Employment outcomes among cancer patients in the United States.

BACKGROUND: Cancer diagnosis and treatment can lead to disruptions in employment, which can, in turn, lead to financial problems and uninsurance. We used a nationally representative survey to describe predictors of non-employment among cancer patients compared to a matched cohort of individuals without cancer. METHODS: This was a retrospective study of the 2005-2018 nationally representative Medical Expenditure Panel Survey. We included respondents aged 18-64 and identified the cohort with current cancer by healthcare utilization related to a cancer diagnosis in the given year. We propensity-score matched controls to cancer cases in a 2:1 ratio. Survey weights were applied to generate national estimates of non-employment among the study cohort compared to the overall U.S. POPULATION: The Adjusted Wald test was used to compare employment outcomes between groups. Weighted multivariable linear regression was utilized to assess factors independently associated with non-employment. RESULTS: An estimated annual mean of 3.9 million cancer patients in the U.S. were included. Relative to controls, cancer patients had higher rates of part-year (36.0% vs 28.3%, P < 0.0001) and full-year non-employment (22.7% vs 17.5%, P < 0.0001). In a multivariable model, cancer diagnosis was associated with a 6.8% higher risk of part-year non-employment, 4.1% higher risk of full-year non-employment, and 14.8% lower individual earnings relative to the matched U.S. POPULATION: Sub-groups of cancer patients at high risk of negative employment outcomes included those enrolled in Medicaid, those without a high school degree, and those with high healthcare utilization. Low family income was the strongest predictor of non-employment. CONCLUSION: Cancer patients were at greater risk of non-employment relative to matched controls and adverse employment outcomes disproportionately affected cancer patients from vulnerable populations.

Duke Scholars

Author Haley A Moss Obstetrics and Gynecology, Gynecologic Oncology