Association of Employment Disruptions and Financial Hardship among Individuals Diagnosed with Cancer in the U.S.: Findings from a Nationally Representative Study

Abstract Financial hardship (FH), defined as adverse patient effects due to cancer costs, is experienced by approximately half of individuals diagnosed with cancer. Many individuals diagnosed with cancer also experience disruptions with their employment. This study examines associations of employment disruptions and FH among a nationally-representative sample of individuals diagnosed with cancer in the U.S. We utilized 2016/2017 Medical Expenditure Panel Survey Experiences with Cancer data from individuals who worked for pay following cancer diagnosis. Employment disruption included taking extended paid-time off-work; switching to part time/less demanding jobs; and/or retiring early due to cancer diagnosis/treatment. FH domains included: material (e.g., borrowing money/financial sacrifices); psychological (e.g., worrying about medical bills/income); and behavioral (delaying/forgoing healthcare services because of cost). Multivariable logistic regression analyses determined associations of employment disruption and FH. Among 732 individuals with a cancer history, 47.4% experienced employment disruptions; 55.9% experienced any FH. Any FH was significantly more common among individuals with vs. without employment disruptions across multiple measures and domains (68.7% vs. 44.5%; p-value of difference <0.0001). Individuals with employment disruptions were more likely to have any FH (odds ratio [OR] 2.38, 95%CI 1.62,3.52) and more FHs (OR 2.76; 95%CI 1.96,3.89). This study highlights that employment disruptions are common and significantly associated with multiple domains of financial hardship among individuals with a cancer history. Employer workplace accommodation, physician discussions regarding potential impacts of cancer care on employment, and other policies to minimize employment disruptions among individuals diagnosed with cancer may reduce financial hardship in this vulnerable population.