Persons who survive cancer more likely to be unemployed

February 17, 2009

An analysis of previous studies finds an association between being a cancer survivor and being unemployed, compared to healthy individuals, especially for survivors of breast and gastrointestinal cancers, according to an article in the February 18 issue of JAMA.

Long-term medical and psychological effects of cancer or its treatment may cause impairments that effect social functioning, including the obtainment or retention of employment. Almost half of all cancer survivors are younger than 65 years. "Many cancer survivors want and are able to return to work after diagnosis and treatment," the authors write. "Relatively few studies have assessed the association of cancer survivorship with unemployment." They add there are several factors that may promote unemployment after the diagnosis and treatment of cancer, including job discrimination, difficulty combining treatment with full-time work and physical or mental limitations.

Angela G. E. M. de Boer, Ph.D., of the Coronel Institute of Occupational Health, Academic Medical Center, Amsterdam, the Netherlands, and colleagues conducted a meta-analysis to determine the risk and factors associated with unemployment among adult cancer survivors compared with healthy control participants. After a search of various databases, the authors identified 26 articles reporting results from 36 studies meeting criteria for inclusion in the analysis. There were 16 studies from the United States, 15 from Europe and 5 from other countries. The 36 studies included 177,969 participants, with 20,366 cancer survivors and 157,603 healthy control participants.

The researchers found that overall, cancer survivors were 1.37 times more likely to be unemployed than healthy control participants (33.8 percent vs. 15.2 percent). Additional analysis by diagnosis showed an increased risk of unemployment for survivors of breast cancer (35.6 percent vs. 31.7 percent), gastrointestinal cancers (48.8 percent vs. 33.4 percent), and cancers of the female reproductive organs (49.1 percent vs. 38.3 percent). Higher risks of unemployment compared with healthy control participants were not shown among survivors of blood cancer, prostate cancer and testicular cancer.

In studies with a relatively low background unemployment rate, the risk for unemployment for cancer patients was lower compared with healthy control participants than in studies performed in countries with a relatively high background unemployment rate.

Seven studies reported unemployment because of disability, with analysis indicating a nearly 3 times higher risk for unemployment because of disability for cancer patients compared with control participants. "… the mechanism behind the higher unemployment rate among cancer survivors is likely to be a higher disability rate," the authors write.

They add that several studies indicated that cancer survivors were more likely than healthy controls to report that the reasons for unemployment included physical limitations, cancer-related symptoms, or both. "Furthermore, voluntary unemployment is not likely unless patients have other resources for income, which is not the case for most cancer survivors."

"Apart from the effects on employment, there are probably long-term effects of cancer on work ability, work capacity, and wage losses for a large group of survivors. Employment outcomes can be improved with innovations in treatment and with clinical and supportive services aimed at better management of symptoms, rehabilitation, and accommodation for disabilities. Moreover, workplace interventions are needed that are aimed at realizing workplace accommodations and paid sick leave during treatment. The development and evaluation of such interventions is urgently needed because they could mitigate the economic impact of surviving cancer and improve the quality of life for survivors," the researchers conclude.

More information: JAMA. 2009;301[7]:753-762.

Source: JAMA and Archives Journals