Employment disruption following diagnosis of gynecologic malignancies

Abstract

<h3>Objectives:</h3> Financial toxicity is a significant challenge for cancer survivors, which may be compounded a decrease in work hours or cessation of work altogether after diagnosis. We evaluated the frequency of employment change in the year following diagnosis of a gynecologic cancer, and assessed factors associated with a disruption in employment. <h3>Methods:</h3> A cohort of patients 18-63 years old who were diagnosed with cervical, ovarian, endometrial or vulvar cancer (January 2009-December 2017) were identified in the Truven MarketScan database, an insurance claims database of commercially insured patients in the United States. All patients who were working full or part-time at diagnosis were included, and all employment changes during the year following diagnosis were followed monthly. Clinical information, including receipt of surgery, chemotherapy and radiation, were identified using Common Procedural Terminology codes, and International Statistical Classification of Diseases codes. Cox proportional-hazards models incorporating measured covariates were used to evaluate the impact of covariates on change in employment status. Patients were censored when a change in employment was identified. <h3>Results:</h3> A total of 7,446 women diagnosed with a gynecologic cancer (12.6% cervical, 24.7% ovarian, 2.6% vulvar, and 60.1% endometrial cancer) were identified. All patients held a full-time or part-time job 12 months prior to diagnosis. While most patients continued working following diagnosis, 20.6% cervical, 20.8% ovarian, 15.7% vulvar, and 21.7% of endometrial cancer patients experienced a change in employment from full-or part-time to long-term disability, retirement, or cessation of work. Older age (58-63), presence of comorbidities, and metastatic disease were associated with an increased risk of change in employment (P<0.0001, P=0.0091, P=0.002 respectively). In a multivariable model controlling for age, region of residence, comorbidities, insurance plan type, presence of adverse events, presence of metastatic disease, and cancer type, recipients of surgery plus adjuvant therapy (chemotherapy, radiation or chemoradiation) were 20% more likely to experience an employment change than those who underwent surgery alone (HR 1.23 95% CI 1.082-1.409). <h3>Conclusions:</h3> A total of 16-22% women with a gynecologic malignancy and employer-subsidized health insurance experienced a change in employment status in the year following diagnosis. Adjuvant therapy, older age, presence of comorbidities and presence of metastatic disease.