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Age-related differences in employment, insurance, and financial hardship among colorectal cancer patients: a report from the ColoCare Study

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Abstract

Purpose

Employment and financial hardships are common issues for working-age colorectal cancer patients. We surveyed colorectal cancer survivors to investigate employment, insurance, and financial outcomes by age at diagnosis.

Methods

Cross-sectional survey of six ColoCare Study sites regarding employment, insurance, and financial hardship outcomes. Eligible participants were 1 to 5 years from colorectal cancer diagnosis. Diagnosis age (18–49, 50–64, 65+ years) with outcomes of interest were compared using chi-square and t-tests. Multivariable logistic and Poisson regressions were fit to examine association of demographic factors with any material/psychological hardship (yes/no) and the count of hardships.

Results

N = 202 participants completed the survey (age: 18–49 (n = 42, 20.8%), 50–64 (n = 79, 39.1%), 65+ (n = 81, 40.1%)). Most diagnosed age < 65 worked at diagnosis (18–49: 83%; 50–64: 64%; 65+ : 14%, p < 0.001) and continued working after diagnosis (18–49: 76%; 50–64: 59%; 65+ : 13%; p < 0.001). Participants age 18–49 reported cancer-related difficulties with mental (81.3%) and physical (89%) tasks at work more than those working in the older age groups (45%-61%). In regression models, among those reporting any hardship, the rates of material and psychological hardships were higher among those age 18–64 (Incidence Rate Ratios (IRR) range 1.5–2.3 vs. age 65+) and for those with < college (IRR range 1.3–1.6 vs. college +).

Conclusions

Younger colorectal cancer patients are more likely to work after a cancer diagnosis and during cancer treatment, but report higher levels of financial hardship than older patients.

Implications for Cancer Survivors

Younger colorectal cancer patients may encounter financial hardship, thus may feel a need to work during and after treatment.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. “Cancer Facts & Figures 2021 | American Cancer Society.” https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-2021.html (accessed Jul. 12, 2022).

  2. Hewitt M, Rowland JH, Yancik R. Cancer survivors in the United States: age, health, and disability. J Gerontol A Biol Sci Med Sci. 2003;58(1):82–91. https://doi.org/10.1093/gerona/58.1.m82.

    Article  PubMed  Google Scholar 

  3. Goo A-J, Song Y-M, Shin J, Ko H. Factors Associated with Depression Assessed by the Patient Health Questionnaire-2 in Long-Term Cancer Survivors. Korean J Fam Med. 2016;37(4):228–34. https://doi.org/10.4082/kjfm.2016.37.4.228.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Richardson LC, Wingo PA, Zack MM, Zahran HS, King JB. Health-related quality of life in cancer survivors between ages 20 and 64 years: population-based estimates from the Behavioral Risk Factor Surveillance System. Cancer. 2008;112(6):1380–9. https://doi.org/10.1002/cncr.23291.

    Article  PubMed  Google Scholar 

  5. Bhalla A, et al. One-third of patients fail to return to work 1 year after surgery for colorectal cancer. Tech Coloproctol. 2014;18(12):1153–9. https://doi.org/10.1007/s10151-014-1232-y.

    Article  CAS  PubMed  Google Scholar 

  6. Earle CC, et al. Employment among survivors of lung cancer and colorectal cancer. J Clin Oncol. 2010;28(10):1700–5. https://doi.org/10.1200/JCO.2009.24.7411.

    Article  PubMed  PubMed Central  Google Scholar 

  7. McGrath C, Mihala G, Beesley VL, Lynch BM, Graves N, Gordon LG. ‘Cancer Put My Life on Hold’: Work-Related Challenges Among Middle-aged Adults 12 Months After a Diagnosis of Colorectal Cancer. Cancer Nurs. 2017;40(2):160–7. https://doi.org/10.1097/ncc.0000000000000359.

