Paid Medical Leave and Mortality Risk in Working Cancer Survivors

• Published in: International journal of radiation oncology, biology, physics Vol. 120; no. 2; p. S73
• Main Authors: Kohut-Jackson, A., Chino, F., Zheng, Z., Han, X., Johnson, K., Yabroff, R., Johnston, K., Barnes, J.M.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.10.2024
• ISSN: 0360-3016
• DOI: 10.1016/j.ijrobp.2024.07.125

Paid medical leave provides patients both time and financial stability, important factors that affect access to cancer screenings and diagnostic workup, treatment, and survivorship care. Access to paid leave has been associated with reduced all-cause mortality and increased access to healthcare services. However, it is unclear if access to paid leave is associated with cancer outcomes. We investigated whether paid medical leave is associated with mortality risk in working cancer survivors. Individuals ages 18-64 years with a history of cancer were identified from the 2011-2018 National Health Interview Survey (NHIS) with linked mortality files from the National Death Index. Individuals with no documented employment history were excluded. Cox proportional hazards models using age as the time scale were utilized to determine whether having access to paid medical leave at the time of survey completion was associated with overall and cancer mortality. Models accounted for the NHIS survey design and survey weights. Models were adjusted for insurance status, marital status, sex, race, ethnicity, comorbidities, education, income, national region, cancer site, and time since cancer diagnosis. A total of 7746 working adults with a history of cancer participated in NHIS, representing 9,456,587 United States cancer survivors. 57.2% reported having paid medical leave at the time of the survey. In adjusted analyses, paid medical leave was found to be associated with significant reductions in overall mortality (HR for risk of death = 0.79, 95% confidence interval [CI] = 0.65 to 0.96, P = 0.018) and cancer mortality (HR = 0.74, 95% CI = 0.57 to 0.97, P = 0.028). Subgroup analyses suggested that the associations between paid leave and mortality were strongest among individuals ages 40-64 years (overall HR = 0.78, 95% CI = 0.64 to 0.96, P = 0.02; cancer HR = 0.72, 95% CI = 0.55 to 0.95, P = 0.02), with comorbidities (overall HR = 0.76, 95% CI = 0.61 to 0.95, P = 0.014; cancer HR = 0.67, 95% CI = 0.49 to 0.92, P = 0.013), who completed high school but did not have a college degree (overall HR = 0.65, 95% CI = 0.5 to 0.85, P = 0.002; cancer HR = 0.56, 95% CI = 0.39 to 0.8, P = 0.002), with cervical cancer history (overall HR = 0.35, 95% CI = 0.11 to 1.11, P = 0.075; cancer HR = 0.02, 95% CI = 0 to 0.72, P = 0.033), and who were 3-6 years from their cancer diagnosis (overall HR = 0.58, 95% CI = 0.35 to 0.86, P = 0.033; cancer HR = 0.42, 95% CI = 0.22 to 0.81, P = 0.009), with less evidence for individuals who were 0-2 (overall HR = 1.00), 7-15 (HR = 0.85), and ≥ 16 (HR = 0.62) years from their cancer diagnosis. In working adults with a history of cancer, access to paid medical leave was associated with reductions in overall and cancer mortality. Paid medical leave may lead to better outcomes by reducing financial burdens and/or improving access to care, not only during initial diagnosis and treatment, but also during recovery and survivorship care.