The positive effect of workplace accommodations on the continued employment of cancer survivors five years after diagnosis

Who Requests and Receives Workplace Accommodations? An Intersectional Analysis

PURPOSE

This study investigates who requests workplace accommodations and who is more likely to have requests granted. We investigate the role of demographic characteristics and their intersection, including disability, gender, race/ethnicity, and age. We also consider the role of other personal and job-related factors.

METHODS

We use the data from the Current Population Survey (CPS) 2021 Disability Supplement to estimate the odds ratio of having requested workplace accommodations and having such request granted during the COVID-19 pandemic when the survey was conducted. In supplementary analyses, we explore the relationship between remote work and flexible scheduling and workplace accommodations, as well as possible trends using CPS 2019 Disability Supplement.

RESULTS

Our results indicate that Hispanics with disabilities are more likely than others to request workplace accommodations, but they are substantially less likely to be granted accommodations. Consistent with other studies, our paper also finds that people with disabilities, women, and older people are more likely to request accommodations than their respective counterparts. Other personal and job-related factors such as higher education, parenthood, being single, being a citizen, and working in management-related occupations are associated with higher likelihood of requesting workplace accommodations compared to their counterparts, while receiving accommodations is largely explained by occupational differences.

CONCLUSION

Our findings show that there are still disparities in the rates of workplace accommodation requests and provision for multiply marginalized groups, and as such, taking into account intersectional differences in addition and in relation to disability is important.

Inability to Work Fulltime and the Association with Paid Employment One Year After the Work Disability Assessment: A Longitudinal Register-Based Cohort Study

OBJECTIVES

Disability benefit applicants with residual work capacity are often not able to work fulltime. In Dutch work disability benefit assessments, the inability to work fulltime is an important outcome, indicating the number of hours the applicant can sustain working activities per day. This study aims to gain insight into the association between inability to work fulltime and having paid employment 1 year after the assessment.

METHODS

The study is a longitudinal register-based cohort study of work disability applicants who were granted a partial disability benefit (n = 8300). Multivariable logistic regression analyses were conducted to study the association between inability to work fulltime and having paid employment 1 year after the assessment, separately for working and non-working applicants.

RESULTS

For disability benefit applicants, whether working (31.9%) or not working (68.1%) at the time of the disability assessment, there was generally no association between inability to work fulltime and having paid employment 1 year later. However, for working applicants diagnosed with a musculoskeletal disease or cancer, inability to work fulltime was positively and negatively associated with having paid employment, respectively. For non-working applicants with a respiratory disease or with multimorbidity, inability to work fulltime was negatively associated with paid employment.

CONCLUSIONS

Inability to work fulltime has limited association with paid employment 1 year after the disability benefit assessment, regardless of the working status at the time of assessment. However, within certain disease groups, inability to work fulltime can either increase or decrease the odds of having paid employment after the assessment.

Investigating municipal and company influences on employment of people with chronic health conditions

AIMS

In many countries, people with chronic health conditions have a weaker attachment to the labour market and fewer chances of re-employment. Much of the existing literature estimates the importance of institutional factors at the level of the municipality of residence or employer accommodation at the company level individually. This study examined the two levels simultaneously to disentangle the separate effects of municipal-level and of company-level factors.

METHODS

Using full population data from Denmark, we estimated cross-classified multilevel models for people newly diagnosed with chronic conditions in 2010-2013 (more than 60,000 individuals in 20,000 companies). We tracked their employment outcomes for up to 5 years after diagnosis.

RESULTS

The findings suggest that, in the short term, factors at the company level explain differences in the employment levels of individuals with chronic conditions more than institutional factors at the municipal level. A combination of average wage, company-level seniority, company size, and industry seem to explain much of company-level influence. In the longer term, the importance of company-level factors seemed to decline. Company-level factors explained blue collar workers' employment rates better than those of white collar workers, which is in line with the notion that blue collar workers expend more physical effort in their work so that they may be more reliant on company accommodation than white collar workers in the case of chronic conditions.

CONCLUSIONS

Company-level factors affected the employment of persons newly diagnosed with chronic health conditions in the short term (in particular among workers in blue collar jobs), while municipal-level factors did not.

Facilitators and barriers to employment for rural women cancer survivors

PURPOSE

Limited research exists on the employment experiences of rural women cancer survivors, yet this population may face unique barriers to employment following a cancer diagnosis. This study aims to identify facilitators and barriers to employment for rural women cancer survivors.

