Work and financial disparities among adult cancer survivors in the United States.

Abstract

238 Background: The prevalence of cancer in the US continues to increase, with 18.1 million projected survivors by 2020. Few recent population-based studies have examined cancer-related work and financial disparities in this growing population. Methods: Cancer-related work modifications (e.g., changing to a flexible schedule or less demanding job, early or delayed retirement, extended or unpaid time off) and financial difficulties (e.g., debt, worry about medical bills, bankruptcy) were examined in the 2011 Medical Expenditures Panel Survey Experiences with Cancer Survivorship Supplement (n=1,592). Survey-weighted logistic regression was used to model the odds of having any work modification or financial difficulty and negative binomial regression to model counts of these outcomes as functions of survivorship status (i.e., active treatment, <5 years post-treatment, and ≥5 post-treatment=reference) and socio-demographic covariates. Results are generalizable to the civilian, non-institutionalized US population. Results: Among survivors, 27% reported at least one financial difficulty and 37% reported making work modifications due to cancer. Significant predictors of work modifications included: active treatment (OR 2.9; 95% CI 1.7-4.9), with 40% more modifications than those ≥5 years post-treatment; females (OR 1.5; 95% CI 1.1-2.2), with 30% more modifications; and race/ethnicity other than white (OR 1.7; 95% CI 1.1-2.6,), with 54% more modifications. Significant predictors of financial difficulties included: active treatment (OR 3.2; 95% CI 2.1-5.0), with 92% more difficulties; age <65 years (OR 2.4; 95% CI 1.7-3.3), with 130% more difficulties; no insurance (OR 2.4; 95% CI 1.3-4.4), with 67% more difficulties; and race/ethnicity other than white (OR 1.6; 95% CI 1.1-2.3), with 41% more difficulties. Conclusions: Significant work and financial disparities exist among US cancer survivors, particularly women, younger survivors, racial/ethnic minorities, and those without insurance. Active treatment predicted these concerns, but did not fully account for observed disparities. Screening and support for work and financial concerns is needed across the survivorship trajectory, with particular attention to groups at risk.