Main Session
Sep
29
PQA 06 - Radiation and Cancer Biology, Health Care Access and Engagement
3082 - Paid Sick Leave and Access to Care and Financial Hardship among Working Cancer Survivors
Presenter(s)
Abigail Kohut-Jackson, BS, MBS - Saint Louis University School of Medicine, Saint Louis, MO
A. L. Kohut-Jackson1, F. Chino2, Z. Zheng3, X. Han4, K. Johnson5, R. R. Yabroff6, K. Johnston7, and J. M. Barnes8; 1Saint Louis University School of Medicine, St. Louis, MO, 2Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 3American Cancer Society, Atlanta, GA, 4American Cancer Society, Inc., Atlanta, GA, 5Washington University in St. Louis, St. Louis, MO, 6American Cancer Society, Kennesaw, GA, 7Washington University School of Medicine, St. Louis, MO, 8WashU Medicine, Saint Louis, MO
Purpose/Objective(s):
Paid sick leave allows patients time off from work to receive recommended medical care while maintaining income. In patients with cancer, access to paid leave is associated with improved overall and cancer-specific survival and increased healthcare utilization, but the mechanisms driving these improvements are unclear. We investigated whether access to paid sick leave is associated with care delays and financial hardship in working cancer survivors.Materials/Methods:
Working individuals ages 18-64 with a history of cancer were identified from the nationally representative 2019-2023 National Health Interview Survey (NHIS). Logistic regression models accounting for NHIS survey design examined whether access to paid sick leave at the time of survey completion was associated with care delays due to cost in the past year and problems paying medical bills. Covariates included age, sex, race and ethnicity, metropolitan status, marital status, comorbidities, income, education, and health insurance status. Analyses were conducted overall and by sociodemographic subgroups.Results:
3052 working adults with a history of cancer participated in NHIS between 2019-2023, representing 5,016,447 US cancer survivors. 69.8% reported having paid sick leave at the time of the survey. The prevalence of delayed medical care due to cost in the past year was 9.8% in working adults with a history of cancer. In adjusted analyses, access to paid leave was associated with decreased odds of delayed medical care (odds ratio [OR] 0.50, 95% confidence interval [CI] 0.35-0.70, P<0.001), particularly for those ages 40-64 years (OR 0.44, 95% CI 0.30-0.64, P<0.001), females (OR 0.36, 95% CI 0.24-0.54, P<0.001), and those with private insurance (OR 0.44, 95% CI 0.30-0.64, P<0.001). In expanded models with interaction terms, there were stronger associations between paid leave and delayed medical care in those ages 40-64 (OR40-64 years = 0.44, OR18-39 years=0.83, Pinteraction=0.024), females (ORfemale=0.36, ORmale=1.09, Pinteraction=0.067), and privately insured individuals (ORprivate=0.44, ORuninsured=1.34, Pinteraction=0.054). Access to paid leave was not associated with problems paying medical bills (OR 0.90, 95% CI 0.59-1.36) for survivors overall, though it was for unmarried survivors (OR 0.65, 95% CI 0.45-0.93, P=0.020). Interaction terms analysis revealed a stronger association between paid leave and financial hardship in unmarried survivors (ORunmarried=0.65, ORmarried=1.08, Pinteraction=0.028).Conclusion:
Access to paid sick leave is associated with decreases in delaying medical care due to cost among working adults with a history of cancer. It can also mitigate the financial burden of cancer for unmarried survivors. Despite its associations with access to care, paid leave was not available to a third of working cancer survivors.