Associations of State Mandatory Paid Sick Leave Policies With Cancer Outcomes in the United States

PURPOSE – Since 2012, several states have implemented mandatory paid sick leave (PSL) policies. PSL can provide patients time and income continuity to undergo screening and/or timely diagnostic workup for new cancer-related symptoms and complete lengthy and expensive cancer treatment courses. This study aimed to examine the association between mandatory PSL policies and cancer stage at diagnosis and overall survival (OS).METHODS – Adults age 18-64 years diagnosed with cancer were identified from the Surveillance, Epidemiology, and End Results program registries between 2010 and 2019. Difference-in-differences (DID) analyses were used to compare absolute changes in stage I and stage IV diagnoses and 1-year OS before and after policy implementation in states that enacted mandatory PSL relative to states that did not enact such policies.RESULTS – A total of 1, 052, 307 patients with cancer were included. In adjusted DID analyses, there were a 0.83 (95% CI = –1.49 to –0.16, P =.014) PP decrease in stage IV diagnoses and a 0.63 (95% CI = 0.10 to 1.17, P =.021) PP increase in 1-year OS associated with implementation of mandatory PSL policies. In exploratory analyses, males and individuals with lung cancer experienced the greatest shifts in policy-associated changes in stage at diagnosis and OS.CONCLUSION – PSL policy implementation is associated with decreased late-stage diagnoses and improved OS in patients with cancer. Policies that improve opportunities to receive medical care may facilitate earlier cancer detection and ultimately contribute to better patient outcomes.