Working poor and working nonpoor cancer survivors: Work-related and employment disparities.

African American cancer survivors disproportionately experience financial difficulties after cancer. Decreased work participation (going from being employed full time to part time or from employed to not employed) can contribute to financial hardship after cancer but employment outcomes among African American cancer survivors have not been well described. This study estimates the prevalence of work changes and identifies factors associated with decreased work participation among African American cancer survivors. We analyzed data from 916 African American breast, colorectal, lung, and prostate cancer survivors who participated in the Detroit Research on Cancer Survivors (ROCS) cohort and were employed before their cancer diagnosis. Modified Poisson models estimated prevalence ratios of decreased work participation and work changes, including changes to hours, duties, or schedules, between diagnosis and ROCS enrollment controlling for sociodemographic and cancer‐related factors. Nearly half of employed survivors made changes to their schedules, duties, or hours worked due to cancer and 34.6% took at least one month off of work, including 18% who took at least one month of unpaid time off. More survivors employed full time (vs. part time) at diagnosis were on disability at ROCS enrollment (18.7% vs. 12.6%, P < 0.001), while fewer were unemployed (5.9% vs. 15.7%, P < 0.001). Nearly half (47.5%) of employed survivors decreased work participation. Taking paid time off was not associated with decreased work participation; however, taking unpaid time off and making work changes were associated with prevalence ratios of decreased work participation of 1.29 (95% CI: 1.03, 1.62) and 1.37 (95% CI: 1.07, 1.75), respectively. Employment disruptions are common after a cancer diagnosis. Survivors who take unpaid time off and make other work changes may be particularly vulnerable to experiencing decreased work participation.

175 Background: Cancer patients commonly rely on loved ones to act as informal caregivers during and after treatment. Caregivers may need to take time off work or make other employment changes to handle caregiving demands. Employment changes due to caregiving and their impacts on psychological outcomes are not well understood, especially among caregivers of African American cancer survivors. Methods: Results include information from caregivers of participants in the Detroit Research on Cancer Survivors (ROCS) cohort, a population-based study of African American survivors of breast, colorectal, lung, or prostate cancer from Metropolitan Detroit. ROCS participants nominated a friend or family member who acted as a caregiver to participate in the caregiver study. Caregivers provided information on employment and PROMIS depression and anxiety measures. The relationship between work outcomes and anxiety/depression was assessed using logistic regression models controlling for age, sex, income, and the caregiver’s relationship to the survivor. Results: For the first 350 caregivers enrolled, more than half (56%) were employed (42% full time, 14% part time) at the time of the survivor’s diagnosis. 53% of employed caregivers took time off work, including 40% who took unpaid time off to provide care. 16% took one month or more off work, including 12% who took at least one month of unpaid time. Taking at least one month off was associated with 2.3 (95% CI: 1.0, 5.4) times the odds of depressive symptoms but was not associated with anxiety. Extended unpaid time off was not associated with depression or anxiety. 38% of employed caregivers reported that it was somewhat, very or extremely difficult to balance work and caregiving. Difficulty balancing work and caregiving was associated with 3.1 times the odds of depressive symptoms (95% CI: 1.5, 6.2), and 2.2 times the odds of any anxiety (95% CI: 1.1, 4.3) compared with those who reported little or no difficulty. Conclusions: Difficulty balancing work and caregiving is common among caregivers of African American cancer survivors, and is associated with symptoms of depression and anxiety. Supports for caregivers facing employment challenges may improve their psychosocial wellbeing.