METHODS

We used a qualitative descriptive design to examine facilitators and barriers to employment for rural women cancer survivors. We conducted interviews with 33 rural women with cancer histories.

RESULTS

Facilitators of employment included paid time off, flexible work arrangements, and supportive workplace social networks, while barriers to employment included compromised immunity, long-term treatment effects, stigma and discrimination, and limited rural job markets. Rural women with secure employment histories generally experienced facilitators of employment, while rural women with insecure (e.g., temporary, informal, non-standard) employment histories generally faced barriers to retaining jobs and finding employment.

CONCLUSIONS

Formal and informal workplace support helped rural women retain their jobs during and following cancer treatment, especially those with secure employment. However, women with insecure employment histories generally faced multiple barriers to retaining and finding employment. More inclusive policies to support workers facing disabling illnesses, such as paid medical leave, are needed to ensure cancer survivors can maintain employment and/or financial security during and following their cancer treatment.

IMPLICATIONS FOR CANCER SURVIVORS

Cancer survivors with secure employment may benefit from formal and informal workplace support in retaining their employment. Those with insecure employment histories may benefit from access to job placement services and inclusive policies protecting employment for all workers experiencing disabling illness.

Sustainable return to work among breast cancer survivors

PURPOSE

This study assessed sustainable return to work (SRTW) of breast cancer survivors (BCS).

METHODS

We used data from the prospective French cohort, CANTO. We included 1811 stage I-III BCS who were <57 years old and employed at the moment of diagnosis and working 2 years after diagnosis. Using logistic regression, we investigated the role of clinical, health and socio-economic factors, and the work environment on SRTW 3 years after diagnosis. We compared having any sick leave with having worked continuously and being unemployed to having worked continuously between 2 and 3 years after diagnosis.

RESULTS

Overall, 77% (n = 1395) worked continuously after return to work (RTW). Out of the other 416 BCS, 66% had any sick leave period, 33% had been unemployed, 4% had an early retirement, 2% a disability and 1% another status (multiple situations possible). Being on sick leave was associated with age > 50 (OR = 0.59; 95%CI = 0.43-0.82), stage III (2.56; 1.70-3.85), tumour subtype HR+/HER2+ (0.61; 0.39-0.95), severe fatigue (1.45; 1.06-1.98), workplace accommodations (1.63; 1.14-2.33) and life priorities (0.71; 0.53-0.95). Unemployment was associated with age > 50 (0.45; 0.29-0.72), working in the public sector (0.31; 0.19-0.51), for a small company (3.00; 1.74-5.20) and having a fixed-term contract (7.50; 4.74-11.86).

CONCLUSIONS

A high number of BCS have periods of sick leave or unemployment after RTW. The determinants differ between sick leave and unemployment.

IMPLICATIONS FOR CANCER SURVIVORS

BCS need to be supported even after RTW, which should be regarded as a process.

Impact of flexible work arrangements on job resignation after cancer diagnosis among Japanese young adult cancer survivors

PURPOSE

Many workers had flexible work arrangements during the COVID-19 pandemic. This study aimed to identify the association between flextime and remote working and job resignation among Japanese young adult cancer survivors after diagnosis.

METHODS

This cross-sectional observational study was conducted using an online survey with 401 Japanese young adult cancer survivors diagnosed with adult-onset cancer and aged 20-39 years at the time of the survey in January 2022. A multivariable Cox regression analysis was performed to analyze the impact of flextime and remote working on job resignation.

RESULTS

In the sample, 264 participants (65.8%) were female, and 185 (46.1%) had been diagnosed with cancer between 1 and 5 years ago. After adjusting for potential confounders, the multivariable Cox regression analysis revealed that young adult cancer survivors using remote working only (HR 0.44, 95% CI 0.21-0.96, p = 0.04) and both flextime and remote working (HR 0.37, 95% CI 0.21-0.64, p < 0.01) experienced a lower risk of job resignation after cancer diagnosis compared to those who did not use flextime and remote working.

CONCLUSIONS

Young adult cancer survivors who used remote working only or remote working combined with flextime could reduce their risk of job resignation after a cancer diagnosis.

