title: Working after a metastatic cancer diagnosis: Factors affecting employment in the metastatic setting from ECOG-ACRIN's Symptom Outcomes and Practice Patterns study.
abstract: Improved survival for individuals with metastatic cancer accentuates the importance of employment for cancer survivors. A better understanding of how metastatic cancer affects employment is a necessary step toward the development of tools for assisting survivors in this important realm.
  
  
  
  The ECOG-ACRIN Symptom Outcomes and Practice Patterns study was analyzed to investigate what factors were associated with the employment of 680 metastatic cancer patients. Univariate and multivariate logistic regression analyses were conducted to compare patients stably working with patients no longer working.
  
  
  
  There were 668 metastatic working-age participants in the analysis: 236 (35%) worked full- or part-time, whereas 302 (45%) had stopped working because of illness. Overall, 58% reported some change in employment due to illness. A better performance status and non-Hispanic white ethnicity/race were significantly associated with continuing to work despite a metastatic cancer diagnosis in the multivariate analysis. The disease type, time since metastatic diagnosis, number of metastatic sites, location of metastatic disease, and treatment status had no significant impact. Among the potentially modifiable factors, receiving hormonal treatment (if a viable option) and decreasing symptom interference were associated with continuing to work.
  
  
  
  A significant percentage of the metastatic patients remained employed; increased symptom burden was associated with a change to no longer working. Modifiable factors resulting in work interference should be minimized so that patients with metastatic disease may continue working if this is desired. Improvements in symptom control and strategies developed to help address workplace difficulties have promise for improving this aspect of survivorship.
authors.affiliation: University of Wisconsin-Madison, Madison, Wisconsin.
authors.forename: Amye J
authors.initials: AJ
authors.lastname: Tevaarwerk
authors.affiliation: Dana-Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Ju-Whei
authors.initials: JW
authors.lastname: Lee
authors.affiliation: University of Wisconsin-Madison, Madison, Wisconsin.
authors.forename: Abigail
authors.initials: A
authors.lastname: Terhaar
authors.affiliation: University of Wisconsin-Madison, Madison, Wisconsin.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Sesto
authors.affiliation: Research Advocacy Network.
authors.forename: Mary Lou
authors.initials: ML
authors.lastname: Smith
authors.affiliation: The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Charles S
authors.initials: CS
authors.lastname: Cleeland
authors.affiliation: The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Fisch
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000150:complications; D015179:Colorectal Neoplasms / Q000150:complications; D018450:Disease Progression; D004651:Employment / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008175:Lung Neoplasms / Q000150:complications; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009369:Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000208:ethnology / Q000473:pathology / Q000628:therapy; D010568:Peru / Q000453:epidemiology; D015995:Prevalence; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000150:complications; D057566:Self Report; D012720:Severity of Illness Index; D017741:Survivors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014937:Work
keywords: advanced cancer; employment; metastatic cancer; symptom burden; treatment toxicity