Managing the cancer–work interface: the effect of cancer survivorship on unemployment

Abstract

ObjectiveThis study assessed differences in employment outcomes among cancer survivors using data from a nationally representative sample.MethodsThe 2011 Medical Expenditure Panel Survey (MEPS) data and the 2011 MEPS Experiences with Cancer Survivorship Supplement representing 3,360,465 people in the US population were analyzed to evaluate factors associated with unemployment among cancer survivors during the 5 years following diagnosis and treatment. The sample included adults 1) diagnosed with cancer within 5 years prior to survey completion and 2) engaged in paid employment since diagnosis. Individuals diagnosed with nonmelanoma skin cancer (n=33) were excluded from analyses.ResultsData of 221 cancer survivors were used to identify factors associated with employment status at the time respondents were employed (n=155) vs unemployed (n=66). Results of bivariate analyses indicated that unemployed survivors were older, more likely to be women, more likely to be uninsured at the time of cancer diagnosis, and to report lower incomes than cancer survivors who continue to be employed. Unemployed survivors were more likely than employed survivors to have had anxiety about being forced to retire or quit early when they were employed because of cancer and to report cancer-related interference with physical and mental aspects of their job tasks; unemployed survivors also took less paid time off and were less likely to change to a flexible job schedule when they were employed. In multiple logistic regression analyses, worry about being forced to retire (protective), worry that cancer recurrence will interfere with home or work responsibilities (risk), and change to a flexible work schedule (risk) following cancer diagnosis were associated with unemployment after controlling for demographic differences between employed and unemployed cancer survivors.ConclusionFindings of this study highlight the extent to which the challenges of managing the cancer–work interface create challenges to employment among cancer survivors and may lead to long-term unemployment among cancer survivors. Future studies should evaluate the strategies that the survivors could use to manage the cancer–work interface during cancer treatment to attain medical, psychological, social, and employment outcomes.

Adult Cancer Survivors' Engagement and Interest in Patient-Centered Research

“…Despite differences between engaging in research development and being a participant in a study, engaging in research development also involves a substantial commitment that may not be overcome by interest alone. For example, survivor engagement may be driven by feasibility factors such as, work schedule and flexibility, familial responsibilities, transportation, and the availability of social resources to balance competing demands (34,35). The consequence is that recruiting survivors to engage in developing research may be based on convenience (i.e., nonprobability or purposive) sampling (15,36), which may not represent the perspectives of all interested survivors and could induce selection bias in the development of patientcentered research.…”

Cancer‐related impairments and functional limitations among long‐term cancer survivors: Gaps and opportunities for clinical practice

“…Numerous studies have described the diverse functional limitations that affect survivors' ability to work both during treatment and after treatment has been completed 3,4 . Although many survivors do not experience work‐related consequences of cancer, working‐age survivors have reported changes in their employment status as a result of their diagnosis, including taking extended leave from work (paid/unpaid), changing their work schedule, changing to a less demanding job, and moving from full‐time to part‐time employment 5,6 . Functional limitations have detrimental employment effects on individuals and their families and lead to a substantial economic burden and loss of productivity 7 .…”

“… 3 , 4 Although many survivors do not experience work‐related consequences of cancer, working‐age survivors have reported changes in their employment status as a result of their diagnosis, including taking extended leave from work (paid/unpaid), changing their work schedule, changing to a less demanding job, and moving from full‐time to part‐time employment. 5 , 6 Functional limitations have detrimental employment effects on individuals and their families and lead to a substantial economic burden and loss of productivity. 7 In the United States, cancer‐related impairments and resultant functional limitations that negatively affect work ability may lead survivors to apply for Social Security Administration (SSA) disability financial assistance.…”

Evaluation of Usability and Satisfaction of Two Online Tools to Guide Return to Work for Cancer Survivors on the Cancer and Work Website

“…Returning to work after a cancer diagnosis is recognized as a key milestone for many cancer survivors, as it restores a sense of normalcy, and improves self-esteem, psychological well-being, and financial security [1,2]. More than 70% of incident cancers are diagnosed between the ages of 20 to 74 which are prime employment years for adults [3] and, on average, 89% of individuals with cancer return to work within 2 years of diagnosis [4]. However, cancer survivors face challenges when returning to work compared to individuals without cancer, including higher risks of unemployment, workplace stigma [5], and employer misperceptions of cancer survivors' work abilities, productivity, and reliability [6].…”

“…Between 26%-53% of cancer survivors will experience job loss or will resign during or after treatment [4,7,8]. Higher risks of unemployment among cancer survivors have also been associated with the increasing presence of late and long-term effects of cancer and its treatment [3,9,10] such as cancer-related fatigue [11], cancer distress, and cognitive impairment [12]. As well, worksite factors negatively associated with return to work include experiences of discrimination at work [13] and lack of accommodations and support at the workplace [10,14,15].…”