Cancer survivors' experiences with insurance, finances, and employment: results from a multisite study.
Cancer has significant implications on survivors' insurance coverage, financial status, and employment. We aimed to examine how these outcomes vary for survivors of different cancer types.



Using the Cancer Survivorship Supplement of the Medical Expenditures Panel Survey (MEPS), in 2013, we surveyed survivors of five common cancers who were diagnosed during 2003-2008 and were continuously enrolled in one of three health plans in Massachusetts, Colorado, and Washington State.



Among 615 eligible respondents, 96 % reported having health insurance at the time of or since diagnosis; of those, few reported barriers in coverage to visit doctors or facilities of their choice. Approximately 15 % reported experiencing financial hardships due to cancer. Of the 334 who responded as having been employed at the time of or since diagnosis, approximately 25 % reported that they or their spouses remained at their jobs due to concerns about losing medical insurance. Further, 63 % reported making changes in their jobs or careers (e.g., took extended time off, worked part time, or declined promotion) due to cancer, and 42 % reported that cancer interfered with their physical and/or mental tasks at work or reduced productivity. Negative employment and financial implications were most common among those with lung, breast, and colorectal cancer, and those diagnosed before age 65.



In this insured population, few experienced restrictions in cancer care coverage, though maintaining health insurance often drove employment decisions. Significant negative effects on finances and employment were observed among specific cancer types and younger survivors.



Our study findings emphasize a need to identify ways of supporting survivors and provide tailored resources to reduce the untoward financial and work-related implications of cancer.
Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, 133 Brookline Avenue, 6th Floor, Boston, MA, 02215, USA. Larissa_nekhlyudov@hphc.org.
Larissa
L
Nekhlyudov
Group Health Research Institute, Seattle, WA, USA.
Rod
R
Walker
Group Health Research Institute, Seattle, WA, USA.
Rebecca
R
Ziebell
Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, USA.|Department of Family Medicine and Adult and Child Center for Health Outcomes and Delivery Science, School of Medicine, University of Colorado, Aurora, CO, USA.|Department of Family Medicine and Public Health, School of Medicine, University of California San Diego, La Jolla, California, USA.
Borsika
B
Rabin
LIVESTRONG Foundation, Austin, TX, USA.|Texas Department of State Health Services, Austin, TX, USA.
Stephanie
S
Nutt
Group Health Research Institute, Seattle, WA, USA.
Jessica
J
Chubak
D000368:Aged; D000369:Aged, 80 and over; D004651:Employment / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000706:statistics & numerical data*; D009369:Neoplasms / Q000191:economics*; D011795:Surveys and Questionnaires; D017741:Survivors / Q000706:statistics & numerical data*
Cancer survivor; Employment; Finances; Insurance