Cancer Survivors and Unemployment
- Study type
- Meta-analysis
- Design
- Systematic review with meta-analysis and Bayesian meta-regression
- Sample size
- 26 articles comprising 36 studies; 20,366 cancer survivors and 157,603 healthy control participants
- Source
- JAMA · 2009
In plain words
This research brought together the results of 36 studies and showed that people who have survived cancer are more likely to be unemployed than healthy people. This problem was seen in survivors of breast cancer, cancers of the digestive system and cancers of the female reproductive organs. In survivors of blood cancers, prostate cancer and testicular cancer, unemployment was not significantly higher. If you are having trouble returning to work, you can talk to your care team or a career counsellor.
Key results
Treatment arms and regimens
No therapeutic intervention (an observational study based on pooled data). Details in the full text.
Healthy people with no history of cancer.
Source of the regimen details: Abstract of the paper
Doses are given for the information of specialists, as in this study’s protocol, and are not a prescription. Every drug must be prescribed by the treating physician for the individual patient.
Study population
Studies were included if they had adult cancer survivors and a control group and assessed employment as an outcome. Of the 36 included studies, 16 were from the United States, 15 from Europe and 5 from other countries.
Endpoints
Outcome: association of cancer survivorship with unemployment compared with healthy people. A pooled relative risk (pooled RR) was calculated for all studies and by cancer type. Bayesian meta-regression assessed the association of unemployment with cancer type, study country, mean age at diagnosis and background unemployment rate.
Safety and side effects
The paper does not address treatment safety outcomes, and no adverse events are reported in the abstract.
Clinical significance and place in guidelines
This meta-analysis shows that monitoring employment status and supporting return to work should be part of cancer survivorship care, especially for survivors of breast, gastrointestinal and female reproductive cancers. The difference in unemployment between the United States and Europe disappeared after adjustment for diagnosis, age and background unemployment rate. The abstract draws no conclusions about clinical guidelines or specific interventions to reduce unemployment; the status of formal recommendations should be checked separately.
Limitations
According to the abstract, the included studies were observational with control groups and show association, not causation. For more detail, for example on disease stage, type of treatment and the definition of unemployment across studies, the full text should be consulted. The confidence intervals for blood cancers and prostate cancer are close to or include the line of no effect.
This summary was prepared by the editorial team from the published paper; the original paper is the final reference. Read the original abstract on PubMed.