Skip to main content
SpringerLink
Log in

The dynamic relationship between cancer and employment-related financial toxicity: an in-depth qualitative study of 21 Australian cancer survivor experiences and preferences for support

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Background

People with a cancer diagnosis experience physical and emotional impacts that may affect employment. Alongside cancer care costs, reduced ability to generate an income is a key contributor to financial toxicity which is associated with poor emotional wellbeing, quality of life, treatment adherence and survival. This study aimed to explore people’s experiences of changes to employment and their suggestions for how cancer survivors can be better supported.

Methods

Semi-structured telephone interviews were conducted with a purposive sample of 21 cancer survivors identified as part of a larger study of emotional distress. Purposive sampling was used to include a diverse group of people across age, gender, tumour type, self-reported financial difficulties and employment status. Interviews were inductively and iteratively coded by two independent coders and analysed using thematic analysis.

Results

There is a dynamic relationship between a person’s cancer treatment and their employment. For some, employment was disrupted due to physical or emotional impacts of cancer, or workplace stigma and discrimination. Others continued to work at the detriment of their health. Participants wished they had been made aware earlier how cancer might impact their capacity to work, their finances and their health. There was a lack of knowledge on the financial supports that may be available to them.

Conclusions

Healthcare professionals may have a role in minimising the financial impact of a cancer diagnosis through early assessment, communication of patients’ potential work capacity and appropriate referrals to occupational therapy to aid return to work or financial planning. A robust government social support system specifically for households experiencing cancer is urgently required.

Highlights

  • There is a dynamic relationship between people’s cancer diagnosis and ability to maintain or engage with employment.

  • Early and accurate information from health professionals can help people with a cancer diagnosis to manage their employment and finances.

  • A robust public financial welfare system is needed to support people during diagnosis, treatment and survivorship.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Availability of data and material

The authors confirm that the data supporting the findings of this study are available within the article and its supplementary materials.

Code availability

n/a

References

  1. Australian Institute of Health and Welfare. (2017). Cancer in Australia 2017. Cancer series no.101. Cat. no. CAN 100. Canberra: AIHW. https://www.aihw.gov.au/getmedia/3da1f3c2-30f0-4475-8aed-1f19f8e16d48/20066-cancer-2017.pdf.aspx?inline=true

  2. Aldiabat KM, Le Navenec C-L (2018) Data saturation: the mysterious step in grounded theory methodology. Qual Rep 23(1):245–261 https://www.proquest.com/docview/2122315861?pq-origsite=gscholar&fromopenview=true

    Google Scholar 

  3. Amir Z, Brocky J (2009) Cancer survivorship and employment: epidemiology. Occup Med 59(6):373–377. https://doi.org/10.1093/occmed/kqp086

    Article  CAS  Google Scholar 

  4. Bates N, Callander E, Lindsay D, Watt K (2018) Labour force participation and the cost of lost productivity due to cancer in Australia. BMC Public Health 18(1):1–7

    Article  Google Scholar 

  5. Beesley VL, Vallance JK, Mihala G, Lynch BM, Gordon LG (2017) Association between change in employment participation and quality of life in middle-aged colorectal cancer survivors compared with general population controls [10.1002/pon.4306]. Psycho-Oncology 26(9):1354–1360. https://doi.org/10.1002/pon.4306

    Article  PubMed  Google Scholar 

  6. Blinder VS, Gany FM (2020) Impact of cancer on employment. J Clin Oncol : Off J Am Soc Clin Oncol 38(4):302–309. https://doi.org/10.1200/JCO.19.01856

    Article  Google Scholar 

  7. Braun V, Clarke V (2006) Using thematic analysis in psychology. Qual Res Psychol 3(2):77–101

    Article  Google Scholar 

  8. Braun V, Clarke V (2021) One size fits all? What counts as quality practice in (reflexive) thematic analysis? Qual Res Psychol 18(3):328–352. https://doi.org/10.1080/14780887.2020.1769238

