Maggie L. Shaw
A majority of women younger than 45 years faced employment and insurance coverage difficulties following treatment for early stage breast cancer, with 35% fearing loss of health insurance coverage if they left their current job during treatment—despite wanting to continue working.
Using data on 708 female patients collected through the multicenter longitudinal observational Menstrual Cycle Maintenance and Quality of Life Study, the authors of the present study conducted their own subanalysis on the particular employment and health insurance coverage issues these women may face. Study recruitment took place between January 1998 and November 2005 at 5 major US cancer centers and hospitals:
- Memorial Sloan Kettering Cancer Center
- The University of Texas MD Anderson Cancer Center
- University of Texas Southwestern Medical Center
- Texas Health Presbyterian Hospital Dallas
- Wake Forest University Baptist Medical Center
To qualify for study inclusion, their participants had to be between 18 and 45 years of age and received their diagnosis of stage I to III breast cancer in the preceding 8 months; 54% were younger than 40 years. Most were non-Hispanic white (90%) and married/partnered (76%), and they had at least a 4-year college degree (67%). Comparisons for changes in employment were obtained from patient reports taken at study entry and at the 18-month mark, while insurance status was only evaluated after the same 18-month period.
At the end of the study period, 56% of the women were still employed full time, while 18% were homemakers, 16% were working only part time, 4.5% had become unemployed or were looking for work, and 2.5% were disabled and could not work. The most common work-related problems the patients actually encountered included fearing a job switch meant they could not get employer-sponsored health insurance coverage because of their preexisting cancer diagnosis (35%), losing their health insurance (0.8%), having to take a demotion (1.0%), being denied a potential promotion (2.5%) or a wage increase (4.3%), being fired/laid off (2.3%), and being forced to accept reduced responsibilities (3.9%)
Some women also faced job-related discrimination if they were considered overweight (body mass index, 25-29.9 kg/m2) compared with being underweight (P = .006), and a greater number of job employment-related issues was positively correlated with yearly incomes of less than $50,000 (P = .001) and working full time compared with part time (P = .003).
In addition, despite 86% having private insurance, 26.8% had to contend with at least 1 insurance-related issue in the 18 months after their diagnosis, 14.8% were denied a health benefit payment, 11.4% were denied life insurance, 4.3% faced higher health insurance rates, 2.9% encountered issues if they wanted to switch from group to individual coverage, 2.6% were denied coverage altogether, and 1.4% had health insurance premiums increased.
“These young survivors experienced significant employment and insurance-related issues following their diagnosis and treatment for breast cancer,” the authors concluded. “Given the high proportion of work years ahead for these women, insurance- and work-related issues should try to be anticipated and addressed prior to treatment to inform work expectations and avoid unnecessary insurance difficulties.”
To head off these problems for patients in the future, the study authors strongly suggest maximizing the time before treatment begins by addressing any work- and insurance-related concerns and being upfront on expectation for both.
Naughton MJ, Hery CMB, Janse SA, Naftalis EZ, Paskett ED, Van Zee KJ. Prevalence and correlates of job and insurance problems among young breast cancer survivors within 18 months of diagnosis. BMC Cancer. Published online May 18, 2020. doi: 10.1186/s12885-020-06846-w