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From Cancer Patient to Cancer Survivor: Lost in Transition
percent of men were not employed 6 months following diagnosis but, at 12 and 18 months, survivors’ employment was statistically not different from controls (Bradley, 2004). At 12 months, 26 percent of men with prostate cancer reported that cancer interfered with their ability to perform tasks that involved physical effort (Bradley et al., 2005b). Up to 16 percent of men said that they noticed changes in their ability to perform cognitive tasks (e.g., concentrate, keep up with others, learn new things). The implication of these findings is that interventions to assist survivors who stop working (e.g., income replacement programs, information about access to health insurance) are needed within 6 months of diagnosis. Workplace reintegration programs may be most needed through the year following diagnosis.
Nearly one out of five cancer survivors reported cancer-related limitations in ability to work when interviewed 1 to 5 years following their diagnosis as part of one of the largest cross-sectional studies to date (Short et al., 2005b). Nine percent were unable to work at all. Labor force participation dropped by 12 percentage points from diagnosis to follow-up and about two-thirds of survivors who quit working attributed the change to cancer. Other studies have found the drop in employment following cancer to be similar in magnitude. For example, a 10 percentage point greater decline in employment was noted among breast cancer survivors as compared to women without breast cancer (Bradley et al., 2002a,b).
The impact of cancer on employment has not been well studied across all types of cancer. However, work-related outcomes have been shown to be significantly worse for cancers of the central nervous system, hematologic cancers (Short et al., 2005b), and cancer of the head and neck. In one study, 52 percent of survivors of head and neck cancer who had worked before their diagnosis were disabled by their cancer treatment and could no longer work when assessed, on average, more than 4 to 5 years following their diagnosis (Taylor et al., 2004). Nearly three-quarters (74 percent) of survivors considered potentially cured of acute myelogenous leukemia (excluding those receiving allogenic marrow transplants) returned to full-time work according to a long-term follow-up study (median of 9.2 years from first or second complete remission) (de Lima et al., 1997). Less than a third of those who were not working cited physical limitation as the reason.
Other studies of cancer survivors have also shown that most cancer survivors continue to work, but that a minority have limitations that interfere with work. Of those working at the time of their initial diagnosis, 67 percent of survivors of lung, colorectal, breast, or prostate cancer were employed 5 to 7 years later when interviewed in 1999 (Bradley and Bednarek, 2002). Survivors in this study who stopped working did so because they retired (54 percent), were in poor health or disabled (24 percent), quit (4 percent), their business closed (9 percent), or for other reasons