    Article  PubMed  Google Scholar 

  8. Rottenberg Y, Ratzon NZ, Cohen M, Hubert A, Uziely B, de Boer AGEM. Unemployment risk at 2 and 4 years following colorectal cancer diagnosis: a population based study. Eur J Cancer. 2016;69:70–6. https://doi.org/10.1016/j.ejca.2016.09.025.

    Article  PubMed  Google Scholar 

  9. Lang K, Lines LM, Lee DW, Korn JR, Earle CC, Menzin J. Lifetime and treatment-phase costs associated with colorectal cancer: evidence from SEER-Medicare data. Clin Gastroenterol Hepatol. 2009;7(2):198–204. https://doi.org/10.1016/j.cgh.2008.08.034.

    Article  PubMed  Google Scholar 

  10. Zafar SY, Abernethy AP. Financial Toxicity, Part I: A New Name for a Growing Problem. Oncology (Williston Park). 2013;27(2):80–149.

    PubMed  Google Scholar 

  11. Corrigan KL, et al. Financial toxicity impact on younger versus older adults with cancer in the setting of care delivery. Cancer. 2022;128(13):2455–62. https://doi.org/10.1002/cncr.34220.

    Article  PubMed  Google Scholar 

  12. Parsons HM, et al. Young and uninsured: Insurance patterns of recently diagnosed adolescent and young adult cancer survivors in the AYA HOPE study. Cancer. 2014;120(15):2352–60. https://doi.org/10.1002/cncr.28685.

    Article  PubMed  Google Scholar 

  13. Nekhlyudov L, Walker R, Ziebell R, Rabin B, Nutt S, Chubak J. Cancer survivors’ experiences with insurance, finances, and employment: results from a multisite study. J Cancer Surviv. 2016;10(6):1104–11. https://doi.org/10.1007/s11764-016-0554-3.

    Article  PubMed  Google Scholar 

  14. Parsons HM, Schmidt S, Tenner LL, Bang H, Keegan THM. Early Impact of the Affordable Care Act on Insurance Among Young Adults with Cancer: Analysis of the Dependent Insurance Provision. Cancer. 2016;122(11):1766–73. https://doi.org/10.1002/cncr.29982.

    Article  PubMed  Google Scholar 

  15. Barnes JM, Harris JK, Brown DS, King A, Johnson KJ. Impacts of the Affordable Care Act Dependent Coverage Provision on Young Adults With Cancer. Am J Prev Med. 2019;56(5):716–26. https://doi.org/10.1016/j.amepre.2018.12.011.

    Article  PubMed  Google Scholar 

  16. Kaddas HK, et al. Age-Related Differences in Financial Toxicity and Unmet Resource Needs Among Adolescent and Young Adult Cancer Patients. J Adolesc Young Adult Oncol. 2020;9(1):105–10. https://doi.org/10.1089/jayao.2019.0051.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Landwehr MS, Watson SE, Macpherson CF, Novak KA, Johnson RH. The cost of cancer: a retrospective analysis of the financial impact of cancer on young adults. Cancer Med. 2016;5(5):863–70. https://doi.org/10.1002/cam4.657.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Yabroff KR, et al. Financial Hardship Associated With Cancer in the United States: Findings From a Population-Based Sample of Adult Cancer Survivors. J Clin Oncol. 2016;34(3):259–67. https://doi.org/10.1200/JCO.2015.62.0468.

    Article  PubMed  Google Scholar 

  19. Ulrich CM, et al. The ColoCare Study: A Paradigm of Transdisciplinary Science in Colorectal Cancer Outcomes. Cancer Epidemiol Biomarkers Prev. 2019;28(3):591–601. https://doi.org/10.1158/1055-9965.EPI-18-0773.

    Article  PubMed  Google Scholar 

  20. Altice CK, Banegas MP, Tucker-Seeley RD, Yabroff KR. Financial Hardships Experienced by Cancer Survivors: A Systematic Review. J Natl Cancer Inst. 2017;109(2):djw205. https://doi.org/10.1093/jnci/djw205.

