ASPO Abstracts
Employment disruption after breast cancer diagnosis and financial burden in the Sister and Two Sister Studies
Category: Financial Hardship Associated with Cancer
Conference Year: 2020
Abstract Body:
Purpose: High costs of cancer care in the U.S. contribute to financial hardship and poor outcomes for cancer
patients. We estimated the effect of cancer-related employment disruption on financial burden in a national sample
of women diagnosed with breast cancer who were relatively financially stable and had health insurance at
diagnosis.
Methods: Women with breast cancer who were enrolled in the Sister Study or the Two Sister Study completed a
survivorship survey in 2012. Employment disruption was defined as stopping work or working fewer hours after
cancer treatment. Financial burden was defined as experiencing financial problems paying for cancer care,
borrowing money or going into debt because of cancer, or filing for bankruptcy because of cancer. Prevalence
ratios (PRs) and 95% confidence intervals (CIs) for financial burden related to employment disruption were
estimated using Poisson regression with robust error variance, adjusted for demographic and clinical
characteristics.
Results: We analyzed data from women who were ≥1 year from breast cancer diagnosis who reported being
employed at diagnosis (n=1605 total, n=1425 non-Hispanic White (NHW), n=79 non-Hispanic Black (NHB)). On
average, women were age 50 at diagnosis (range=28-77 years) and 5 years from diagnosis at survey (range=1-
8.5 years). Most women had health insurance at diagnosis (99% NHW, 97% NHB) and an annual household
income of at least $50,000/year (84% NHW, 75% NHB). Overall, 27% of women reported employment disruption
after diagnosis and 21% experienced financial burden, including 16% experiencing difficulty paying for cancer
care, 13% borrowing money or going into debt, and 2% filing for bankruptcy. In adjusted analyses, employment
disruption was associated with a higher prevalence of financial burden (NHW PR=2.00, 95% CI: 1.62, 2.47; NHB
PR=3.81, 95% CI: 1.89, 7.67).
Conclusions: Women experiencing disruptions to employment after cancer diagnosis are vulnerable to financial
distress related to cancer and its treatment. Our results indicate financial burden is prevalent even among women
who have insurance coverage and financial resources at breast cancer diagnosis. These findings could inform
sick leave and work policies which may help to limit employment disruption after cancer.
Keywords: breast cancer; financial burden; employment