The association between employment changes and healthcare use in the year after cancer diagnosis.

Abstract

6551 Background: Employed adults diagnosed with cancer face difficult decisions about continuing/returning to work and intensity of work following diagnosis. We examined the association between employment changes and healthcare use among cancer survivors. Methods: Data on adults enrolled at two health plans (Kaiser Permanente (KP) Colorado and KP Washington), diagnosed with breast, colorectal, lung, melanoma, and prostate cancers between 2003-2008, who responded to a 2013 survey with items on employment patterns following diagnosis were used. Survey data were linked to electronic health record (EHR) data on healthcare use, demographics, and cancer characteristics. Employment status and changes following diagnosis were measured. Multivariable logistic and negative binomial regression models were used to assess associations between employment changes and healthcare use in the year after diagnosis, adjusting for demographic and cancer characteristics. Results: Among 465 cancer survivors with complete survey and EHR data, 225 (48.4%) reported being employed since diagnosis. Among employed survivors, 126 (56.0%) reported making an employment change. Those who made a change were more likely to be female, diagnosed with AJCC stage 3 or 4 cancer, have received chemotherapy or hormone therapy, and had a caregiver (all p < 0.01). The most common employment changes were taking extended paid time off (53.2%), unpaid time off (39.7%), and switching to a flexible schedule (29.4%). Employment changes were made at initial diagnosis (18.3%), during treatment (70.6%), and ≤12 months post-treatment (26.2%); 28.6% made more than one change. Survivors who made an employment change had significantly more oncology visits (IRR = 1.85 [95% CI: 1.14-3.00]) and higher odds of hospitalization (OR = 5.18 [95% CI: 2.50-10.8]), but not primary care visits (IRR = 1.19 [95% CI: 0.94-1.50]) in the year after diagnosis, compared to those who did not make a change. Conclusions: Employment changes among cancer survivors are common and may be associated with treatment intensity and other healthcare use in the year after diagnosis. Prospective studies are needed to assess the impact of employment and healthcare use patterns on health outcomes.