    Article  Google Scholar 

  9. Butow P, Laidsaar-Powell R, Konings S, Lim CYS, Koczwara B (2020) Return to work after a cancer diagnosis: a meta-review of reviews and a meta-synthesis of recent qualitative studies. J Cancer Surviv 14(2):114–134. https://doi.org/10.1007/s11764-019-00828-z

    Article  PubMed  Google Scholar 

  10. Carrera PM, Kantarjian HM, Blinder VS (2018) The financial burden and distress of patients with cancer: understanding and stepping-up action on the financial toxicity of cancer treatment. CA Cancer J Clin 68(2):153–165

    Article  Google Scholar 

  11. Chan RJ, Gordon LG, Tan CJ, Chan A, Bradford NK, Yates P, Agbejule OA, Miaskowski C (2019) Relationships between financial toxicity and symptom burden in cancer survivors: a systematic review. J Pain Symptom Manag 57(3):646–660

    Article  Google Scholar 

  12. de Boer AGEM, Taskila T, Ojajärvi A, van Dijk FJH, Verbeek JHAM (2009) Cancer survivors and snemployment: a meta-analysis and meta-regression. JAMA 301(7):753–762. https://doi.org/10.1001/jama.2009.187

    Article  PubMed  Google Scholar 

  13. Delgado-Guay M, Ferrer J, Rieber AG, Rhondali W, Tayjasanant S, Ochoa J, Cantu H, Chisholm G, Williams J, Frisbee-Hume S (2015) Financial distress and its associations with physical and emotional symptoms and quality of life among advanced cancer patients. Oncologist 20(9):1092

    Article  Google Scholar 

  14. Etikan I, Musa SA, Alkassim RS (2016) Comparison of convenience sampling and purposive sampling. Am J Theor Appl Stat 5(1):1–4

    Article  Google Scholar 

  15. Fair Work Ombudsman. (2021). National employment standards. Retrieved 6 October 2021 from https://www.fairwork.gov.au/employee-entitlements/national-employment-standards#nes-entitlements

  16. Fradgley EA, Boltong A, O'Brien L, Boyes AW, Lane K, Beattie A, Clinton-McHarg T, Jacobsen PB, Doran C, Barker D (2019) implementing systematic screening and structured care for distressed callers using cancer council’s telephone services: protocol for a randomized stepped-wedge trial. JMIR Res Protoc 8(5):e12473

    Article  Google Scholar 

  17. Gao N, Ryan M, Krucien N, Robinson S, Norman R (2020) Paid work, household work, or leisure? Time allocation pathways among women following a cancer diagnosis. Soc Sci Med 246:112776

    Article  Google Scholar 

  18. Gilfillan G (2018) Characteristics and use of casual employees in Australia. Statistics and Mapping, Parliamentary Services, Canberra

    Google Scholar 

  19. Gordon LG, Merollini K, Lowe A, Chan RJ (2017) Financial toxicity-what it is and how to measure it. Cancer Forum 41(2):30 https://search.informit.org/doi/epdf/10.3316/informit.112368207693667

    Google Scholar 

  20. Heinesen E, Imai S, Maruyama S (2018) Employment, job skills and occupational mobility of cancer survivors. J Health Econ 58:151–175

    Article  Google Scholar 

  21. Ho PJ, Hartman M, Gernaat SAM, Cook AR, Lee SC, Hupkens L, Verkooijen HM (2018) Associations between workability and patient-reported physical, psychological and social outcomes in breast cancer survivors: a cross-sectional study. Support Care Cancer 26(8):2815–2824. https://doi.org/10.1007/s00520-018-4132-2

    Article  PubMed  Google Scholar 

  22. Iragorri N, de Oliveira C, Fitzgerald N, Essue B (2021) The out-of-pocket cost burden of cancer care—a systematic literature review. Curr Oncol 28(2):1216–1248