IMPLICATIONS FOR CANCER SURVIVORS

This study showed that having the option of remote working can be important for young adult cancer survivors' continuing employment. Furthermore, social welfare systems need to promote a workplace culture and climate that allows remote working.

Exploring the independent association of employment status to cancer survivors' health-related quality of life

BACKGROUND

Having a job has been associated with better Health-Related Quality of Life (HRQOL) in cancer survivors. However, the sociodemographic and disease-related profiles characterizing the survivors being employed and those having better HRQOL largely overlap. The present study aims to discern the degree to which employment status is independently associated with cancer survivors' HRQOL or if it mainly reflects the impact of other sociodemographic and cancer-related variables.

METHODS

Cross-sectional study on a heterogeneous sample of 772 working-age survivors of adult-onset cancer. An instrument specifically designed to assess HRQOL in cancer survivors and Multivariate Variance Analysis (MANOVA) were used.

RESULTS

Survival phase, cancer type, and employment status showed the main effects on cancer survivors' HRQOL. In particular, being employed (vs unemployed) had the greatest positive association with HRQOL, affecting ten of the twelve HRQOL domains considered. Also, interaction effects highlighted the role of age (younger) and marital status (single) as risk factors for a greater negative impact of variables affecting the survivor's HRQOL.

CONCLUSIONS

The application of a multivariate methodology sheds new light on two relevant issues for the cancer survivor's HRQOL: (i) the existence of differences between diagnostic groups that are not attributed to other variables such as sex, and (ii) the important and independent role that employment status plays. Comprehensive cancer survivorship care should focus more on high-risk groups and include having a job as an essential aspect to consider and prompt. The fact that the employment status is susceptible to change represents a valuable opportunity to care for the wellbeing of this population.

Proceedings of the International Scientific Conference “Cancer, Work & Employment”

This paper is an overview of the International Scientific Conference on “Cancer, Work & Employment” that was held in Paris on November 21 and 22, 2022, and organized by the French National Cancer Institute (INCa). The conference was structured around four keynote presentations and two roundtables, with renowned international speakers. The focus of this conference was to discuss the challenges of return or access to work and job retention when facing cancer, from interdisciplinary perspectives (e.g., psychology, sociology, economics). Speakers analyzed return-to-work (RTW) determinants for cancer patients, with a particular focus on specific forms of cancer, working conditions (e.g., self-employment, adaptations at work when returning), and the influence of differences in social welfare systems. Current interventions to support RTW were analyzed, from the patient’s point of view and in terms of improving healthcare professionals’ practices. Prospects for future research in the field were also discussed (e.g., focus on underrepresented populations, considering the influence of longer treatments, incorporating changes in career paths). Finally, the broad spectrum of disciplines and the diversity in involved countries offered a rare opportunity to exchange ideas and helped initiate collaboration between participants.

"The Last Thing You Have to Worry About": A Thematic Analysis of Employment Challenges Faced by Cancer Survivors

The evidence base for interventions that support the employment goals of cancer survivors is growing but inconclusive. As the first step in initiating a community-engaged program of research aimed at developing and testing interventions to support the employment goals of cancer survivors, 23 cancer survivors, 17 healthcare providers, and 5 employers participated in individual interviews to elicit perceptions regarding local challenges and resources related to work maintenance and optimization within the context of cancer treatment. Interviews were recorded and transcribed verbatim. A thematic analysis was conducted to identify cross-cutting experiences that were voiced by all three types of participants. Three themes were found in the data: (1) the onus for identifying and articulating work-related issues is upon the cancer survivor; (2) the main support offered to cancer survivors involved time away from work and flexibility with scheduling work and treatment activities; and (3) participants voiced a lack of information regarding one or more aspects related to supporting employment goals of cancer survivors. Supportive resources designed for cancer survivors, employers, and/or healthcare providers are needed to help cancer survivors optimize their employment situations.

Perceived discrimination at work: examining social, health and work-related factors as determinants among breast cancer survivors – evidence from the prospective CANTO cohort

Background

We assessed the prevalence of self-reported perceived discrimination in the workplace after the end of treatment among breast cancer (BC) survivors and studied its association with social, health-related and work-related factors.

Methods

We used data from a French prospective cohort (CANcer TOxicities) including women diagnosed with stage I–III BC. Our analysis included 2130 women who were employed, <57 years old at BC diagnosis and were working 2 years afterwards. We assessed the association between social, health-related and work-related factors and perceived discrimination in the workplace using logistic regression models.

