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Does Pain Affect the Employment and Financial Outcomes of Cancer Survivors?


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In a study reported in the Journal of Clinical Oncology, Halpern et al found that cancer survivors with pain had worse employment and financial outcomes than did those reporting no pain.

Study Details

The study used data from 1,213 adult survivors identified from the 2016–2017 Medical Expenditure Panel Survey Experiences with Cancer Survivorship Supplement. Patients were queried on their average level of pain over the past 7 days on a 0 (no pain) to 10 scale (worst imaginable pain), as well as their employment and financial outcomes. Pain was classified as none, mild (1–3), moderate (4–6), or severe (≥ 7). Multivariate analyses of outcomes were adjusted for sex, race or ethnicity, age, education, primary cancer site, multiple cancer sites involved, time since last cancer treatment, insurance during the prior 12 months, and physician visits during the prior 12 months.

Employment and Financial Outcomes

Among the 1,213 respondents, 494 (43%) reported no pain, 336 (29%) reported mild pain, 240 (18%) reported moderate pain, and 143 (10%) reported severe pain.

On multivariate analysis of employment outcomes, compared with patients reporting no pain, a significantly higher likelihood was found for:

  • Early retirement (odds ratio [OR] = 3.70) among survivors with mild pain
  • Changing to a part-time or less demanding job (OR = 2.20), not pursuing promotion (OR = 2.70), early retirement (OR = 10.49), feeling less productive at work (OR = 3.56), and staying at a job to keep insurance (OR = 2.46) among those with moderate pain
  • Changing to a part-time or less demanding job (OR = 3.32), not pursuing promotion (OR = 2.25), early retirement (OR = 15.58), feeling less productive at work (OR = 4.38), and staying at a job to keep insurance (OR = 1.92) among those with severe pain.

On multivariate analysis of financial outcomes, compared with patients with no pain, a significantly higher likelihood was found for:

  • Uncovered expenses (OR =1.44), worrying about bills (OR = 1.54), delay of medical care (OR = 3.06), and delay of prescription medication (OR = 2.54) among survivors with mild pain
  • Borrowing money or going into debt (OR = 3.72), inability to cover costs (OR = 2.42), worrying about bills (OR = 2.58), delay of medical care (OR = 3.03), and delay of prescription medication (OR = 4.81) among those with moderate pain
  • Borrowing money or going into debt (OR = 3.50), inability to cover costs (OR = 2.03), worrying about bills (OR = 2.63), delay of medical care (OR = 5.06), and delay of prescription medication (OR = 5.65) among those with severe pain.

The investigators concluded: “Pain is frequently associated with adverse employment and financial outcomes among cancer survivors, and greater pain is associated with worse outcomes. Better assessment of pain severity among survivors and implementation of strategies to assist with employment and financial objectives may be important steps to enhance patient-centered care.”

Michael T. Halpern, MD, PhD, of the Healthcare Delivery Research Program, National Cancer Institute, is the corresponding author of the Journal of Clinical Oncology article.

Disclosure: For full disclosures of the study authors, visit ascopubs.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
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