Lasting effects of cancer and its treatment on employment and finances in adolescent and young adult cancer survivors

Abstract

Background The impact of cancer and its treatment on employment and financial burden in adolescents/young adults (AYAs) is not fully known. Methods Eligibility for this cross‐sectional study of AYA cancer survivors included the diagnosis of a malignancy between ages 18 and 39 years and survey completion within 1 to 5 years from diagnosis and ≥1 year after therapy completion. Participants were selected randomly from the tumor registries of 7 participating sites and completed an online patient‐reported outcomes survey to assess employment and financial concerns. Treatment data were abstracted from medical records. Data were analyzed across diagnoses and by tumor site using logistic regression and Wald‐based 95% confidence intervals adjusting for age (categorized), sex, insurance status, education (categorized), and treatment exposures. Results Participants included 872 survivors (breast cancer, n = 241; thyroid cancer, n = 126; leukemia/lymphoma, n = 163; other malignancies, n = 342). Exposure to chemotherapy in breast cancer survivors was associated with an increase in self‐reported mental impairment in work tasks (odds ratio [OR], 2.66) and taking unpaid time off (OR, 2.62); survivors of “other” malignancies reported an increase in mental impairment of work tasks (OR, 3.67) and borrowing >$10,000 (OR, 3.43). Radiation exposure was associated with an increase of mental impairment in work tasks (OR, 2.05) in breast cancer survivors, taking extended paid time off work in thyroid cancer survivors (OR, 5.05), and physical impairment in work tasks in survivors of “other” malignancies (OR, 3.11). Finally, in survivors of “other” malignancies, having undergone surgery was associated with an increase in physical (OR, 3.11) and mental impairment (OR, 2.31) of work tasks. Conclusions Cancer treatment has a significant impact on AYA survivors’ physical and mental work capacity and time off from work.

Cancer treatment and survivorship statistics, 2019

“…Cancer survivors are vulnerable to financial hardships that may manifest as material (eg, problems paying medical bills, medical debt, and bankruptcy), psychological (eg, stress or worry about paying medical bills), or behavioral (eg, delaying or forgoing necessary medical care because of cost) aspects. Survivors who are younger, underinsured or uninsured, and/or have lower income are more likely to experience financial hardship, as are long‐term survivors of childhood cancer . For example, in one study, approximately 35% of cancer survivors aged 18 to 49 years reported difficulty in paying medical bills compared with 25% in those without a history of cancer; this gap narrowed substantially in those aged 50 to 64 years (27% vs 23%, respectively) .…”

The Impact of Thyroid Diseases on the Working Life of Patients: A Systematic Review

“…In this regard, concerning the impact of different therapeutic cancer protocols in affecting work absenteeism, the mean duration of sick leave was significantly lower in patients with differentiated thyroid cancer who received rhTSH aided radioiodine ablative therapy (RIT) one week after thyroidectomy than in patients who received rhTSH aided RIT after 4-6 weeks following standard protocol [41]. Moreover, among the employed cancer survivors investigated by Ketterl et al [32], those who had been exposed to radiation were significantly more likely to need a long period of paid work rest compared to those who had not been exposed to radiation. In regards to possible effects of complications from common thyroid surgical procedures on sickness absence, patients experiencing hypoparathyroidism, vocal cord paralysis, as well as vocal cord paralysis and concomitant hypoparathyroidism reported 43, 115 and 97 days lost from work [42].…”

“…Analysis of the data by gender showed a significantly higher risk of being unemployed only among women, and this finding was confirmed also when ethnic and education variables were analyzed. A more recent investigation reported that, among 126 survivors of thyroid cancer, 104 (82.5%) were employed sometime between the diagnosis and the study participation period [32]. Mongelli et al [33] reported that about a half of the 1753 investigated cancer survivors were employed full time, 10.6% had a part time employment, while the 4.8% reported being self-employed or a small business owner.…”

“…Ketterl et al [32] Würzburg, Cologne, Germany (1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001) See Table 1 See Table 1 Among employed patients n. 49 (83%) reported some impairment; n. 26 Clinical data The patients were studied at three time points: at baseline on levothyroxine suppressive therapy, after rhTSH while on levothiroxine suppressive on the day of the WBS, or after withdrawal of thyroid hormone on the day of the WBS.…”

Feasibility and Acceptability Findings of an Energy Balance Data Repository of Children, Adolescents, and Young Adults with Cancer

“…The effects of poor physical fitness are particularly concerning due to the negative implications they have on patients' and survivors' ability to fulfill basic life roles (e.g., activities of daily living, personal care). These functional and activity limitations can further lead to other negative consequences, such as poor overall quality of life (QOL), poor mental health, unemployment, financial toxicity, and related comorbidities and mortality [23,24]. However, there is no accepted standardized approach to the screening or treatment of PA and PF declines experienced in young cancer patients and survivors throughout the care continuum [25].…”