Results

Overall, 26% of women reported perceived discrimination in the workplace after the end of treatment. Women working for a small company, in the public sector or with better overall health status were less likely to report perceived discrimination. Women who benefited from easing dispositions at their workplace, who did not feel supported by their colleagues and those who returned to work because of fear of job loss were more likely to report perceived discrimination.

Conclusions

One in four BC survivors perceives discrimination in the workplace. Health and work-related factors are associated with increased likelihood of reporting perceived discrimination.

Trial registration number

NCT01993498.

A Multiple Case Study of Latina Breast Cancer Survivors Returning to Work With Breast Cancer-Related Lymphedema: Adaptation, Resilience, and Quality of Life

Introduction: Breast cancer-related lymphedema (BCRL), a side effect of cancer treatment, may negatively impact the ability to perform work. Factors such as delayed diagnosis, late-stage disease, and a high percentage of service occupations may challenge work choices for Latinas after BCRL diagnosis. Methods: Our multiple case study explored work experiences and quality of life (QOL) for Hispanic/Latina survivors. Participants completed demographic and short form-36 (SF-36) surveys. Semi-structured interviews focused on how work environment, self-management, and QOL were influenced by BCRL. Thematic analysis of cases used In Vivo and descriptive coding and constant cross-case comparative methods. Results: Analysis illustrated how Hispanic/Latina survivors perceive the influence of BCRL on work experience as requiring adaptation and personal resilience. Participants identified BCRL knowledge gap challenges and described coping with physical, psychosocial, and work activity changes. They described creative work adaptations and discussed BCRL's impact on both positive and negative interpersonal perceptions. Strong support from family, friends, and colleagues contributed to improved QOL and continued work activities. Conclusion: Future research should incorporate coping strategies and creative management of BCRL to optimize work activities across the lifespan. These strategies can provide guidance for the creation of survivorship care plans, education of healthcare professionals (HCPs), and lifelong occupational support.

Work ability among employees 2–10 years beyond breast cancer diagnosis: Late treatment effects and job resources - A longitudinal study

BACKGROUND: The number of workers who have previously undergone a cancer treatment is increasing, and possible late treatment effects (fatigue, physical and cognitive complaints) may affect work ability. OBJECTIVE: The aim of the study was to investigate the impact of late treatment effects and of job resources (autonomy, supportive leadership style, and colleagues’ social support) on the future work ability of employees living 2–10 years beyond a breast cancer diagnosis. METHODS: Data at T1 (baseline questionnaire) and at T2 (9 months later) were collected in 2018 and 2019 (N = 287) among Dutch-speaking workers with a breast cancer diagnosis 2–10 years ago. Longitudinal regression analyses, controlling for years since diagnosis, living with cancer (recurrence or metastasis), other chronic or severe diseases, and work ability at baseline were executed. RESULTS: Higher levels of fatigue and cognitive complaints at baseline predicted lower future work ability. The three job resources did not predict higher future work ability, but did relate cross-sectionally with higher work ability at baseline. Autonomy negatively moderated the association between physical complaints and future work ability. CONCLUSIONS: Fatigue and cognitive complaints among employees 2–10 years past breast cancer diagnosis need awareness and interventions to prevent lower future work ability. Among participants with average or high levels of physical complaints, there was no difference in future work ability between medium and high autonomy. However, future work ability was remarkably lower when autonomy was low.

Supporting the Return to Work of Breast Cancer Survivors: From a Theoretical to a Clinical Perspective

Promoting the return to work of breast cancer survivors is of major interest to patients, healthcare and occupational health professionals, companies, governments, and researchers worldwide. We previously conducted a French consensus study resulting in a model describing the multifactorial process of the return to work of breast cancer survivors (the REWORK-BC model). Other work has identified the transtheoretical model as a relevant theoretical framework for interventions to promote the return to work of cancer survivors. In this opinion paper, we provide a theoretically-based clinical framework describing how to support breast cancer survivors at each stage of the return-to-work process. This clinical framework considers several essential aspects of supportive care for breast cancer survivors returning to work, such as: (i) helping the patient actively self-manage, by considering her to be the main decision-maker; (ii) respecting and adapting to the patient’s choice of professional project; (iii) respecting the temporality of the patient’s choices; (iv) proposing tailored interventions; (v) implementing simple tools to promote the return to work, shared representation between the patient and a multidisciplinary team, and improvement of working conditions and the knowledge of health and occupational professionals, and managers or employers; and (vi) maintaining certain flexibility aimed at proposing, but never imposing, changes in practices. This clinical framework, specific to breast cancer survivors, could be extrapolated to other tumor types, offering a practical guide for healthcare and occupational health professionals to better understand the return-to-work process of cancer survivors. This clinical framework aims to be a usable tool for any hospital or cancer care center wishing to implement a patient-centered intervention that promotes returning to work, regardless of the country.