    Article  Google Scholar 

  23. Islam T, Dahlui M, Majid HA, Nahar AM, Mohd Taib NA, Su TT, My BCC, MyBCC study group (2014) Factors associated with return to work of breast cancer survivors: a systematic review. BMC Public Health 14(3):S8. https://doi.org/10.1186/1471-2458-14-S3-S8

    Article  PubMed  PubMed Central  Google Scholar 

  24. Koczwara B (2017) Unemployment after cancer-a hidden driver of financial toxicity. Cancer Forum 41(2):36 https://search.informit.org/doi/abs/10.3316/informit.112480005521216

    Google Scholar 

  25. Longo CJ, Fitch MI, Banfield L, Hanly P, Yabroff KR, & Sharp L (2020). Financial toxicity associated with a cancer diagnosis in publicly funded healthcare countries: a systematic review. Support Care Cancer 1-21.

  26. Mbengi RK, Otter R, Mortelmans K, Arbyn M, Van Oyen H, Bouland C, De Brouwer C (2016) Barriers and opportunities for return-to-work of cancer survivors: time for action—rapid review and expert consultation. Syst Rev 5(1):35

    Article  Google Scholar 

  27. McGann M, Nguyen P, Considine M (2020) Welfare conditionality and blaming the unemployed. Adm Soc 52(3):466–494

    Article  Google Scholar 

  28. Moffatt S, Noble E (2015) Work or welfare after cancer? Explorations of identity and stigma. Sociol Health Illness 37(8):1191–1205

    Article  Google Scholar 

  29. Mols F, Tomalin B, Pearce A, Kaambwa B, Koczwara B (2020) Financial toxicity and employment status in cancer survivors. A systematic literature review. Support Care Cancer 12:2693–5708

    Google Scholar 

  30. Paul CL, Fradgley EA, Roach D, Baird H (2017) Impact of financial costs of cancer on patients-the Australian experience. Cancer Forum 41(2):4

    Google Scholar 

  31. Peterie M, Ramia G, Marston G, Patulny R (2019) Emotional compliance and emotion as resistance: shame and anger among the long-term unemployed. Work Employ Soc 33(5):794–811

    Article  Google Scholar 

  32. Pisu M, Azuero A, McNees P, Burkhardt J, Benz R, Meneses K (2010) The out of pocket cost of breast cancer survivors: a review. J Cancer Survivorship : Res Pract 4(3):202–209. https://doi.org/10.1007/s11764-010-0125-y

    Article  Google Scholar 

  33. Roth AJ, Kornblith AB, Batel-Copel L, Peabody E, Scher HI, Holland JC (1998) Rapid screening for psychologic distress in men with prostate carcinoma: a pilot study. Cancer: Interdiscip Int J Am Cancer Soc 82(10):1904–1908

    Article  CAS  Google Scholar 

  34. Saldaña J (2016). The coding manual for qualitative researchers (3rd ed.). Sage.

  35. Sharp L, O’Leary E, O’Ceilleachair A, Skally M, Hanly P (2018) Financial impact of colorectal cancer and its consequences: associations between cancer-related financial stress and strain and health-related quality of life. Dis Colon Rectum 61(1):27–35 https://journals.lww.com/dcrjournal/Fulltext/2018/01000/Financial_Impact_of_Colorectal_Cancer_and_Its.8.aspx

    Article  Google Scholar 

  36. Tevaarwerk AJ, Kwekkeboom K, Buhr KA, Dennee A, Conkright W, Onitilo AA, Robinson E, Ahuja H, Kwong RW, Nanad R, Wiegmann DA, Chen K, LoConte NK, Wisinski KB, Sesto ME (2021) Results from a prospective longitudinal survey of employment and work outcomes in newly diagnosed cancer patients during and after curative-intent chemotherapy: a Wisconsin Oncology Network study. Cancer 127(5):801–808. https://doi.org/10.1002/cncr.33311

