Managing the Cancer-Work Interface: Work Experiences That Influence Unemployment Among Cancer Survivors

Background:

More than 72.5% of new of cancer cases occur in working-age adults aged 20 to 74. Many cancer survivors face challenges returning to work post-treatment or remaining at work during treatment. Work-related factors such as access to paid leave, workplace flexibility, and job task modifications can ease the strain associated with survivors’ experiences of cancer-work conflict enabling survivors to remain employed during treatment and/or transition back to work with minimal disruption. However, limited research has examined the influence of work-related factors on cancer survivors’ long-term employment. This study aims to address this gap by using the 2011 Medical Expenditure Panel Survey (MEPS) data and the 2011 MEPS Experiences with Cancer Survivorship Supplement (CSAQ) to: 1) assess differences in work experiences between currently employed and unemployed cancer survivors who were employed in the last five years post cancer treatment, and 2) evaluate how differences in these work experiences may contribute to unemployment.

Methods:

All analyses accounted for weighting using complex samples statistical design.  Independent samples t-tests compared employed versus unemployed cancer survivors by age. Differences in selected demographic, cancer factors and job-related factors (cancer-related physical and mental job task interference, paid and unpaid leave, and various flexible work arrangements) by employment status were assessed using Chi-square statistics.  Based on results of bivariate analyses, a stepwise logistic regression was used to calculate the odds of being unemployed within five years of cancer diagnosis. 

Results:

Women were more likely than men to be unemployed at the time of survey completion.  Most respondents (93.3%) had insurance at the time of their cancer diagnosis, but those who were unemployed had a higher proportion of being uninsured (13% vs 1% of employed survivors).  A higher proportion of unemployed respondents reported cancer-related physical and mental job task interference, taking extended paid time off, and “flexing” their schedule compared to employed respondents.

After controlling for age, sex, income, and health insurance status in logistic models, respondents who reported cancer-related mental job task interference had higher odds of unemployment (OR=2.86, CI=1.40-5.84); however, cancer-related physical job task interference and extended paid time off were not related to employment status.  Cancer survivors who did not change to a flexible schedule following their cancer diagnosis had lower odds (OR=0.24, CI=0.10-0.56) of being unemployed compared to their counterparts. 

Conclusions:

Cancer-related mental job task interference increased odds of unemployment, after controlling for socio-demographics factors. Although neither cancer-related interference with physical job tasks nor availability of paid time off were associated with employment status, this is likely related to limited sample size as both factors trended in the expected direction. More research is needed to characterize how cancer patients manage the cancer-work interface in order to maintain employment during the cancer treatment and beyond.