Prevalence and correlates of job and insurance problems among young breast cancer survivors within 18\u2009months of diagnosis

Michelle J Naughton,Kimberly J Van Zee,Chloe M Beverly Hery,Elizabeth Z Naftalis,Sarah A Janse,Electra D Paskett

doi:10.1186/s12885-020-06846-w

Michelle J Naughton, Kimberly J Van Zee + Show 4 more

Open Access

https://doi.org/10.1186/s12885-020-06846-w

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Abstract

BackgroundThe prevalence and correlates of job and insurance problems were examined among a cohort of young U.S. breast cancer survivors during the first 18-months following diagnosis.MethodsParticipants were 708 women diagnosed at ≤45 years with stage I-III breast cancer. 90% were non-Hispanic white, 76% were married/partnered and 67% had ≥4-year college degree. Univariable and multivariable logistic regression examined the associations between demographic, lifestyle and clinical factors with job and insurance problems.Results18-months after diagnosis, 56% of participants worked full-time, 16% part-time, 18% were homemakers and/or students, 4.5% were unemployed, and 2.4% were disabled. The majority (86%) had private insurance. Job-related problems were reported by 40% of women, and included believing they could not change jobs for fear of losing health insurance (35.0%), being fired (2.3%), and being demoted, denied promotion or denied wage increases (7.8%). Greater job-related problems were associated with being overweight vs. under/normal weight (p = 0.006), income <$50,000/per year (p = 0.01), and working full-time vs. part-time (p = 0.003). Insurance problems were reported by 27% of women, and included being denied health insurance (2.6%), health insurance increases (4.3%), being denied health benefit payments (14.8%) or denied life insurance (11.4%). Insurance problems were associated with being under/normal weight vs. obese (p = 0.01), not being on hormone therapy (p < 0.001), and a tumor size > 5 cm vs. < 2 cm (p = 0.01).ConclusionsYoung survivors experienced significant job- and insurance-related issues following diagnosis. To the extent possible, work and insurance concerns should be addressed prior to treatment to inform work expectations and avoid unnecessary insurance difficulties.

Highlights

The prevalence and correlates of job and insurance problems were examined among a cohort of young U.S breast cancer survivors during the first 18-months following diagnosis
Many cancer survivors are able to return to work fully after treatment, some are at risk of employment and insurance discrimination [3]
This paper focuses on the experience of a cohort of young breast cancer survivors, during the first 18 months post-diagnosis

Summary

Introduction

The prevalence and correlates of job and insurance problems were examined among a cohort of young U.S breast cancer survivors during the first 18-months following diagnosis. The diagnosis and treatment of breast cancer can result in major changes in a woman’s daily routine, and for many younger women, this includes their employment status [1]. Despite intentions to continue working while receiving treatment, a majority of women have to reduce their paid work hours at least temporarily, within 6 months of diagnosis [1]. Many cancer survivors are able to return to work fully after treatment, some are at risk of employment and insurance discrimination [3]. Concerns among cancer survivors include a reduced ability to change jobs or get promoted, denied or reduced health insurance coverage, and changing health care providers [3]. Even among insured populations, continuing coverage frequently influences employment decisions [4], and younger patients have been shown to be at a higher risk for financial difficulties [4,5,6]

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