The Economic Consequences of Cancer Survival
National Cancer Institute
09/30/99 - 07/31/06
Pamela Farley Short, Director, Center for Health Policy Research and Professor of Health Policy and Administration
Joseph J. Vasey, Institute for Policy Research and Evaluation
Ibrahim Ibrahim, Department of Health Policy and Administration
Mark Hayward, Population Research Insititute
Gene Lengerich, Department of Health Evaluation Sciences
David Mauger, Department of Health Evaluation Sciences
Stephany Romano, Department of Health Policy and Administration
James Zabora, Johns Hopkins, Oncology Center
Erin Hirschbeck, Department of Health Policy and Administration
Kaan Tunceli, Department of Health Policy and Administration
This study was designed to answer the following research questions: (1) What changes in employment, earnings, and health insurance do cancer patients experience shortly after diagnosis and treatment?; (2) What is the effect of cancer survival on trajectories of employment, earnings, and health insurance over the long term?; (3) How do the economic effects of cancer vary by type of cancer, patient characteristics, and pre-diagnosis employment and insurance?; (4) What adjustments in the employment and health insurance of spouses are made to accommodate changes in the health employment, and health insurance of married cancer survivors?; and (5) What are the implications of these economic adjustments for the psycho-social well-being and quality of life of cancer survivors?
We identified a cohort of cancer survivors from four tumor registries in the Mid-Atlantic region, which together drew patients from inner-city, small urban, suburban, and rural areas. We conducted a computer-assisted telephone interview with the subjects one to three years after diagnosis and re-interviewed them annually (a total of four times) until about half survived to five years. The first interview included retrospective questions about employment, insurance, and health just prior to cancer diagnosis. Each cancer patient's employment and insurance was compared pre- and post-diagnosis and treatment, identifying factors that differentially protect or expose cancer survivors to economic changes. We also compared cancer cohort experiences to those of a comparison group without cancer, drawn from either or both of two national panel surveys covering the same time period (the Health and Retirement Survey and the Survey of Income and Program Participation). By emphasizing hazard modeling as our main analytic approach, we estimated and projected both short-term and long-term effects of cancer on survivors' economic well-being.
Related Publications
Vasey, J., Mallonee, E., Short, P., Ibrahim, I. (In press) Gender Differences in Health-Related Quality of Life of Cancer Survivors. Forthcoming in Psychosocial Oncology.
Short, P.F., and Mallonee, E. (2006) Income Disparities in the Quality of Life of Cancer Survivors. Medical Care 44(1): 16-23.
Short, P.F., J. Vasey, and Tunceli, K. (2005) Employment Pathways in a Large Cohort of Adult Cancer Survivors. CANCER 103(6):1291-1302, March 15.