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Cancer survivors’ financial hardship and their caregivers’ employment: results from a statewide survey

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Abstract

Purpose

Many caregivers take paid and/or unpaid time off work, change from full-time to part-time, or leave the workforce. We hypothesized that cancer survivor-reported material hardship (e.g., loans, bankruptcy), behavioral hardship (e.g., skipping care/medication due to cost), and job lock (i.e., staying at a job for fear of losing insurance) would be associated with caregiver employment changes.

Methods

Adult cancer survivors (N = 627) were surveyed through the Utah Cancer Registry in 2018–2019, and reported whether their caregiver had changed employment because of their cancer (yes, no). Material hardship was measured by 9 items which we categorized by the number of instances reported (0, 1–2, and ≥ 3). Two items represented both behavioral hardship (not seeing doctor/did not take medication because of cost) and survivor/spouse job lock. Odds ratios (OR) were estimated using survey-weighted logistic regression to examine the association of caregiver employment changes with material and behavioral hardship and job lock, adjusting for cancer and sociodemographic factors.

Results

There were 183 (29.2%) survivors reporting their caregiver had an employment change. Survivors with ≥ 3 material hardships (OR = 3.13, 95%CI 1.68–5.83), who skipped doctor appointments (OR = 2.88, 95%CI 1.42–5.83), and reported job lock (OR = 2.05, 95%CI 1.24–3.39) and spousal job lock (OR = 2.19, 95%CI 1.17–4.11) had higher odds of caregiver employment changes than those without these hardships.

Conclusions

Caregiver employment changes that occur because of a cancer diagnosis are indicative of financial hardship.

Implications for Cancer Survivors

Engaging community and hospital support for maintenance of stable caregiver employment and insurance coverage during cancer may lessen survivors’ financial hardship.

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Data availability

The data that support the findings of this study are available from the Utah Cancer Registry but restrictions apply to the availability of these data, which were used with permissions for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of the Utah Cancer Registry.

Code availability

The code that supports the findings of this study are available upon reasonable request from the authors.

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Funding

This study was supported by the US Centers for Disease Control and Prevention’s National Program of Cancer Registries, Cooperative Agreement No. NU58DP006320. The Utah Cancer Registry is also funded by the National Cancer Institute's SEER Program, Contract No. HHSN261201800016I, with additional support from the University of Utah and Huntsman Cancer Foundation. Dr. Warner is supported in part by the National Cancer Institute under award T32CA078447.

Author information

Authors and Affiliations

  1. University of Utah College of Nursing, 10 S 2000 E, Salt Lake City, UT, 84112, USA

    Echo L. Warner

  2. Huntsman Cancer Institute, 2000 Circle of Hope Dr, Salt Lake City, UT, 84112, USA

    Echo L. Warner, Perla L. Vaca Lopez, Carol Sweeney & Anne C. Kirchhoff

  3. Utah Cancer Registry, University of Utah, 250 East 200 South, Suite 1375, Salt Lake City, UT, 84111, USA

    Morgan M. Millar, Sandra L. Edwards, Marjorie E. Carter & Carol Sweeney

  4. Division of Epidemiology, School of Medicine, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84108, USA

    Morgan M. Millar, Brian Orleans & Carol Sweeney

  5. Department of Pediatrics, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84108, USA

    Anne C. Kirchhoff

Authors
  1. Echo L. Warner
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  2. Morgan M. Millar
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  3. Brian Orleans
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  4. Sandra L. Edwards
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  5. Marjorie E. Carter
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  6. Perla L. Vaca Lopez
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  7. Carol Sweeney
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  8. Anne C. Kirchhoff
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Contributions

All authors contributed to the study conception and design. Survey design, material preparation, and data collection were performed by Morgan Millar, Sandra Edwards, Marjorie Carter, Carol Sweeney, and Anne Kirchhoff. Data analysis was performed by Echo Warner and Brian Orleans. The first draft of the manuscript was written by Echo Warner and Perla Vaca Lopez and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Echo L. Warner.

Ethics declarations

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study was approved by the Utah Department of Health institutional review board.

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Participants who completed the consent process provided free-given, informed consent to participate in the study.

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Not applicable.

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The authors declare no competing interests.

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Warner, E.L., Millar, M.M., Orleans, B. et al. Cancer survivors’ financial hardship and their caregivers’ employment: results from a statewide survey. J Cancer Surviv 17, 738–747 (2023). https://doi.org/10.1007/s11764-022-01203-1

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  • DOI: https://doi.org/10.1007/s11764-022-01203-1

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