Long-Term Effects of Cancer Survivorship on the Employment of Older Workers

There is little doubt that cancer treatment takes a toll on the employment and productivity of patients in the short term. About 40 percent stop working during treatment (Short, Vasey, and Tunceli 2005). In a recent prospective study by Bradley et al. (2005a, b), employment rates 6 months after diagnosis were 10 and 17 percentage points lower for patients with prostate and breast cancer, respectively, compared with control groups without cancer. A study of absenteeism found that patients being treated for cancer missed more work than patients with a number of other chronic conditions (Kessler et al. 2001). Most of the published evidence suggests that cancer also has long-term effects on employment, that is, effects extending beyond the initial period of treatment and recovery. Not only are survivors at risk for recurrence of the original cancer, but treatment puts them at increased risk for second primary cancers (National Cancer Institute 2006) and a range of health problems including functional and cosmetic changes after surgery, organ damage, hormonal changes, cognitive deficits, and psychological distress (Hewitt, Greenfield, and Stovall 2005). Several surveys have found evidence of impairments that could affect employment over the long run (Bradley and Bednarek 2002; Chirikos, Russell-Jacobs, and Cantor 2002; Short, Vasey, and BeLue in press; Short, Vasey, and Tunceli 2005; Bradley et al. 2005a, b). Studies of breast cancer survivors at 3 years (Maunsell et al. 2004), 5 years (Chirikos, Russell-Jacobs, and Jacobsen 2002), and an average of 7 years after diagnosis (Bradley, Bednarek, and Neumark 2002) found lower employment rates for the survivors than for similar women with no cancer history. A study of the predominantly long-term survivors in the National Health Interview Survey found that significantly fewer survivors were employed compared with matched controls (Yabroff et al. 2004). However, findings from the Bradley study have recently raised doubts about the significance of long-term employment effects, because the significant differences between controls without cancer and prostate or breast cancer survivors 6 months after diagnosis did not persist at 12 or 18 months (Bradley et al. 2007). Whether and how much the employment of survivors is affected over the long run is a question that has taken on greater importance as the average 5-year survival rate has reached 64 percent (Jemal et al. 2004), and the number of cancer survivors in the United States has increased to more than 10 million (Hewitt, Greenfield, and Stovall 2005). Experts now emphasize the importance of viewing cancer as a chronic condition that requires ongoing, systematic, and coordinated services (Centers for Disease Control and Prevention, Lance Armstrong Foundation 2004; President's Cancer Panel 2004; Hewitt, Greenfield, and Stovall 2005). We undertook this study to learn more about long-term employment outcomes associated with cancer survivorship. As in most well-designed studies of this topic in the literature, we compared changes in employment from diagnosis to follow-up for a sample of survivors with a comparison group without cancer (Steiner et al. 2004). Economists commonly refer to this quasi-experimental design as a “difference-in-differences” analysis. The comparison group is critical in distinguishing the effects of cancer from general influences on the employment of survivors over time, such as changes in macroeconomic conditions or the normal propensity of older workers to retire. Comparing changes in individual behavior over time nets out unobservable, individual-specific differences in propensity to work. We compared primary data from the Penn State Cancer Survivor Study (PSCSS) with secondary data from the Health and Retirement Study (HRS), an ongoing national cohort study of Americans born from 1931 to 1947. Most earlier studies of long-term survivors have focused on female breast cancer, but our study included both males and females and virtually all cancer types. It distinguished between survivors with and without new cancers that are likely to reduce employment later in survivorship. In making comparisons with the HRS, we specifically focused on older survivors (55–65 years of age in 2002) as they approached retirement. Cancer is likely to have different effects on workers at different stages of their lives and careers, and older workers are far more likely to be affected by cancer than younger workers. Three-quarters of adult cancer survivors in the age group from 30 to 64 are 50 or older (Hewitt, Greenfield, and Stovall 2005), and nearly half of new cancers diagnosed in the age group from 20 to 64 are diagnosed after age 54 (Ries et al. 2006).