Background: Cancer-related financial hardship is common and is associated with lower health-related quality of life, particularly among African American cancer survivors. Employment outcomes during and after cancer treatment may represent modifiable risk factors to reduce financial hardship and improve wellbeing among cancer survivors, but employment outcomes among African American survivors are not well understood. Methods: We utilized data from the Detroit Research on Cancer Survivors (ROCS) cohort. African American adults ages 20-79 were eligible to join the cohort if they were diagnosed with a first primary breast, colorectal, lung, or prostate cancer since January 1, 2013, as identified through the Metropolitan Detroit Cancer Surveillance System cancer registry. The present analyses include 445 survivors who reported being employed before their cancer diagnosis. We estimated prevalence of work-related outcomes, including changes to hours, duties, and schedules; and extended time off. We further estimated the prevalence and identified predictors of decreased work participation (going from being employed at diagnosis to not employed or from full time to part time employment) between diagnosis and ROCS baseline survey (median: 13 months) using modified Poisson regression. Adjusted models controlled for age, household income, and cancer site. Results: One-third (33%) of survivors reported taking at least one month off of work, including 19% who used paid sick time, 8% who used paid vacation, and 21% who took at least one month of unpaid time off. Changes to work schedules (46%), hours worked (40%), or work duties (25%) were also common. Nearly half (47%) of employed survivors experienced a decrease in work participation. A greater proportion of survivors employed full time before diagnosis reported being on disability at ROCS baseline compared with those employed part time (20.4% vs. 14.3%), while unemployment was more common among survivors employed part time before diagnosis (16.9% vs. 7.9%; p&amp;lt;0.001). In adjusted models, older age (RR 65+ vs. &amp;lt;55: 1.5, 95% CI: 1.1, 1.9), lower income (RR $80,000+ vs. &amp;lt;$20,000: 0.3, 95%CI: 0.2, 0.4), cancer site (RR lung vs. breast: 1.6, 95% CI: 1.2, 2.0; RR colorectal vs. breast: 1.3, 95% CI: 1.0, 1.7) and receipt of chemotherapy (RR: 1.4, 95% CI: 1.1, 1.8) were associated with decreased work participation, as were taking at least one month of unpaid time off (RR: 1.4, 95% CI: 1.1, 1.8) and changing work duties related to cancer (RR: 1.4, 95% CI: 1.1, 1.7). Conclusions: Our findings of strong associations between low household incomes and receipt of chemotherapy and decreased employment participation may represent opportunities to improve employment outcomes. Possible interventions focused on rehabilitation or additional policy or employer-level supports could improve employment outcomes among survivors at greatest risk for financial difficulties. Citation Format: Theresa A Hastert, Mrudula Nair, Julia Mantey, Jennifer L Beebe-Dimmer, Stephanie Pandolfi, Tara E Baird, Ann G Schwartz. Work changes and predictors of decreased work participation among African American cancer survivors [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A118.

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, &lt;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 &lt;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.

15 Background: YA survivors face challenges unique from those of survivors of childhood cancer or of older adults. The potential impact of cancer or its treatment upon employment and finances for YA survivors is unknown. Methods: Eligibility included diagnosis of malignancy between ages 18-39, 1-5 years from diagnosis and &gt; 1 year from therapy completion. Participants (see Table) were randomly selected from tumor registries of 7 academic institutions; 875 (41% of attempted contacts) enrolled and completed online patient reported outcomes survey related to the effects of cancer/treatment on employment, finances, and cancer-related distress. Results: Overall 84% were employed sometime between cancer diagnosis and study enrollment. Of those, 76% took paid time off (40% &lt; 2 mo, 29% 2-5 mo, 31% &gt; 6 mo). Unpaid time off was required by 39% (37% &lt; 2 mo, 25% 2-5 mo, 38% &gt; 6 mo). Other impairments included inability to carry out physical (59%) or mental (55%) tasks required for their job, being less productive (67%), and not pursuing an advancement/promotion (21%). Financial impacts were substantial: 61% worried about medical bills, 31% went into debt related to their cancer/treatment. Of those incurring debt, most (53%) reported this amount to be &lt; $10,000, 29% $10,000-$24,999, and 18% &gt; $25,000; 13 (4.8%) filed for bankruptcy. Chi squares comparing those receiving extensive treatment vs. surgery only indicated greater likelihood of financial debt (10.6, P=.001) and residual distress (13.9, P &lt; .001) if treated with more than surgery. Conclusions: Most YA survivors experience a significant negative impact on employment and finances related to their cancer and treatment, which occurs at a critical time in their careers and at a life phase inherently more financially unstable. Longitudinal follow-up is required to better quantify the long-term burden on work and finances from cancer diagnosed in young adulthood. [Table: see text]