Return to work of Italian cancer survivors: A focus on prognostic work-related factors

BACKGROUND: Return to work (RTW) enhances the general well-being and social participation of cancer survivors (CSs). OBJECTIVE: To describe the predictive value of work-related factors on the RTW process of CSs. The work accommodations, the perceived workload, and the barriers and facilitations of RTW are also reported. METHODS: This population-based cross-sectional survey was conducted in the Province of Reggio Emilia from July 2016 to July 2017. CSs who were 20–59 years old, first diagnosed with cancer, and employed at diagnosis were recruited. RESULTS: The majority of CSs (140/266, 53%) returned to work without difficulties, 42% reported difficulties, and 5% did not RTW. CSs who were shift workers (sex and age-adjusted Relative Risk [adj-RR] 1.30; 95% CI 0.94 –1.78) and who worked at night (adj-RR 1.36 95% CI 0.99 –1.86), in the evening (adj-RR 1.23; 95% CI 0.95 –1.57) and on Sundays (adj-RR 1.15; 95% CI 0.81 –1.63) perceived more difficulties. Physically demanding work and a long commute seemed to negatively impact RTW. Accommodations in work tasks (37%) or schedule (26%) were implemented. Workload was not acceptable for 18% of CSs. The main barriers concerned energy and drive functions, whereas remunerative employment was the foremost facilitation. CONCLUSIONS: Healthcare professionals should address work-related factors that might influence RTW with personalized interventions of vocational rehabilitation.

The disclosure dilemma: requesting accommodations for chronic pain in job interviews

PURPOSE

This study explores the job interview process for those who need disability-related accommodations on the job (in particular an "invisible" disability such as many of the long-term and late effects of cancer and its treatment (e.g., pain, fatigue, cognitive problems)), and explores whether the communication channel or the timing of the disclosure has implications on the perceived employability of applicants, with the aim of helping to close the employment gap for this marginalized population.

METHODS

Using 1917 participants in a partially crossed 2 × 3 × 2 experimental design, we explored disclosing the need for accommodations using each video or audio-only channels, by varying the timing of the disclosure within the interview (early, late, or not at all), and by varying the negotiation strategy used (modest or significant increase over proposed salary). Participants rated the candidate's employability at two different points in time.

RESULTS

Early and late disclosures of the need for accommodations were both associated with poorer ratings of employability. Disclosure via audio was singularly damaging as compared to video disclosure, whether it occurred early or late. Finally, asking for a significant increase in salary resulted in lower ratings of employability, especially if the disclosure of the disability happened late in the process (and proximally to the salary request itself).

CONCLUSIONS

Holding off on the request for accommodations until after the job has been offered may be advisable. Similarly, disability disclosures and requests for accommodation are better received using richer communication channels (video as opposed to audio). Salary requests are also sensitive topics and can be affected by ill-timed disclosures.

IMPLICATIONS FOR CANCER SURVIVORS

If accommodations are needed on the job (based on chronic pain), waiting until later in the process to discuss this topic (using video and not the phone) and ensuring distance in time from making a salary request are apparently the better choices.

