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Relationship between paid leave, financial burden, and patient-reported outcomes among employed patients who have undergone bone marrow transplantation

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Abstract

Purpose

The US does not have universal paid family and medical leave. We examine the direct effects of access to paid leave on patient-reported health, quality of life (QOL), and perceived stress of employed patients who underwent bone marrow transplantation (BMT) to treat advanced blood cancer as well as the indirect effects through reductions in the financial burden (FB) that patients face.

Methods

Our cross-sectional observational study took place at three US transplantation centers in 2014 and 2015. All English-speaking cancer patients 6-month post-BMT were mailed a 43-item survey assessing financial situation, employer benefits, and patient-reported health outcomes. The sample includes the 171 respondents who were employed at the time of BMT.

Results

Seemingly unrelated regression analysis confirms that patient access to paid leave was associated with reductions in all three measures of FB, and lower levels of financial hardship were related with improved health, QOL, and perceived stress outcomes. For self-reported health and perceived stress outcomes, all of the effects of patient paid leave operate indirectly through reductions in FB. For QOL outcomes, there is both a direct effect (over 80%) of paid leave and an indirect effect through reduction of FB.

Conclusion

We found that paid leave affected health outcomes for BMT patients mostly through alleviating FB. These findings suggest universal paid leave policies in the US might alleviate financial hardship and have positive effects on the self-reported QOL of employed patients facing intensive medical treatments.

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Author information

Authors and Affiliations

  1. University of Massachusetts Boston, Boston, MA, USA

    Randy Albelda, Emily Wiemers & Diana Y. Salas Coronado

  2. Dana Farber Cancer Institute, Boston, MA, USA

    Gregory A. Abel

  3. Mayo Clinic Arizona, Phoenix, AZ, USA

    Nandita Khera

  4. Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA

    Theresa Hahn

Authors
  1. Randy Albelda
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  2. Emily Wiemers
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  3. Theresa Hahn
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  4. Nandita Khera
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  5. Diana Y. Salas Coronado
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  6. Gregory A. Abel
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Corresponding author

Correspondence to Randy Albelda.

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All procedures performed in studies involving human participants were in accordance with the Ethical Standards of the Institutional and/or National Research Committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Appendix

Appendix

Table 5 OLS seemingly unrelated regression full results: paid sick leave and paid family leave and financial burden (OLS coefficients, 95% confidence Interval)
Full size table
Table 6 Seemingly unrelated regression full results: patient-reported health and three financial burden (FB) measures with paid leave (OLS coefficients, 95% confidence interval)
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Albelda, R., Wiemers, E., Hahn, T. et al. Relationship between paid leave, financial burden, and patient-reported outcomes among employed patients who have undergone bone marrow transplantation. Qual Life Res 28, 1835–1847 (2019). https://doi.org/10.1007/s11136-019-02150-8

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  • DOI: https://doi.org/10.1007/s11136-019-02150-8

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