Abstract C23: Patterns of employment and income losses among adults with differing levels of wealth following a cancer diagnosis
Authors: Tebbs Margaret , Nikpay Sayeh , Castellanos Emily H. 
Published: February 2019

Abstract
Background: Cancer survivors often face economic hardships resulting from employment changes and rising out-of-pocket health care expenses. Financial strain among cancer survivors is associated with worse clinical outcomes and poorer quality of life. The protective factors against employment and income losses among cancer survivors are not well established.
Objectives: To assess the economic impact of cancer diagnosis among survivors with varying degrees of financial leverage; to determine the relationship between marital status and economic outcomes following diagnosis.
Methods: This study used data from the 1985 to 2013 waves of the Panel Study of Income Dynamics, a nationally representative, longitudinal survey of economic circumstances. Data are collected through annual (prior to 1999) and biennial (after 1999) household interviews. Health information, including a history of cancer, was added to the survey in 1999 and our analytic sample included 1,235 cancer survivors. Individuals were stratified based on marital status and wealth status (&lt;$10,000, $10,000-$110,000, and &gt;$110,000) prior to a cancer diagnosis. Wealth-stratified means and medians for employment status, hours worked, individual earnings, and total family income were calculated 2 years prior to diagnosis as well as 1 and 2 years after diagnosis.
Results: Employment status changes one year after diagnosis were similar among the three wealth groups, each dropping by 8% (low wealth p=0.09, medium and high wealth p &lt;0.05). The medium and highest wealth group's employment continued to drop 1-2% percentage points two years after diagnosis, while the lowest wealth group increased the percent employed by 3% from 1 to 2 years after diagnosis. Individuals with household wealth &gt;$110,000 saw the sharpest declines in yearly earnings, with the mean decreasing by $5,959 (p &lt;0.05). In addition, the group with the highest wealth was the sole group to show declines in total family income (-$7,877; p=0.06). Individuals with lower wealth were more likely to be younger, unmarried, female, and Hispanic or African American. While employment losses were comparable among married and unmarried cancer survivors, unmarried survivors showed a mean $6,000 decrease in total family income two years after diagnosis (p &lt;0.01), while total family income of married households remained unchanged.
Conclusions: Factors such as marital status and higher wealth status appear to be protective against losses of income or employment, allowing households to compensate for financial stress. In contrast, low-wealth individuals with less financial leverage return to work sooner than their higher-wealth counterparts. Racial and ethnic differences associated with lower wealth may contribute to disparities in survival outcomes.
Citation Format: Margaret Tebbs, Sayeh Nikpay, Emily H. Castellanos. Patterns of employment and income losses among adults with differing levels of wealth following a cancer diagnosis [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C23.