Employment issues are cited as one of the most common unmet psychosocial needs of cancer survivors; specifically, patients indicate they want more information on how to navigate working during their illness, the return to work process and how to manage the immediate and long-term effects on job productivity. Yet, most oncology care providers feel limited in their ability to address this topic with patients, citing minimal guidance, limited access to resources they feel clients need to achieve work-related goals, and concerns regarding their knowledge of how cancer may impact work. Likewise, supervisors of employees diagnosed with cancer are ill-prepared to manage the needs of cancer survivors beyond the standard referral to human resources. One limitation of the existing research on cancer and employment is that most studies have only examined these issues among higher income and more educated cancer survivors. The employment experiences of low-wage and less educated cancer survivors have been understudied. This is a significant gap in the research on cancer survivorship and work given the massive growth of low-wage jobs in the US since the 2008 Great Recession. The employment circumstances are significantly different for workers in low-wage jobs than they are for other workers. Thus, the effects of cancer on the work productivity of working poor and working non-poor may vary and consequently may have different effects on long-term employment and quality of life for cancer survivors. This study addresses this gap in the cancer survivorship literature by examining whether there is variation in the effects of cancer on the work productivity of working poor and working non-poor cancer survivors and its radiating effects on employment and the quality of life of cancer survivors. Using data from the Medical Expenditure Panel Survey (MEPS) and the MEPS Cancer Survivorship Supplement, this secondary data analysis will study cancer survivors who were employed at the time of their cancer diagnosis, comparing the effects of cancer on work productivity among working poor and working non-poor respondents and determining whether differences in work productivity influence long-term employment and quality of life. Preliminary results indicate that a higher percentage of working poor cancer survivors were less productive at work due to cancer and reported lower current employment rates and quality of life indicators in comparison to working non-poor survivors. Study results could help oncology medical teams, supervisors, and human resources professionals assist working cancer survivors during this transition period in their lives. Note: This abstract was not presented at the meeting. Citation Format: Helen Nichols, Kathleen Tracy, Paula Rosenblatt, Robin Vanderpool, Jennifer Swanberg. The influence of cancer on working poor and working non-poor cancer survivors’ work productivity, employment and quality of life [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 3277. doi:10.1158/1538-7445.AM2017-3277

Why Employment During and After COVID-19 Is a Critical Women's Health Issue.

The Family and Medical Leave Act of 1993 (FMLA) provided for unpaid time off from work to care for sick relatives or a newborn or adopted child, guaranteeing leave-takers’ jobs when they returned to work. Low-wage workers and single parents, however, cannot fully benefit from the FMLA because it offers no replacement income. In families that depend on women’s earnings to maintain living standards, unpaid time off from work threatens family finances that are already strained by the costs of bearing and providing for a new child, or the costs of health care for a sick family member. To ensure that those most in need of the protections of the FMLA can take advantage of the law, New Jersey is one among several states considering legislation to provide Family-Leave Insurance (FLI): paid leave to care for newborn babies and adopted children (BAA), and paid family-disability leave (FDL) to care for an ill child, spouse, or elderly parent. This Research-in-Brief summarizes a research project conducted by Michele I. Naples and Meryl Frank that examined proposals in New Jersey for paid family and medical leave programs. It discusses the policy context in which these programs are being considered and details the technical considerations behind estimating the cost of providing familyleave insurance.

145 Background: Many survivors of colorectal cancer face long-term job loss stemming from their diagnosis. However, little is known about employment outcomes among their partners and virtually nothing is known about employment impacts among survivor-partner dyads. Methods: In 2019-20 we surveyed 1150 patients who, in 2014-18, underwent resection of Stage III colorectal cancer and were seen at a community oncology practice, academic cancer center, or reported to Georgia SEER (51% RR). Patients gave a separate survey to their partner. 299 partners (73% RR) completed surveys. Patients and partners were asked about employment consequences of the patient’s cancer. Availability of job support benefits and prevalence of adverse employment outcomes were described among partners. Descriptive statistics were generated to identify trends in job loss within dyads. Results: Among partners, 56% were &lt;age 65, 63% female, 86% white, 27% had &lt; high school education. 61% were employed at time of patient’s diagnosis. Among these, 15% had no job support benefits. 33% had paid sick leave, 47% had flexible work schedule, 28% had unpaid time off. Due to the patient’s cancer, 43% missed 7-30 days work and 13% missed &gt;1 month. Due to the patient’s cancer, 18% lost $2000-$10,000 in income and 11% lost &gt;$10,000. 27% were no longer working at the time of survey. In 47% of dyads, both patient and partner were working before patient’s diagnosis. Among those, in 29% only 1 member of dyad was still working at time of survey and in 11% neither member of dyad was still working. In 15% of dyads, only the partner was working before patient’s diagnosis. Among those, in 50% the partner was no longer working at time of survey. In 16% of dyads, only the patient was working before diagnosis. Among those, in 48% the patient was no longer working at time of survey. Job loss in dyads was associated with older age, lower annual income, and lack of flexible work schedule. Conclusions: Missed work and loss of income are common among partners of patients with colorectal cancer. Job loss affects nearly half of dyads in the survivorship period. Employer accommodations such as flexible scheduling may help mitigate job loss among survivors and their partners. [Table: see text]

