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Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs
Reduced Employment and Income
In its review of studies of cancer and employment, the 2006 Institute of Medicine (IOM) report From Cancer Patient to Cancer Survivor: Lostin Transition found that the effect of having cancer on employment has not been well studied across all types of cancer. Nevertheless, studies across different types of cancers and populations have consistently shown that significant portions of individuals (7 to 70 percent across studies [Spelten et al., 2002]) stop working or experience a change in employment (reduction in work hours, interruption of work, change in place of employment) after being diagnosed or treated for cancer (IOM and NRC, 2006), with implications for their income. Data from the 2000 NHIS reveal that in the United States, adults aged 18 and older with a prior diagnosis of cancer13 were less likely than individuals of similar age, sex, and educational levels to have had a job in the past month, were more likely to have limitations in the amount or type of work they could do because of health problems, and (among those with jobs) had fewer days of work in the past year (Yabroff et al., 2004). In another analysis of NHIS data from 1998–2000, 17 percent of individuals with a history of cancer reported being unable to work, compared with 5 percent of those without such a history (Hewitt et al., 2003). A retrospective cohort study carried out in five medical centers in Pennsylvania and Maryland with 1,435 cancer survivors aged 25–62 who were working at the time of their diagnosis in 1997–1999 found 41 and 39 percent of males and females, respectively, stopped working during cancer treatment. Although most (84 percent) returned to work within the 4 years after diagnosis (73 percent within the first 12 month after diagnosis), a significant minority (16 percent) did not do so. Of those who returned to work in the first year, 11 percent quit for cancer-related reasons within the next 3 years. Overall, 13 percent quit working for cancer-related reasons within 4 years of diagnosis (Short et al., 2005). Individuals whose jobs require manual labor or make other physical demands and those with head and neck cancers, cancers of the central nervous system, and stage IV blood and lymphatic cancers appear to be especially at risk for reductions in employment (Spelten et al., 2002; Short et al., 2005). The late effects of the illness or its treatment in survivors of childhood cancer can also prevent many from working (Ness et al., 2005; de Boer et al., 2006).
These changes in employment patterns can be a function of shifting priorities and values after diagnosis, a desire for retirement (consistent with the older age of most cancer patients), or changes in one’s employer having nothing to do with the employee (IOM and NRC, 2006). However, many individuals with cancer report that changes in their employment or their