    Article  PubMed  Google Scholar 

  21. Banegas MP, et al. For Working-Age Cancer Survivors, Medical Debt And Bankruptcy Create Financial Hardships. Health Aff (Millwood). 2016;35(1):54–61. https://doi.org/10.1377/hlthaff.2015.0830.

    Article  PubMed  Google Scholar 

  22. Yabroff KR, et al. The Medical Expenditure Panel Survey (MEPS) experiences with cancer survivorship supplement. J Cancer Surviv. 2012;6(4):407–19. https://doi.org/10.1007/s11764-012-0221-2.

    Article  PubMed  PubMed Central  Google Scholar 

  23. “The State of U.S. Health Insurance in 2022,” Sep. 29, 2022. https://www.commonwealthfund.org/publications/issue-briefs/2022/sep/state-us-health-insurance-2022-biennial-survey (accessed Feb. 08, 2023).

  24. Fair D, et al. Material, behavioral, and psychological financial hardship among survivors of childhood cancer in the Childhood Cancer Survivor Study. Cancer. 2021;127(17):3214–22. https://doi.org/10.1002/cncr.33613.

    Article  PubMed  Google Scholar 

  25. Park ER, et al. Assessing Health Insurance Coverage Characteristics and Impact on Health Care Cost, Worry, and Access. JAMA Intern Med. 2017;177(12):1855–8. https://doi.org/10.1001/jamainternmed.2017.5047.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Loomans-Kropp HA, Umar A. Increasing Incidence of Colorectal Cancer in Young Adults. J Cancer Epidemiol. 2019;2019:9841295. https://doi.org/10.1155/2019/9841295.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Ugai T, et al. Is early-onset cancer an emerging global epidemic? Current evidence and future implications. Nat Rev Clin Oncol. 2022;19(10):656–73. https://doi.org/10.1038/s41571-022-00672-8.

    Article  PubMed  Google Scholar 

  28. Kent EE, de Moor JS, Zhao J, Ekwueme DU, Han X, Yabroff KR. Staying at One’s Job to Maintain Employer-Based Health Insurance Among Cancer Survivors and Their Spouses/Partners. JAMA Oncol. 2020;6(6):929–32. https://doi.org/10.1001/jamaoncol.2020.0742.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Bailey J, Colman G, Dave D. The Evolution of Job Lock in the U.S.: Evidence from the Affordable Care Act. J Risk Financ Manage. 2022;15(7):296. https://doi.org/10.3390/jrfm15070296.

    Article  Google Scholar 

  30. Blanck P. Disability-inclusive employment, cancer survivorship, and the Americans with Disabilities Act. J Cancer Surviv. 2022;16(1):142–51. https://doi.org/10.1007/s11764-021-01141-4.

    Article  PubMed  PubMed Central  Google Scholar 

  31. “Work & Cancer | Triage Cancer,” Triage Cancer | Finances-Work-Insurance. https://triagecancer.org/work-and-cancer (accessed Feb. 08, 2023).

  32. Doherty MJ, Thom B, Gany F. Evidence of the Feasibility and Preliminary Efficacy of Oncology Financial Navigation: A Scoping Review. Cancer Epidemiol Biomark Prev. 2021;30(10):1778–84. https://doi.org/10.1158/1055-9965.EPI-20-1853.

    Article  Google Scholar 

  33. Offodile AC, Gallagher K, Angove R, Tucker-Seeley RD, Balch A, Shankaran V. Financial Navigation in Cancer Care Delivery: State of the Evidence, Opportunities for Research, and Future Directions. J Clin Oncol. 2022;40(21):2291–4. https://doi.org/10.1200/JCO.21.02184.

    Article  PubMed  Google Scholar 

  34. Smith GL, et al. Navigating financial toxicity in patients with cancer: A multidisciplinary management approach. CA Cancer J Clin. 2022;72(5):437–53. https://doi.org/10.3322/caac.21730.

