title: Working with cancer: health and employment among cancer survivors.
abstract: Cancer affects a growing proportion of US workers. Factors contributing to whether they continue or return to work after cancer diagnosis include: age, physical and mental health, health insurance, education, and cancer site. The purpose of this study was to assess the complex relationships between health indicators and employment status for adult cancer survivors.
  
  
  
  We analyzed pooled data from the 1997-2012 US National Health Interview Survey (NHIS). Our sample included adults with a self-reported physician diagnosis of cancer (n = 24,810) and adults with no cancer history (n = 382,837). Using structural equation modeling (SEM), we evaluated the relationship between sociodemographic factors, cancer site, and physical and mental health indicators on the overall health and employment status among adults with a cancer history.
  
  
  
  The overall model for cancer survivors fit the data well (χ(2) (374) = 3654.7, P < .001; comparative fit index = 0.98; root mean square error of approximation = 0.04). Although black cancer survivors were less likely to report good-to-excellent health, along with Hispanic survivors, they were more likely to continue to work after diagnosis compared with their white counterparts. Health insurance status and educational level were strongly and positively associated with health status and current employment. Age and time since diagnosis were not significantly associated with health status or employment, but there were significant differences by cancer site.
  
  
  
  A proportion of cancer survivors may continue to work because of employment-based health insurance despite reporting poor health and significant physical and mental health limitations. Acute and long-term health and social support are essential for the continued productive employment and quality of life of all cancer survivors.
authors: Department of Epidemiology and Public Health, Miller School of Medicine, University of Miami, Miami, FL.
authors: Tainya C
authors: TC
authors: Clarke
authors: Department of Human Development and Family Studies, Purdue University, West Lafayette, IN; Department of Statistics, Purdue University, West Lafayette, IN.
authors: Sharon L
authors: SL
authors: Christ
authors: Department of Epidemiology and Public Health, Miller School of Medicine, University of Miami, Miami, FL; Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.
authors: Hosanna
authors: H
authors: Soler-Vila
authors: Department of Epidemiology and Public Health, Miller School of Medicine, University of Miami, Miami, FL.
authors: David J
authors: DJ
authors: Lee
authors: Department of Epidemiology and Public Health, Miller School of Medicine, University of Miami, Miami, FL.
authors: Kristopher L
authors: KL
authors: Arheart
authors: Department of Epidemiology and Public Health, Miller School of Medicine, University of Miami, Miami, FL.
authors: Guillermo
authors: G
authors: Prado
authors: Department of Epidemiology and Public Health, Miller School of Medicine, University of Miami, Miami, FL.
authors: Alberto
authors: A
authors: Caban-Martinez
authors: Department of Epidemiology and Public Health, Miller School of Medicine, University of Miami, Miami, FL; European Centre for Environment and Human Health, University of Exeter Medical School, Truro, Cornwall, UK. Electronic address: L.E.Fleming@Exeter.ac.uk.
authors: Lora E
authors: LE
authors: Fleming
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D003430:Cross-Sectional Studies; D004522:Educational Status; D004651:Employment / Q000523:psychology; D005260:Female; D054624:Health Status Disparities; D006305:Health Status Indicators; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology / Q000523:psychology*; D011788:Quality of Life; D017741:Survivors / Q000523:psychology*; D014481:United States; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Cancer; Employment; Epidemiology; Health policy; Survivors; Survivorship