Long-Term Survivors of Childhood Cancer Prone to ‘Job Lock’ due to Worries About Losing Health Insurance

Key Points

  • 23% of childhood cancer survivors reported job lock, compared to just under 17% of the survivors’ siblings who never had cancer.
  • Female survivors and survivors with chronic health conditions were more likely to report job lock.
  • Survivors who had a history of problems paying medical bills and those with past health insurance denials were more likely to report feeling like they couldn’t change jobs because of insurance worries.

The results of a national cancer survey reveal a significant number of childhood cancer survivors are worried about keeping their health insurance, to the point of letting it affect their career decisions. The findings were published by Kirchhoff et al in JAMA Oncology.

Anne Kirchhoff, PhD, investigator at Huntsman Cancer Institute (HCI) and Assistant Professor of Pediatrics at the University of Utah, led the study. Her goal was to examine the prevalence of “job lock” in full-time, employed childhood cancer survivors. Job lock is when an employee stays at a job in order to keep work-related health insurance. The study found 23% of childhood cancer survivors reported job lock, compared to just under 17% of the survivors’ siblings who never had cancer.

“Even with protections and expansions of insurance coverage in the United States, this study proves there is still quite a bit of worry about insurance, and it’s affecting how people make decisions from a job standpoint. Employer-based insurance coverage is the most common way people get insurance in the United States. If someone gets stuck in a certain job because they want to keep their insurance coverage, that could really affect their earning power across a lifetime. It could potentially stymie their ability to start a new company or take on a job that would allow them to have more career or income growth—all because of health insurance worries,” explained Dr. Kirchhoff.

Additional Study Findings

The study found female survivors and survivors with chronic health conditions were more likely to report job lock. Researchers also determined survivors who had a history of problems paying medical bills and those with past health insurance denials were more likely to report feeling like they couldn’t change jobs because of insurance worries.

Dr. Kirchhoff said, “This information gives us a feel for high-risk groups of survivors who may need more information about insurance. Many people experience a gap in education and literacy around insurance, and it’s important for people to understand their options—even those who are employed and consistently had access to insurance through work. We want to know what their concerns are so we can help patients and survivors. Getting health care should not be a worry for cancer survivors.”

The study analyzed 394 pediatric cancer survivors from pediatric oncology institutions across the United States, along with 128 of their siblings. All of the participants worked 35 hours or more per week. Eighty-eight percent of them had employer-sponsored health insurance. Only 4% of survivors (and just over 6% of siblings) were uninsured.

The cancer survivors were treated for cancer between birth and age 20, and all of the participants ranged in age at the time of the survey from their 20s to early 60s. They were asked to fill out surveys analyzing their insurance and work concerns. About a third of pediatric survivors in this survey reported a severe, disabling, or life-threatening chronic condition.

“Survivors have been through a lot when they were younger and understand the importance of making sure they can get health care when they need it,” explains Kirchhoff. “I think a lot of them also saw what their parents and families went through in terms of the financial stress and burden of dealing with a health crisis. So they’re just primed to understand the importance of health insurance.”

This study was conducted as the Affordable Care Act (ACA) was rolling out. Dr. Kirchhoff said she would like to do a follow-up study to see if the insurance exchanges and Medicaid expansion have lessened job-related insurance worries. Dr. Kirchhoff also explained she believes the study demonstrates what the country could expect if the ACA is dismantled.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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