline.Methods: We recruited 830 women under 40 years of age diagnosed with breast cancer between January 2013 and December 2014. The study population was identified through California, Florida, Georgia, and North Carolina population-based cancer registries. The cross-sectional survey was fielded in 2017 and included questions on demographics, insurance, employment, out-of-pocket costs, and financial well-being. We present descriptive statistics and multivariate analysis to assess factors associated with financial decline.Results: Although 92.5% of the respondents were continuously insured over the past 12 months, 9.5% paid a "higher price than expected" for coverage. Common concerns among the 73.4% of respondents who were employed at diagnosis included increased paid (55.1%) or unpaid (47.3%) time off, suffering job performance (23.2%), and staying at (30.2%) or avoiding changing (23.5%) jobs for health insurance purposes. Overall, 47.0% experienced financial decline due to treatment-related costs. Patients with some college education, multiple comorbidities, late stage diagnoses, and self-funded insurance were most vulnerable.Conclusions: The breast cancer diagnosis created financial hardship for half the respondents and led to myriad challenges in maintaining employment. Employment decisions were heavily influenced by the need to maintain health insurance coverage.Impact: This study finds that a breast cancer diagnosis in young women can result in employment disruption and financial decline.

Results from a prospective longitudinal survey of employment and work outcomes in newly diagnosed cancer patients during and after curative‐intent chemotherapy: A Wisconsin Oncology Network study

“…Work ability reflects a complex interaction of individual and occupational factors 21 . Individual factors associated with employment outcomes may include education, income, marital status, race, rurality and age 13,16,22‐25 . Occupational factors may include physical, cognitive, and interpersonal work demands, company size, coworker support, and flexibility of work hours and work tasks 26 .…”

“…However, the literature often focuses on employment as a simple dichotomous outcome (employed vs unemployed); the variations in employment laws by country may also confound outcomes 21,28 . Furthermore, the published literature often assesses survivors in cross‐sectional surveys: data suggest that difficulties seen at 6 to 12 months posttreatment predict difficulty at later time points, 13 but the inclusion of individuals who are years removed from diagnosis may increase response bias 17,22,23 …”

An equity‐based narrative review of barriers to timely postoperative radiation therapy for patients with head and neck squamous cell carcinoma

“… 25 Patients who are un‐ or underemployed may lack benefits such as health insurance, paid sick leave, and disability insurance, which may worsen their financial status and make it more difficult to attend medical appointments in a timely manner. 33 , 56 , 57 …”

Are there employment and income gains of a national breast cancer screening program?

“…Previous studies have shown the adverse effects of breast cancer on employment but have not empirically assessed the employment effects of a breast cancer screening program [ 9 – 13 ]. Such employment effects for breast cancer survivors depend on how the program affects their employability.…”