Background: Many employed cancer survivors have difficulty maintaining employment during and after cancer treatment, potentially contributing to financial hardship related to cancer and lower health-related quality of life (HRQOL). The objective of this study is to estimate associations between work changes and decreased work participation and financial distress and HRQOL among employed African American cancer survivors. Methods: We utilized data from 910 employed participants in the Detroit Research on Cancer Survivors (ROCS) cohort. African American survivors diagnosed with primary invasive female breast, colorectal, lung, or prostate cancer since January 1, 2013 and identified through the Metropolitan Detroit Cancer Surveillance System were eligible to participate. Participants self-reported employment status; decreases in employment participation (going from full time to part time employment or from being employed to unemployed or on disability after diagnosis); taking paid and unpaid leave; making changes to their hours, schedules, or duties related to cancer; financial distress using the COST measure; and HRQOL using the FACT-G. Linear regression models controlled for demographic, socioeconomic, and cancer-related factors. Results: Mean FACT-G score was 83.1 and mean COST score was 24.6. In adjusted models, FACT-G scores were 13.8 (95% CI: 10.7, 17.2) points lower among survivors who decreased work participation, 5.7 (95% CI: 3.0, 8.4) points lower among those who changed their hours, duties, status, or schedules, 4.6 (95% CI: 1.9, 7.2) points lower among those who took unpaid time off, and 3.4 (95% CI: 0.4, 6.4) points lower among survivors who took extended paid time off. Similarly, COST scores were 9.4 (95% CI: 7.5, 11.2) points lower (reflecting higher financial distress) among survivors who decreased work participation, 5.5 (95% CI: 4.0, 7.0) points lower among those making work changes, 6.5 (95% CI: 5.0, 7.9) points lower among those taking unpaid leave, and 1.8 (95% CI: 0.1, 3.5) points lower among those taking extended paid time off. Work changes were not associated with changes in FACT-G scores between ROCS enrollment and first year follow-up. Work changes and paid and unpaid leave were not associated with differences in COST scores between ROCS enrollment and first year follow-up; however, among survivors who decreased work participation between diagnosis and ROCS enrollment COST scores increased by 3.2 (95% CI: 1.4, 5.0) points between ROCS enrollment and first year follow-up. Conclusions: Employment changes after cancer, particularly decreased work participation and changing hours, duties, employment status, and schedules were associated with lower HRQOL among cancer survivors, but not with differences in HRQOL over time. Survivors who experienced employment changes due to cancer also reported higher financial distress, although this distress lessened over time among survivors who decreased work participation. Citation Format: Theresa A. Hastert, Jaclyn M. Kyko, Julie J. Ruterbusch, Angie S. Wenzlaff, Mrudula Nair, Jennifer L. Beebe-Dimmer, Stephanie S. Pandolfi, Ann G. Schwartz. Work outcomes, financial distress, and health-related quality of life among African American cancer survivors [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PR20.

The impact of cancer and its treatment on employment and financial burden in adolescents/young adults (AYAs) is not fully known. Eligibility for this cross-sectional study of AYA cancer survivors included the diagnosis of a malignancy between ages 18 and 39years and survey completion within 1 to 5years from diagnosis and ≥1year after therapy completion. Participants were selected randomly from the tumor registries of 7 participating sites and completed an online patient-reported outcomes survey to assess employment and financial concerns. Treatment data were abstracted from medical records. Data were analyzed across diagnoses and by tumor site using logistic regression and Wald-based 95% confidence intervals adjusting for age (categorized), sex, insurance status, education (categorized), and treatment exposures. Participants included 872 survivors (breast cancer, n=241; thyroid cancer, n=126; leukemia/lymphoma, n=163; other malignancies, n=342). Exposure to chemotherapy in breast cancer survivors was associated with an increase in self-reported mental impairment in work tasks (odds ratio [OR], 2.66) and taking unpaid time off (OR, 2.62); survivors of "other" malignancies reported an increase in mental impairment of work tasks (OR, 3.67) and borrowing >$10,000 (OR, 3.43). Radiation exposure was associated with an increase of mental impairment in work tasks (OR, 2.05) in breast cancer survivors, taking extended paid time off work in thyroid cancer survivors (OR, 5.05), and physical impairment in work tasks in survivors of "other" malignancies (OR, 3.11). Finally, in survivors of "other" malignancies, having undergone surgery was associated with an increase in physical (OR, 3.11) and mental impairment (OR, 2.31) of work tasks. Cancer treatment has a significant impact on AYA survivors' physical and mental work capacity and time off from work.

