Working with cancer: Health and disability disparities among employed cancer survivors in the U.S.
Highlights
► We examine differences in reported health and disability by cancer history. ► We compare health and disability status by occupation sector. ► Working survivors have poorer health than workers with no cancer history. ► Blue-collar workers report poorer health compared to other occupations. ► Blue-collar workers may work post diagnosis out of necessity rather than desire.
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.
Section snippets
Methods
We analyzed pooled cross-sectional data from the 1997–2009 U.S. National Health Interview Survey (NHIS). The study sample included persons ≥ 18 years (n = 381,447). In this study, “cancer survivors” were individuals who reported being diagnosed with cancer. Employment status was determined by whether or not respondents were working during the week prior to the NHIS interview. Employed participants were stratified by occupational sector (Krieger et al., 2005).
Participants' self-reported health
Results
Table 1 describes the socio demographics of the study sample. There were 22,952 persons who reported a cancer diagnosis. Among adult cancer survivors, workers were significantly less likely to report poor health and multiple disabilities when compared to the unemployed.
Table 2 illustrates that irrespective of occupational sector, cancer survivor workers were significantly less likely than unemployed survivors, but more likely than workers without cancer, to report “poor–fair” health. Among
Discussion
These nationally representative data reflect differences in the health of working cancer survivors according to occupational sector. As one may expect, the major differences are found between white- and blue-collar workers. The former were more likely to report low prevalence of functional limitations as well as good-to-excellent health. In contrast, blue-collar workers reported 30% increased risk for ≥ 2 functional limitations, and twice the risk of ≥ 2 chronic conditions and poor–fair overall
Funding
This research was funded in part by a National Cancer Institute fellowship at the National Institutes of Health (1F31CA153937); and by the National Institute of Occupational Safety and Health (NIOSH, R01 OH03915).
Conflict of interest statement
The authors have no conflicts of interest to disclose.
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