Job Accommodations, Return to Work and Job Retention of People with Physical Disabilities: A Systematic Review

Purpose We aimed to identify job accommodations that help persons with physical disabilities maintain or return to work and explore the barriers and facilitators that influence the provision and reception of job accommodations. Methods We conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The review was registered in PROSPERO (CRD42019129645). The search strategy incorporated keywords describing physical disabilities, employer-approved job accommodations, and employment retention or return to work approaches. We searched MEDLINE, the Cochrane Library, Embase, CINAHL, PsycINFO, Web of Science, and ProQuest Theses and dissertations. Reviewers independently selected studies for inclusion. We used Hawker et al.'s method to assess study quality. Results We identified 2203 articles, of which 52 met inclusion criteria, developed a table of job accommodations commonly used by persons with physical disabilities, summarized the percentages of job accommodations used by persons with disabilities, synthesized evidence of the effectiveness of job accommodations, and identified the factors that influence job accommodation use. The most frequently reported accommodations were as follows: modification of job responsibilities, change of workplace policy, supportive personnel provision, flexible scheduling, and assistive technology. We summarized four types of facilitators and barriers that affect job accommodation use: employee-related factors, accommodation-related factors, job-related factors, and social workplace-related factors. Conclusion The absence of randomized controlled trials and prevalence of cross-sectional surveys provides inconclusive evidence regarding the effectiveness of specific job accommodations for people with particular functional limitations. Our system of categorizing job accommodations provides a guide to investigators seeking to evaluate the effectiveness of job accommodations using experimental methods.

Survivorship, Version 1.2021

The NCCN Guidelines for Survivorship are intended to help healthcare professionals working with cancer survivors to ensure that each survivor's complex and varied needs are addressed. The Guidelines provide screening, evaluation, and treatment recommendations for consequences of adult-onset cancer and its treatment; recommendations to help promote healthful lifestyle behaviors, weight management, and immunizations in survivors; and a framework for care coordination. This article summarizes the recommendations regarding employment and return to work for cancer survivors that were added in the 2021 version of the NCCN Guidelines.

Return to work of breast cancer survivors: toward an integrative and transactional conceptual model

Purpose

To propose a conceptual framework of the return to work (RTW) of breast cancer survivors (BCS) according to the transactional perspective.

Methods

The Technique for Research of Information by Animation of a Group of Experts was implemented. For each determinant in an initial list established from the literature, experts selected for the consensus exercise were firstly asked to indicate their agreement level individually, via an online questionnaire. Determinants obtaining an agreement level of 80% or over during this first phase were retained. Determinants obtaining an agreement level below 80%, and additional determinants proposed by the experts, were then discussed collectively. After discussion, experts voted via a new online questionnaire to retain (or not) each determinant. Determinants obtaining an agreement level of 80% or over after this second phase were retained. Based on the determinants selected, a conceptual model was developed following the transactional approach.

Results

Eleven experts participated in the study. Forty of the 51 determinants listed initially from the literature achieved an agreement level over 80%, and 20 were added after the individual consultation phase. Twenty-two of the 31 determinants discussed collectively were retained. In total, 62 determinants were selected to construct the conceptual model.

Conclusions

This integrative, operational, and transactional conceptual model of the RTW of BCS, constructed following an expert consensus, will help to design more efficient patient-centered intervention studies.

Implications for Cancer Survivors

Identification of the 62 determinants associated with the RTW of BCS will help design tools that are easily used by all stakeholders involved in the RTW process.

Working after cancer: in-depth perspectives from a setting with limited employment protection policies

PURPOSE

A considerable proportion of individuals who are diagnosed with cancer are at a working age. We aimed to gain an in-depth understanding of the challenges, and arising needs related to working after cancer in a setting with limited employment protection policies.

METHODS

Focus group discussions were conducted with cancer patients who were diagnosed at least 1 year prior to recruitment, and either had paid work, were self-employed, currently unemployed, or currently retired (N = 66).

RESULTS

Three main themes were identified: (1) loss of income: While some participants were entitled for a 1-year cancer-specific sick leave, many other participants recounted having insufficient paid sick leave, forcing them to take prolonged unpaid leave to complete treatment; (2) dealing with side effects of cancer and its treatment: The need for workplace accommodations was highlighted including flexible working hours, lighter workloads, and dedicated rest areas to enable patients to cope better; (3) Discrimination and stigma at workplace: Some participants mentioned being passed over on a promotion, getting demoted, or being forced to resign once their cancer diagnosis was disclosed, highlighting an urgent need to destigmatize cancer in the workplace.

CONCLUSION

In settings with limited employment protection policies, a cancer diagnosis severely impacts the working experiences of patients, leading to financial loss. Urgent interventions and legislative reforms are needed in these settings to address the unmet employment needs of cancer survivors.

IMPLICATIONS FOR CANCER SURVIVORS

This study may facilitate planning of local solutions to fulfill the unmet employment needs following cancer, such as return-to-work navigation services.