title: Unemployment Risk and Decreased Income Two and Four Years After Thyroid Cancer Diagnosis: A Population-Based Study.
abstract: Thyroid cancer (TC) often occurs in relatively young patients and has a high cure rate. However, decreased psychological and physical well-being may reduce the work capability of patients with TC. This study aimed to compare the risk for unemployment and decreased income in TC survivors with a matched non-cancer group at two and four years after diagnosis. The study also aimed to predict unemployment and income changes at two and four years after diagnosis.
  
  
  
  A historical prospective study design was used, with cohort inception and baseline measurements drawn from the Israeli Central Bureau of Statistics 1995 National Census, with follow-up until 2011. Cancer incidence was obtained from the Israel Cancer Registry, and employment status from the Tax Authority. A matched group was sampled from the census population. Binary logistic regression analyses were used to assess odds ratios (OR) for the study outcomes, controlled for age, sex, ethnicity, education years, socioeconomic position, and employment status at two years before diagnosis.
  
  
  
  In total, 417 cases of TC and 1277 non-cancer matched subjects were included in the study. People who died during the study period were excluded. The mean age at the time of cancer diagnosis was 43.5 years in the TC group and 43.8 years in the control group (p = 0.6). After adjusting for potential confounders, a positive association was found between TC and risk of unemployment two years after diagnosis (OR = 1.46 [confidence interval (CI) 1.09-1.95]), and decreased income two years after diagnosis (OR = 1.61 [CI 1.23-2.01]) and four years after diagnosis (OR = 1.63 [CI 1.25-2.13]). The association between TC and unemployment at four years after diagnosis weakened and lost significance (OR = 1.30 [CI 0.98-1.72]).
  
  
  
  TC survivorship was associated with unemployment at two years and decreased income at two and four years after diagnosis. Decreased income may be a marker for a shift to part-time work rather than a return to full-time work. The findings suggest that interventions to enhance the return to full-time work are needed in this population.
authors.affiliation: 1 Department of Occupational Therapy, Tel Aviv University , Tel Aviv, Israel .
authors.forename: Navah Z
authors.initials: NZ
authors.lastname: Ratzon
authors.affiliation: 2 Department of Oncology, Hadassah-Hebrew University Medical Center and Hebrew University-Hadassah Medical School , Jerusalem, Israel .
authors.forename: Beatrice
authors.initials: B
authors.lastname: Uziely
authors.affiliation: 3 Coronel Institute of Occupational Health , Academic Medical Center, Amsterdam, Netherlands .
authors.forename: Angela G E M
authors.initials: AG
authors.lastname: de Boer
authors.affiliation: 2 Department of Oncology, Hadassah-Hebrew University Medical Center and Hebrew University-Hadassah Medical School , Jerusalem, Israel .|4 Jerusalem Institute of Aging Research, Hadassah-Hebrew University Medical Center and Hebrew University-Hadassah Medical School , Jerusalem, Israel .
authors.forename: Yakir
authors.initials: Y
authors.lastname: Rottenberg
mesh_terms: D000328:Adult; D000073116:Cancer Survivors; D004651:Employment; D005260:Female; D006801:Humans; D007182:Income; D008297:Male; D008875:Middle Aged; D062707:Return to Work; D013964:Thyroid Neoplasms / Q000175:diagnosis* / Q000191:economics*; D014478:Unemployment