Productivity in Survivors of Cancer

Cancer survivors may experience decreased productivity compared with individuals with no history of cancer, although multiple, patient-specific factors influence the degree of productivity loss, the changes to employment arrangements, and the challenges faced by those who are returning to work after treatment or who are working while undergoing treatment.^1,2 There are few studies regarding interventions for productivity loss among cancer survivors, and multiple gaps in the research on productivity loss have been identified.²

Productivity loss is becoming an increasingly important aspect to survivorship as survival rates improve and newer treatments (some of which are, generally, better tolerated) become available. As a result, more patients continue to work during their treatment and/or choose to return to work after treatment.¹ However, cancer treatment affects productivity due to the need to take time off for treatments, clinic visits, and manage side effects. Fatigue and/or decreased physical and/or cognitive functioning related to the malignancy and the therapies to treat it can also factor into an employee’s efficiency.

Loss of Productivity

Productivity is typically measured in the literature by health-related missed work days, employment disability, or loss of employment. It has been estimated that about 25% of cancer survivors feel less productive at work, with 25% having difficulty with physical tasks and 14% have difficulty with mental tasks required by their job.³

Data from the 2008–2012 Medical Expenditure Panel Survey (MEPS) of 3278 patients with colorectal, breast, or prostate cancer and 109,423 patients without a history of cancer demonstrated that nonelderly survivors of colorectal and breast cancers had significantly greater productivity loss at work in terms of economic costs, and rates of employment disability (13.6%; P < .001 and 4.8%; P = .001, respectively), and days in bed (4.5 days; P < .001 and 3.3 days; P = .003, respectively) compared with those without prior cancer.⁴ Elderly patients (age 65 or older) and those with a history of prostate cancer did not experience a significant decrease in productivity.

Adolescents and young adults aged 15 to 39 also experienced productivity loss after cancer treatment.⁵ A systematic review concluded that cancer-related changes in physical and cognitive function could affect income and cause distress. Cancer survivors in this age group were older than those without a history of cancer at the time of first employment, though survivors were just as likely to graduate from university or gain eventual employment.

Adult childhood cancer survivors who were diagnosed with cancer when they were aged 0 to 14 also demonstrated decreased productivity.⁶ Although most adults were able to work, a greater number were more likely to report being unable to work due to health (18.7% vs 7.1%; P < .001) and those who were employed had a greater number of health-related missed work days (8.6 days vs 3.7 days; P = .07) and were more likely to spend a day in bed due to health (14.6 days vs 4.1 days; P = .004) compared with adults without a history of cancer. In addition, more adult childhood cancer survivors needed help with personal care needs (14.5% vs 3.7%; P < .001) and were limited in the amount or type of work they could perform (12.8% vs 4.4%; P < .001) compared with adults without a history of cancer.