Employment outcomes among survivors of common cancers: The Symptom Outcomes and Practice Patterns (SOAPP) study

Introduction: Risk factors for employment difficulties after cancer diagnosis are incompletely understood, and interventions to improve post-cancer employment remain few. New targets for intervention are needed. Methods: We assessed a cohort of 530 nonmetastatic cancer patients (aged ≤ 65 years, >6 months from diagnosis, off chemo- or radiotherapy) from the observational multi-site Symptom Outcomes and Practice Patterns study. Participants reported employment change, current employment, and symptoms. Groups were based on employment at survey (working full- or part-time versus not working) and whether there had been a change due to illness (yes versus no). The predictive power of symptom interference with work was evaluated for employment group (working stably versus no longer working). Race/ethnicity, gender, cancer type, therapy, and time since diagnosis were also assessed. Association between employment group and specific symptoms was examined. Results: The cohort was largely non-Hispanic white (76 %), female (85 %), and diagnosed with breast cancer (75 %); 24 % reported a change in employment. On multivariable analysis, participants with at least moderate symptom interference were more likely to report no longer working than their less effected counterparts (odds ratio (OR) = 8. 0, 95 % CI, 4. 2-15. 4), as were minority participants compared with their non-Hispanic white counterparts (OR = 3. 2, 95 % CI, 1. 8-5. 6). Results from the multiple regression model indicated the combination of fatigue (OR = 2. 3, 95 % CI, 1. 1-4. 7), distress (OR = 3. 9, 95 % CI, 1. 7-9. 0), and dry mouth (OR = 2. 6, 95 % CI, 1. 1-6. 2) together with race/ethnicity and time since diagnosis adequately accounted for employment group. Conclusions: Our findings support the hypothesis that residual symptom burden is related to post-cancer employment: Residual symptoms may be targets for intervention to improve work outcomes among cancer survivors. Implications for Cancer Survivors: This analysis examines whether increased symptom burden is associated with a change to not working following a cancer diagnosis. We also examined individual symptoms to assess which symptoms were most strongly associated with not working after a cancer diagnosis. Our hope is that we will be able to use this information to both screen survivors post-active treatment as well as target high-risk symptoms for further and more aggressive intervention, in an attempt to improve post-cancer work outcomes.