Impact of Cancer, Cancer Directed Therapy and Its Lasting Effects on Employment and Finances in Young Adult Cancer Survivors

Abstract

Background: Young adult (YA) cancer survivors face challenges unique from survivors of childhood cancer or older adults. The potential impact of cancer or its treatment upon employment and financial burden in YAs are not fully known. Methods: We conducted a multi-center, cross-sectional study of YA cancer survivors. Eligibility included diagnosis of malignancy between ages 18-39, 1-5 years from diagnosis and >1 year from therapy completion. Participants were randomly selected from tumor registries of 7 participating sites and asked to complete an online patient reported outcomes (PRO) survey. Diagnostic/treatment data were abstracted from medical records. Data were analyzed all together and separately by tumor site, including: 1) breast, 2) thyroid, 3) leukemia and lymphoma, 4) and all other cancer sites. Associations of therapeutic course with PROs were analyzed using logistic regression, and Wald based 95% confidence intervals (CI) with adjustment for age (categorized), gender (except for breast cancer), and other appropriate treatment exposures. Results: Study participants included 872 survivors (Nbreast=209, Nthyroid=104, Nlymphoma=91, & Nother=332). Most survivors (84.4%) reported working for pay at some time between diagnosis and survey completion. Exposure to chemotherapy was associated with an increased risk of mental impairment of work tasks in breast cancer survivors (OR 2.77, CI 1.39-5.53) and ‘other’ cancer survivors (OR 3.68, CI 2.18-6.21); in survivors of ‘other’ cancers, chemotherapy was also associated with increased risk of taking any time off work (OR 5.24, CI 2.66-10.32) and borrowing greater than $10,000 (OR 3.29, CI 1.53-5.98). Exposure to radiation was associated with an overall increased risk of mental impairment of work tasks (OR 1.92, CI 1.06-3.49), and of taking an extended paid time off work in YA thyroid cancer survivors (OR 2.52, CI 1.02-6.21) and leukemia & lymphoma survivors (OR 5.48, CI 1.48-20.32). Finally, exposure to having had a surgical procedure was associated with an increased risk of physical impairment (OR 2.11, CI 1.02-4.36) and mental impairment (OR 2.01, CI 1.03-3.92) of work tasks in ‘other’ cancer survivors. Conclusions: In YA survivors, cancer treatment has a significant impact on the physical and mental activities of their jobs and time off from work. Our study suggest that further longitudinal studies and interventions are needed to describe and support YA cancer survivors in the work-force during and after cancer-directed therapy.