    Article  PubMed  Google Scholar 

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Funding

C.M. Ulrich, E.M. Siegel, J.C. Figueiredo, D. Shibata, C.I. Li, A.T. Toriola, and M. Schneider have been awarded U01 CA206110. This project was supported under a supplement, awarded to A.C. Kirchhoff, to the U01 award. C.M. Ulrich has been awarded R01 CA254108 and R01 CA211705, as well as funding from the German Consortium of Translational Cancer Research (DKTK), German Cancer Research Center, Matthias Lackas Stiftung, ERA-NET, JTC 2012 call on Translational Cancer Research (TRANSCAN), and Federal Ministry of Education and Research (BMBF), Germany, projects 01KT1503 and 01KD2101D. C.M. Ulrich and C.I. Li have been awarded R01 CA189184 and R01 CA207371. J. Ose was awarded R03CA270473. S. Hardikar was awarded K07 CA222060. C.M. Ulrich, J. Ose, and S. Hardikar have been awarded funding from the Huntsman Cancer Foundation and Cancer Control and Population Health Sciences (CCPS) at the University of Utah.

Author information

Authors and Affiliations

  1. Cancer Control and Population Sciences Research Program, Huntsman Cancer Institute, Salt Lake City, UT, USA

    Karely M. van Thiel Berghuijs, Heydon K. Kaddas, Amy Chevrier, Jennifer Ose, Anita R. Peoples, Sheetal Hardikar & Anne C. Kirchhoff

  2. Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA

    Gillian Trujillo, Gazelle Rouhani & Erin M. Siegel

  3. Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA

    Jennifer Ose, Anita R. Peoples, Sheetal Hardikar & Cornelia M. Ulrich

  4. University of Tennessee Health Science Center, Memphis, TN, USA

    David Shibata

  5. Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA

    Adetunji T. Toriola

  6. Cedars-Sinai Medical Center Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA, USA

    Jane C. Figueiredo

  7. Fred Hutchinson Cancer Center, Seattle, WA, USA

    Christopher I. Li

  8. Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany

    Biljana Gigic & Martin Schneider

  9. Huntsman Cancer Institute, Salt Lake City, UT, USA

    Cornelia M. Ulrich

  10. Department of Pediatrics, University of Utah, Salt Lake City, UT, USA

    Anne C. Kirchhoff

Authors
  1. Karely M. van Thiel Berghuijs
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  15. Martin Schneider
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Contributions

Dr. Anne C. Kirchhoff and Dr. Cornelia M. Ulrich contributed to the study conception and design. Material preparation, data collection and analysis were performed by Karely M. van Thiel Berghuijs and Heydon K. Kaddas. The first draft of the manuscript was written by Karely van Thiel Berghuijs, Heydon Kaddas, Amy Chevrier, and Dr. Anne C. Kirchhoff and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Karely M. van Thiel Berghuijs.

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Ethics approval

Each site (Cedars-Sinai Medical Center (Los Angeles, California), the University of Health Sciences of Tennessee (Memphis, Tennessee), Fred Hutchinson Cancer Research Center (Seattle, Washington), H. Lee Moffitt Cancer Center Research Institute (Tampa, Florida), Huntsman Cancer Institute (Salt Lake City, Utah), and Washington University School of Medicine (St. Louis, Missouri) received approval from their respected institutional review boards.

Consent to participate

Informed consent was obtained from all individual participants included in the study.

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All research participant data have been de-identified so participants did not need to consent for publication.

Competing interests

Dr. Cornelia M. Ulrich, as Cancer Center Director, oversees research funded by several pharmaceutical companies but has not received funding directly. The other authors have no conflicts of interest to report.

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Berghuijs, K.M.v.T., Kaddas, H.K., Trujillo, G. et al. Age-related differences in employment, insurance, and financial hardship among colorectal cancer patients: a report from the ColoCare Study. J Cancer Surviv (2023). https://doi.org/10.1007/s11764-023-01362-9

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