Working with cancer: Health and disability disparities among employed cancer survivors in the U.S.

Abstract

Introduction

Approximately 40% of Americans annually diagnosed with cancer are working-age adults. Using a nationally representative database, we characterized differences in health status and occupation of working cancer survivors and persons without cancer.

Methods

Cross-sectional data pooled from the 1997–2009 US National Health Interview Survey for adults with self-reported physician-diagnosed cancer (n = 22,952) and those without (n = 358,495), were analyzed. Multivariable logistic regression was used to compare the health and disability status of employed cancer survivors across occupational sectors relative to workers without a cancer history and unemployed cancer survivors.

Results

Relative to workers with no cancer history, cancer survivors were more likely (OR; 95%CI) to be white-collar workers and less likely to be service workers. Working cancer survivors were significantly less likely than unemployed survivors, but more likely than workers with no cancer history, to report poor–fair health (0.25; 0.24–0.26) and (2.06; 1.96–2.17) respectively, and ≥ 2 functional limitations (0.37; 0.35–0.38) and (1.72; 1.64–1.80) respectively. Among employed cancer survivors, blue-collar workers reported worse health outcomes, yet they reported fewer workdays missed than white-collar workers.

Conclusion

Blue-collar cancer survivors are working with high levels of poor health and disability. These findings support the need for workplace accommodations for cancer survivors in all occupational sectors, especially blue-collar workers.

Introduction

More than 11 million people in the United States (U.S.) are cancer survivors. Of the more than one million Americans newly diagnosed with cancer each year, about 40% are working-age adults (Horner et al., 2009). Significant advances in cancer treatment have translated into improved survival and quality of life (Hubbard, 2010) and up to 85% of persons diagnosed continue working during treatment or return to work shortly after treatment (Hoffman, 2005, Short et al., 2005). This percentage varies by cancer type and stage of diagnosis.

Employed cancer survivors tend to be as productive and to have a comparable number of absentee days as employees without a cancer history (NCI, 2009). Nevertheless, due to differences in work load, stress and accommodation (Brown et al., 2006), certain job sectors may facilitate a higher rate of return of cancer patients than others. With earlier diagnoses among younger working-aged persons, job-related accommodations could have far reaching social and economic effects. Information on the occupational distribution and sociodemographic composition of the cancer survivors who continue to work after diagnosis is integral to understanding the potential health needs and burdens on this subpopulation.

Although some studies have investigated the functional limitations of adult survivors (Dellapasqua et al., 2006, Sehl et al., 2009), few have focused on the cancer survivors who continue and/or return to work (Frazier et al., 2009). Studies aimed at identifying which groups of cancer survivors return to work and if there is a significant disparity between these groups are needed to develop workplace-support programs. With most existing literature focusing on return to work among specific types of cancer, this study satisfies a gap in cancer literature by investigating health disparities among all survivors who continue to work post diagnosis.