Abstract
IntroductionCancer-related employment disruption contributes to financial toxicity and associated clinical outcomes through income loss and changes in health insurance and may not be uniformly experienced. We examined racial/ethnic differences in the financial consequences of employment disruption.MethodsWe surveyed a national sample of cancer patients employed at diagnosis who had received assistance from a national nonprofit about the impact of cancer diagnosis and treatment on employment. We used logistic regression models to examine racial/ethnic differences in income loss and changes in health insurance coverage.ResultsOf 619 cancer patients included, 63% identified as Non-Hispanic/Latinx (NH) White, 18% as NH Black, 9% as Hispanic/Latinx, 5% as other racial/ethnic identities, and 5% unreported. Over 83% reported taking a significant amount of time off from work during cancer diagnosis and treatment, leading to substantial income loss for 64% and changes in insurance coverage for 31%. NH Black respondents had a 10.2 percentage point (95% CI: 4.8 – 19.9) higher probability of experiencing substantial income loss compared to NH White respondents, and Hispanic or Latinx respondents had a 12.4 percentage point (95% CI: 0.3 – 24.5) higher probability compared to NH White respondents, controlling for clinical characteristics (i.e., cancer type, stage and age at diagnosis, and time since diagnosis). Similarly, NH Black respondents had a 9.3 percentage point (95% CI: -0.7 – 19.3) higher probability of experiencing changes in health insurance compared to NH White respondents, and Hispanic or Latinx respondents had a 10.0 percentage point (95% CI: -3.0 – 23.0) higher probability compared to NH White respondents.DiscussionCompared with NH White respondents, NH Black and Hispanic/Latinx respondents more commonly reported employment-related income loss and health insurance changes. Given documented racial/ethnic differences in job types, benefit generosity, and employment protections as a result of historic marginalization, policies to reduce employment disruption and its associated financial impact must be developed with a racial equity lens.
Highlights
Cancer-related employment disruption contributes to financial toxicity and associated clinical outcomes through income loss and changes in health insurance and may not be uniformly experienced
Of the 619 participants included in the analytic sample, 63% were categorized as Non-Hispanic or Latinx (NH) White, 18% as NH Black, 9% as Hispanic or Latinx, 5% as Other, and 5% as not reported
Compared to NH White participants, NH Black participants in this sample were more likely to be diagnosed at a younger age and to be single at diagnosis (Table 1)
Summary
Cancer-related employment disruption contributes to financial toxicity and associated clinical outcomes through income loss and changes in health insurance and may not be uniformly experienced. Almost half of over 16.9 million cancer survivors in the United States report cancer-related financial hardship, termed financial toxicity [1,2,3] This multidimensional construct encompasses material financial burden, altered care-seeking behaviors, and associated psychological distress stemming from medical costs, non-medical costs (e.g., transportation, childcare), and productivity loss [4, 5]. Financial toxicity may cause patients to delay or forego treatment, including oral medications, as a way of coping with mounting costs [4, 12, 13] These cumulative effects of financial toxicity are associated with worse health-related quality of life and psychological health [3, 14], higher symptom burden [15], and heightened mortality risk [16]. Given that workers in higher paying jobs are more likely to have robust benefits and protections, including paid leave and employersubsidized health insurance [21, 22], the financial consequences of employment disruption have the potential to exacerbate existing socioeconomic and racial inequities
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