ObjectiveThis study assessed differences in employment outcomes among cancer survivors using data from a nationally representative sample.MethodsThe 2011 Medical Expenditure Panel Survey (MEPS) data and the 2011 MEPS Experiences with Cancer Survivorship Supplement representing 3,360,465 people in the US population were analyzed to evaluate factors associated with unemployment among cancer survivors during the 5 years following diagnosis and treatment. The sample included adults 1) diagnosed with cancer within 5 years prior to survey completion and 2) engaged in paid employment since diagnosis. Individuals diagnosed with nonmelanoma skin cancer (n=33) were excluded from analyses.ResultsData of 221 cancer survivors were used to identify factors associated with employment status at the time respondents were employed (n=155) vs unemployed (n=66). Results of bivariate analyses indicated that unemployed survivors were older, more likely to be women, more likely to be uninsured at the time of cancer diagnosis, and to report lower incomes than cancer survivors who continue to be employed. Unemployed survivors were more likely than employed survivors to have had anxiety about being forced to retire or quit early when they were employed because of cancer and to report cancer-related interference with physical and mental aspects of their job tasks; unemployed survivors also took less paid time off and were less likely to change to a flexible job schedule when they were employed. In multiple logistic regression analyses, worry about being forced to retire (protective), worry that cancer recurrence will interfere with home or work responsibilities (risk), and change to a flexible work schedule (risk) following cancer diagnosis were associated with unemployment after controlling for demographic differences between employed and unemployed cancer survivors.ConclusionFindings of this study highlight the extent to which the challenges of managing the cancer–work interface create challenges to employment among cancer survivors and may lead to long-term unemployment among cancer survivors. Future studies should evaluate the strategies that the survivors could use to manage the cancer–work interface during cancer treatment to attain medical, psychological, social, and employment outcomes.

190 Background: Recent national reports highlight the dramatically rising costs of cancer care and its impact on financial hardship among survivors. Comparatively little attention, however, has been paid to the contributions of family and friends in unpaid caregiving roles—specifically, the impact of caregiving on caregivers jobs and work life. Methods: Using data collected in the 2012 LIVESTRONG Survey of People Affected by Cancer, we examined the prevalence of cancer survivors reporting that they had a friend or family member providing care to them during or after cancer treatment. Then, among those reporting they had a caregiver employed at that time, we used logistic regression to examine caregiver work modifications (i.e., paid time, unpaid time off, changing hours or duties, or making a change in employment status. All models controlled for survivor age at diagnosis, sex, race/ethnicity, income, education and employment status as potential predictors. Results: Of the respondents (n = 6310), 88% reported a family member or friend provided care as follows (in non-mutually exclusive categories): spouses (64%), friends (47%), parents (40%), siblings (31%), children (28%) or other family member (14%). Among survivors with employed caregivers (n = 4,984), 41% reported that their caregiver made a work modification; of these 57% took paid time off, 41% took unpaid time off, 4% switched from full time to part time and 3% took early retirement. Caregivers were more likely to make work modifications for survivors with low (versus high) income or education and for unemployed (versus employed) survivors. The age of the survivor was also a significant factor, with caregivers making more work modifications for younger survivors (ages 18-64) compared to older survivors (age &gt; 65)—with ORs of caregiver work modfications increasing from 1.70 to 6.92 in a dose response by survivor age. Conclusions: Family and friends provide care to a majority of individuals with cancer and many make substantial modifications to their work—contributions which are not routinely counted in estimates of the cost of cancer care. Interventions may be warranted to support caregivers, particular those of survivors with lower income, less education and those of younger age.

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 &lt; 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.

PCN118 - The Role of Cancer Care on Patient Productivity, Caregiver Burden, and Personal Financial Hardship