Cancer Survivors Stay in Jobs to Keep Their Health Insurance

Fran Lowry

April 27, 2020

Erin E. Kent, PhD

Job lock, or the inability to freely leave a job due to fears of losing the health insurance being provided by an employer, is common among cancer survivors as well as their spouses or partners.

In a survey, one third of cancer survivors in the United States reported job lock, either for themselves or their spouses and partners. The survey was published online April 23 in JAMA Oncology.

"Job lock can negatively affect career trajectory and quality of life, as well as family well-being," the letter's lead author, Erin E. Kent, PhD, from the University of North Carolina, Chapel Hill, told Medscape Medical News.

Kent added that clinicians, social workers, and others who work with cancer patients are in a position to identify job lock and other employment concerns throughout treatment and survivorship care. They could connect survivors with employment and health insurance counseling, Kent suggested.

"In a healthy economy, you want to see a lot of fluidity, or the ability to move around. When people get stuck, there can be a lot of inefficiency in the workplace. There can be more absenteeism, more complacency, less productivity, and less innovation, when people feel they are stuck in a job," she said.

Kent and colleagues looked at cancer survivors who responded to questions about job lock on the Experiences With Cancer questionnaire from the 2011, 2016, and 2017 Medical Expenditure Panel Survey.

Of the 1340 cancer survivors surveyed, 266 (19.6%; 95% CI, 17.1% - 22.3%) reported job lock.

Of 1593 partners or spouses of cancer survivors, 171 (10.7%; 95% CI, 8.4% - 11.9%) also reported job lock.

Of 1094 respondents who were cancer survivors themselves and also had spouses or partners, 374 (32.3%; 95% CI, 31.7% - 40.3%) reported any job lock for themselves or their spouse or partner.

The prevalence of job lock was higher in female than male cancer survivors (35.9% vs 27.9%).

Job lock was more likely in younger (< 75 years) individuals and those earning income between 138% and 400% of the federal poverty level (FPL).

"It is important to note that those earning between 138% and 400% of the FPL are ineligible for Medicaid," Kent noted. "They also may have fewer employment alternatives with comprehensive health benefits."

In addition, survivors with three or more comorbidities were more likely to report spouse or partner job lock compared with survivors with no comorbidities (14% vs 6%).

"Our study demonstrates consistent findings in a nationally representative population of adult cancer survivors and also provides data on the prevalence of job lock among spouses and partners of cancer survivors," Kent said.

"We hope our report will expand the conversation about the financial toxicity or hardship many patients and their families face. There are many ancillary impacts, and perhaps we now need to consider what the impact is of having health insurance tied to employment," she added.

Kent has reported no relevant financial relationships.

JAMA Onc. Published online April 23, 2020. Full text

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