M. Khalil1, S. Woldesenbet1, S. Zindani1, R. Thammachack1, Z. Rashid1, A. Altaf1, T.M. Pawlik1 1The Ohio State University Wexner Medical Center, Department Of Surgery, Columbus, OHIO, USA
Introduction: A cancer diagnosis is a major life event that brings significant social, personal, and financial challenges for both patients and their families. We sought to investigate employment disruption and financial toxicity within the first year following gastrointestinal cancer (GI) diagnosis.
Methods: Patients who underwent surgery for GI cancer between 2013 and 2020 were identified using the IBM MarketScan database. Employment disruption was defined as a change in employment status from full- or part-time work to long-term disability, retirement, or complete cessation of work. Multivariable Cox proportional hazards models were used to evaluate the risk of employment disruption.
Results: A total of 11,832 individuals with GI cancer (esophagus: n=680, 5.8%; stomach: n=703, 5.9%; liver: n=832, 7.0%; biliary duct: n=224, 1.9%; pancreas: n=1,096, 9.3%; colon: n=5,464, 46.2%; and rectum: n=2,833, 23.9%) were included. Median patient age was 54 years (IQR: 49–59) with a majority of male patients (n=7,054; 59.6%). In the year following a GI cancer diagnosis, 13.2% (n=1,638) of patients experienced employment disruption. Individuals who experienced employment disruption were older (56 years [IQR: 51 – 60] vs. 53 years [IQR: 48 – 58]) and had a higher Charlson Comorbidity Index score (CCI >2: 14.7% vs. 10.0%) (both p<0.001). Out-of-pocket costs (OOP) were higher among individuals who experienced employment disruption ($3,548 [IQR: $2,127–$5,389] vs. $3,202 [IQR: $1,700–$5,337]; p<0.001). On multivariable analysis, GI cancer diagnosis was associated with a threefold higher risk of employment disruption (HR: 3.16, 95% CI: 2.96–3.38) (Figure). Of note, compared with individuals diagnosed with colorectal cancer, individuals with esophageal (HR: 1.46, 95% CI: 1.20–1.79), gastric (HR:1.44, 95% CI: 1.18–1.76), hepatic (HR: 1.30, 95% CI: 1.06–1.57), biliary tract (HR: 1.41, 95% CI: 1.03–1.94), or pancreatic cancer (HR: 1.75, 95% CI: 1.50–2.04) were at higher risk of employment disruption. In addition, individuals receiving hourly compensation (HR: 1.65, 95% CI: 1.47–1.87) and those working in the transportation (HR: 1.33, 95% CI: 1.11–1.60), or finance industries (HR: 1.66, 95% CI: 1.37–2.02) were at increased risk of employment disruption.
Conclusion: Roughly 1 in 7 individuals experienced employment disruption within the first year following GI cancer diagnosis. Employment disruption in the setting of higher OOP treatment costs can place patients at risk for financial toxicity. Targeted measures, such as flexible work arrangements, job protection policies, and access to vocational rehabilitation services are needed for patients with cancer.