Abstract A118: Work changes and predictors of decreased work participation among African American cancer survivors
Authors: Hastert Theresa A , Nair Mrudula , Mantey Julia , Beebe-Dimmer Jennifer L , Pandolfi Stephanie , Baird Tara E , Schwartz Ann G 
Published: September 2020

Abstract
Background: Cancer-related financial hardship is common and is associated with lower health-related quality of life, particularly among African American cancer survivors. Employment outcomes during and after cancer treatment may represent modifiable risk factors to reduce financial hardship and improve wellbeing among cancer survivors, but employment outcomes among African American survivors are not well understood. Methods: We utilized data from the Detroit Research on Cancer Survivors (ROCS) cohort. African American adults ages 20-79 were eligible to join the cohort if they were diagnosed with a first primary breast, colorectal, lung, or prostate cancer since January 1, 2013, as identified through the Metropolitan Detroit Cancer Surveillance System cancer registry. The present analyses include 445 survivors who reported being employed before their cancer diagnosis. We estimated prevalence of work-related outcomes, including changes to hours, duties, and schedules; and extended time off. We further estimated the prevalence and identified predictors of decreased work participation (going from being employed at diagnosis to not employed or from full time to part time employment) between diagnosis and ROCS baseline survey (median: 13 months) using modified Poisson regression. Adjusted models controlled for age, household income, and cancer site. Results: One-third (33%) of survivors reported taking at least one month off of work, including 19% who used paid sick time, 8% who used paid vacation, and 21% who took at least one month of unpaid time off. Changes to work schedules (46%), hours worked (40%), or work duties (25%) were also common. Nearly half (47%) of employed survivors experienced a decrease in work participation. A greater proportion of survivors employed full time before diagnosis reported being on disability at ROCS baseline compared with those employed part time (20.4% vs. 14.3%), while unemployment was more common among survivors employed part time before diagnosis (16.9% vs. 7.9%; p&lt;0.001). In adjusted models, older age (RR 65+ vs. &lt;55: 1.5, 95% CI: 1.1, 1.9), lower income (RR $80,000+ vs. &lt;$20,000: 0.3, 95%CI: 0.2, 0.4), cancer site (RR lung vs. breast: 1.6, 95% CI: 1.2, 2.0; RR colorectal vs. breast: 1.3, 95% CI: 1.0, 1.7) and receipt of chemotherapy (RR: 1.4, 95% CI: 1.1, 1.8) were associated with decreased work participation, as were taking at least one month of unpaid time off (RR: 1.4, 95% CI: 1.1, 1.8) and changing work duties related to cancer (RR: 1.4, 95% CI: 1.1, 1.7). Conclusions: Our findings of strong associations between low household incomes and receipt of chemotherapy and decreased employment participation may represent opportunities to improve employment outcomes. Possible interventions focused on rehabilitation or additional policy or employer-level supports could improve employment outcomes among survivors at greatest risk for financial difficulties.
Citation Format: Theresa A Hastert, Mrudula Nair, Julia Mantey, Jennifer L Beebe-Dimmer, Stephanie Pandolfi, Tara E Baird, Ann G Schwartz. Work changes and predictors of decreased work participation among African American cancer survivors [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A118.