Employer-sponsored insurance, paid sick leave, and financial toxicity among cancer survivors.

Abstract

11107 Background: Financial toxicity (FT), the adverse economic effects resulting from cancer, its treatment, and associated long-term effects, may affect the majority of cancer survivors. FT is associated with multiple factors including employment disruptions; however, the role of workplace policies in mitigating FT is poorly understood. We examined how employer-sponsored health insurance and paid sick leave influence FT among employed U.S. cancer survivors. Methods: We analyzed data from 1,122 employed cancer survivors aged 18-64 with non-missing insurance status and a self-reported history of cancer (diagnosed age 18 or older), representing a weighted total of almost 5 million survivors from the 2021/2022 National Health Interview Survey (NHIS), a nationally representative household survey of the civilian noninstitutionalized U.S. population. Multivariable logistic regression analyses examining associations of employer-sponsored health insurance and paid sick leave (separately) with FT items, controlling for sociodemographic characteristics and cancer type, were conducted using PROC SURVEYLOGISITC in SAS 9.4 adjusting for the complex survey design of the NHIS. Results: Compared with cancer survivors who had employer-sponsored health insurance (n = 842, weighted 76.6%), those without employer-sponsored insurance were significantly (p < 0.05) more likely to experience FT, including worrying about paying medical bills (odds ratio [OR] 1.7, 95% confidence interval [CI] 1.2-2.4), skipping/delaying medical care due to costs (OR 2.4, 95% CI 1.5-3.9), and delaying counseling/therapy due to costs (OR 2.5, 95% CI 1.3-4.6). These associations persisted when restricting the sample to survivors with private insurance only. Similarly, compared to survivors with paid sick leave (n = 807, weighted 72.0%), those without paid sick leave were significantly more likely to worry about paying medical bills (OR 1.4, 95% CI 1.1-1.9) and skip/delay medical care due to costs (OR 2.2, 95% CI 1.4-3.4), with consistent findings in the private insurance only subgroup. Having employer-sponsored insurance and paid sick leave were also associated with decreased food insecurity. Conclusions: Workplace policies can mitigate FT and food insecurity among cancer survivors. Employers should consider offering benefits that support health and economic outcomes for employees with cancer and other medical conditions and enhance their ability to contribute to positive workplace environments.