    Article  PubMed  Google Scholar 

  37. van Maarschalkerweerd PEA, Schaapveld M, Paalman CH, Aaronson NK, Duijts SFA (2020) Changes in employment status, barriers to, and facilitators of (return to) work in breast cancer survivors 5–10 years after diagnosis. Disabil Rehabil 42(21):3052–3058. https://doi.org/10.1080/09638288.2019.1583779

    Article  PubMed  Google Scholar 

  38. Zafar SY, Abernethy AP (2013a) Financial toxicity, part I: a new name for a growing problem. Oncology 27(2):80 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4523887/pdf/nihms491876.pdf

    PubMed  Google Scholar 

  39. Zafar SY, Abernethy AP (2013b) Financial toxicity, part II: how can we help with the burden of treatment-related costs? Practice 27(4):253 https://www.proquest.com/docview/1347641444?pq-origsite=gscholar&fromopenview=true

    Google Scholar 

  40. Zafar SY, Peppercorn JM, Schrag D, Taylor DH, Goetzinger AM, Zhong X, Abernethy AP (2013) The financial toxicity of cancer treatment: a pilot study assessing out-of-pocket expenses and the insured cancer patient's experience. Oncologist 18(4):381

    Article  Google Scholar 

  41. Stergiou-Kita M, Pritlove C, Kirsh B (2016) The “Big C”—stigma cancer and workplace discrimination. J Cancer Survivorship 10(6):1035–1050. https://doi.org/10.1007/s11764-016-0547-2

Download references

Acknowledgements

The authors acknowledge the participants who contributed their knowledge and experiences to this project. We thank the Aboriginal and Torres Strait Islander participants who contributed knowledge and experiences to this research and acknowledge the traditional custodians of the land upon which we work, the Awabakal people, and pay our respects to elders past and present.

Funding

This interview study was funded by the Hunter Cancer Research Alliance, a Translational Research Centre funded by the Cancer Institute of New South Wales. Dr. Elizabeth Fradgley is supported by a CINSW ECR Fellowship and receives infrastructure support from the Hunter Medical Research Institute. Melissa Carlson is supported by an Australian Government Research Training Program.

Author information

Authors and Affiliations

  1. School of Medicine and Public Health, University of Newcastle, level 4 West, HMRI Building, University Drive, Callaghan, NSW, 2308, Australia

    Melissa A. Carlson, Elizabeth A. Fradgley, Paula Bridge, Jo Taylor, Sarah Morris, Emily Coutts & Christine Paul

  2. Priority Research Centre for Cancer Research Innovation and Translation, University of Newcastle, Callaghan, Australia

    Elizabeth A. Fradgley & Christine Paul

  3. Hunter Cancer Research Alliance, HMRI Building, New Lambton Heights, Australia

    Melissa A. Carlson, Elizabeth A. Fradgley, Paula Bridge, Jo Taylor & Christine Paul

  4. Priority Research Centre for Health Behavior, University of Newcastle, Callaghan, Australia

    Elizabeth A. Fradgley, Paula Bridge, Jo Taylor & Christine Paul

Authors
  1. Melissa A. Carlson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Elizabeth A. Fradgley
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Paula Bridge
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jo Taylor
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sarah Morris
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Emily Coutts
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Christine Paul
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

C. P., E. F., J. T. and E. C. conceptualised the study. S. M., P. B., M. C. and E. C. conducted the interviews. M. C., P. B., E. F. and C. P. analysed the data and prepared the manuscript. All authors reviewed the final manuscript.

Corresponding author

Correspondence to Christine Paul.

Ethics declarations

Ethics approval

This study was approved by the University of Newcastle Human Research Ethics Committee (H-2016-0180).

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Consent for publication

Informed consent was obtained from all individual participants for their data to be included in journal publications.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Carlson, M.A., Fradgley, E.A., Bridge, P. et al. The dynamic relationship between cancer and employment-related financial toxicity: an in-depth qualitative study of 21 Australian cancer survivor experiences and preferences for support. Support Care Cancer 30, 3093–3103 (2022). https://doi.org/10.1007/s00520-021-06707-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-021-06707-7

Keywords

Search

Navigation