Employment status and occupational patterns among working-age US cancer survivors, 2020-2024.

Abstract

e23074 Background: Cancer and its treatment often cause impairments constraining work ability, yet financial burdens may compel survivors to work. This complex dynamic may influence occupational choices after cancer diagnosis and treatment, but employment status and occupational patterns among working-age US cancer survivors remain understudied. Methods: This pooled cross-sectional study analyzed data from the 2020 and 2024 National Health Interview Survey to examine employment status and types of occupation among cancer survivors aged 18 to 65 years. Survivors were matched 1:3 with a non-cancer cohort based on age, sex, race/ethnicity, education, and marital status using propensity score matching. We estimated weighted employment rates for any work, full-time work (≥5 hours/week), and part-time work among cancer survivors and the matched controls. We ranked the prevalence of 23 occupational categories among those who were employed. Multivariable logistic regression identified factors associated with employment. Results: The final sample included 2,628 cancer survivors (mean age: 54.5 [SE: 0.19]; 64.1% female), representing 9.5 million U.S. adults, and 7,860 matched non-cancer controls (mean age: 54.4 [SE: 0.23]; 64.8% female). 57.9% (95% CI: 55.5–60.2) of cancer survivors were employed, including 46.4% (95% CI: 44.0–48.8) in full-time and 11.5% (95% CI: 10.0–12.9) in part-time roles. The overall employment rate of cancer survivors was lower than that of matched controls (difference: -5.6; p < 0.001), primarily driven by lower rates of full-time employment, with the widest gap observed among Hispanic survivors (diff: −9.8; p < 0.05) and those with a high school education or less (diff: −9.7; p < 0.001). Among survivors, the employment rate was significantly lower among those who were older, non-Hispanic Black, had lower education and family income, had cardiovascular conditions or diabetes, had multiple cancers, and were diagnosed after age 55 (p < 0.05). Survivors of melanoma, thyroid, and genitourinary cancers had the highest employment rates, whereas lung and gastrointestinal cancer survivors had the lowest. In multivariable logistic regression, older age, female sex, lower education, never married, and having cardiovascular conditions or diabetes were associated with unemployment among cancer survivors (p < 0.05). Cancer survivors tended to be less likely to engage in occupations with higher physical demands than non-cancer survivors, but differences were not statistically significant. Conclusions: The employment rate among cancer survivors was significantly lower than matched peers, particularly among Hispanic survivors and those with lower education. Future research is needed to explore the impact of health-related limitations and financial toxicity of cancer and its treatment on work choices to inform interventions supporting economic stability and quality of life for survivors.