Cancer care can drastically affect employment status, income for working adults
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Key takeaways:
- Financial hardships more common in individuals with a cancer history than those without one.
- Nearly half of adults with cancer history altered their employment to accommodate care.
As part of routine screening for financial hardship, clinicians should discuss an individual’s employment, access to paid leave and health insurance coverage when constructing a treatment plan relating to cancer care.
Adults with a cancer history reported more medical financial hardships, including difficulty paying medical bills or delaying care due to costs, than those without a diagnosis, according to findings published in CA: A Cancer Journal for Clinicians.
Additionally, nearly half of working adults with cancer made changes in their employment to deal with the burdens of treatment.
“So much discussion related to financial hardship or financial toxicity focuses on the cost of cancer treatment, but the inability to maintain employment, household income or employment-based health insurance coverage are other ways that a cancer diagnosis can result in financial hardship,” Robin Yabroff, PhD, MBA, scientific vice president of health services research at American Cancer Society, told Healio.
National data on financial hardship
Yabroff and colleagues investigated these hardships using the 2019-2021 National Health Interview Survey, which gathers medical, demographic and other information on roughly 90,000 individuals and 35,000 households annually.
They used the data to provide nationally representative estimates of financial hardship that accompanied a composite case of a 40-year-old woman diagnosed with breast cancer living in Texas. The study detailed the challenges she and many other working adults with cancer face while obtaining recommended care.
“A cancer diagnosis is challenging for anyone, but it’s especially challenging for people who are working, who may not have sufficient paid sick leave for treatment and may not have workplace accommodations that will allow them to continue working and maintain that source of household income, as well as their employer-based health insurance coverage,” Yabroff said.
Adults aged 18 to 64 years with a cancer history are more likely to report medical financial hardship than those without a cancer history (57.3% vs. 53.5%; P < 0.05), including paying medical bills (21.6% vs. 12.7%; P < 0.05) or delaying care (12.7% vs. 9.2%; P < 0.05). They also expressed greater concerns about paying for food, housing, utilities and other household costs.
Lack of health insurance coverage, having high-deductible plans without health savings accounts and lower household income are all related to higher prevalence of financial hardships.
For example, 83.7% of cancer survivors without health insurance coverage experienced financial difficulties.
“However, nearly 53% of people with private health insurance coverage still experience financial hardship,” Yabroff said. “Increasingly, we are learning how having health insurance coverage is necessary but not sufficient to ensure that people can afford the treatments they need.”
Employment data reported by researchers demonstrated the frequency of employment disruptions among working adults with cancer. Roughly 47% of adults with a cancer history altered their employment following their diagnosis, including going on extended leave (35.6%); changing schedules, roles or career paths (15.9%); or declining a promotion or retiring early (27.2%).
Individuals with a cancer history are more likely to report an inability to work than those without a cancer history (25.9% vs. 15.3%; P < 0.05) and miss more days of work (11.9 vs. 3.1; P < 0.05).
About 25% of informal caregivers alter their employment to help individuals with a cancer diagnoses as well.
Roughly 40% of working adults with a cancer history do not have paid sick leave.
Patients without paid sick leave are more likely to have financial hardships compared with those who do (23.3% vs. 18%; P < 0.05), concern about their medical bills (57.4% vs. 49.6%; P < 0.05) and delay or forego care because of cost (16.7% vs. 8%; P < 0.05).
Expanding access: the clinician’s role
These issues can worsen based on the state individuals live in because laws regarding Medicaid eligibility, disability benefits and paid leave are location dependent.
“There are 10 states that have not yet expanded Medicaid income eligibility and those states have some of the highest cancer mortality rates in the country,” Yabroff said.
“There’s a large body of evidence showing that Medicaid expansion is associated with better health insurance coverage, earlier stage cancer diagnosis, timely treatment initiation, longer survival and reduced mortality. There are also positive economic spillover effects for hospitals and communities in states that have expanded,” she added. “For clinicians who live in a state that did not expand Medicaid income eligibility, that is something that will come up when treating patients.”
Yabroff and colleagues noted clinicians and other researchers have an opportunity to advocate for policies that improve public health locally and across the country.
“These local, state and federal policies make a huge difference in how and whether patients can get the care they need,” Yabroff told Healio.
Researchers also stressed the need for investment in and developing of partnerships with community programs and nonprofit organizations that can provide resources to patients.
However, changing policy and developing relationships take time.
If clinicians could take potential hardships into account with screening, they could possibility alleviate some of the burden on patients.
“Because those included in national surveys are mostly long-term survivors who are no longer receiving cancer care, the national estimates reported in the study are likely an underestimate of the magnitude of financial hardship for a patient newly diagnosed with cancer and receiving treatment,” Yabroff said. “Understanding that some patients may have to make tradeoffs between getting the cancer treatment they need and putting food on the table is important for figuring out how to make sure that all patients can afford the care they need.”
For more information:
Robin Yabroff, PhD, MBA, can be reached at robin.yabroff@cancer.org.
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