Paid Sick Leave Among Working Cancer Survivors and Its Associations With Use of Preventive Services in the United States

Authors: Zhiyuan Zheng PhD1, Stacey A. Fedewa PhD1, Farhad Islami MD, PhD1, Leticia Nogueira PhD, MPH1, Xuesong Han PhD1, Jingxuan Zhao MPH1, Weishan Song MS2, Ahmedin Jemal DVM, PhD1, and K. Robin Yabroff PhD, MBA1
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  • 1 Surveillance and Health Equity Science, American Cancer Society; and
  • | 2 Rollins School of Public Health, Emory University, Atlanta, Georgia.

Background: We sought to examine the lack of paid sick leave among working cancer survivors by sociodemographic/socioeconomic and employment characteristics and its association with preventive services use in the United States. Methods: Working cancer survivors (ages 18–64 years; n=7,995; weighted n=3.43 million) were identified using 2001–2018 National Health Interview Survey data. Adjusted prevalence of lack of paid sick leave by sociodemographic and socioeconomic characteristics, as well as job sector, working hours, and employer size, were generated using multivariable logistic regression models. Separate analyses examined the associations of lack of paid sick leave with use of various preventive services. Results: Of all working cancer survivors, 36.4% lacked paid sick leave (n=2,925; weighted n=1.25 million), especially those working in food/agriculture/construction/personal services occupations or industries (ranging from 54.9% to 88.5%). In adjusted analyses, working cancer survivors with lower household income (<200% of the federal poverty level, 48.7%), without a high school degree (43.3%), without health insurance coverage (70.6%), and who were self-employed (89.5%), were part-time workers (68.2%), or worked in small businesses (<50 employees, 48.8%) were most likely to lack paid sick leave. Lack of paid sick leave was associated with lower use of influenza vaccine (ages 18–39 years, 21.3% vs 33.3%; ages 40–49 years, 25.8% vs 38.3%; ages 50–64 years, 46.3% vs 52.4%; P<.001 for all), cholesterol screening (ages 18–39 years, 43.1% vs 62.5%; P<.05), and blood pressure check (ages 18–39 years, 43.1% vs 62.5%; P<.05) compared with survivors having paid sick leave. Conclusions: In the United States, more than one-third of all working cancer survivors and more than half of survivors working for small employers and in certain occupations/industries lack paid sick leave. Survivors with lower household income or educational attainment are particularly vulnerable. Moreover, lack of paid sick leave is associated with lower use of some recommended preventive services, suggesting that ensuring working cancer survivors have access to paid sick leave may be an important mechanism for reducing health disparities.

Submitted December 2, 2021; final revision received July 28, 2022; accepted for publication July 29, 2022.

Author contributions: Study concept and design: All authors. Statistical analysis: Zheng. Interpretation of results: All authors. Manuscript preparation: Zheng. Manuscript revision: All authors.

Disclosures: Z. Zheng, X. Han, and J. Zhao have disclosed receiving grant/research support from AstraZeneca, outside the scope of this study. Dr. Yabroff has disclosed serving as a member of the Flatiron Health Equity Advisory Board. All authors from the American Cancer Society (ACS) are employed by the ACS, which receives grants from private and corporate foundations, including foundations associated with companies in the health sector for research. W. Song has disclosed not receiving any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.

Correspondence: Zhiyuan Zheng, PhD, Surveillance and Health Equity Science, American Cancer Society, 250 Williams Street, Atlanta, GA 30303. Email: jason.zheng@cancer.org

Supplementary Materials

    • Supplemental Materials (PDF 512 KB)
  • 1.

    Miller KD, Nogueira L, Devasia T, et al. Cancer treatment and survivorship statistics, 2022. CA Cancer J Clin 2022;72:409436.

  • 2.

    de Boer AG, Taskila T, Ojajärvi A, et al. Cancer survivors and unemployment: a meta-analysis and meta-regression. JAMA 2009;301:753762.

  • 3.

    Yabroff KR, Lawrence WF, Clauser S, et al. Burden of illness in cancer survivors: findings from a population-based national sample. J Natl Cancer Inst 2004;96:13221330.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Earle CC, Chretien Y, Morris C, et al. Employment among survivors of lung cancer and colorectal cancer. J Clin Oncol 2010;28:17001705.

  • 5.

    Blinder VS, Gany FM. Impact of cancer on employment. J Clin Oncol 2020;38:302309.

  • 6.

    Sun W, Chen K, Terhaar A, et al. Work-related barriers, facilitators, and strategies of breast cancer survivors working during curative treatment. Work 2016;55:783795.

  • 7.

    Greidanus MA, de Boer AG, de Rijk AE, et al. Perceived employer- related barriers and facilitators for work participation of cancer survivors: a systematic review of employers’ and survivors’ perspectives. Psychooncology 2018;27:725733.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Banegas MP, Guy GP Jr, de Moor JS, et al. For working-age cancer survivors, medical debt and bankruptcy create financial hardships. Health Aff (Millwood) 2016;35:5461.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9.

    Zheng Z, Jemal A, Han X, et al. Medical financial hardship among cancer survivors in the United States. Cancer 2019;125:17371747.

  • 10.

    Miller S. High-value care, workplace flexibility aid employees with cancer. Accessed September 9, 2021. Available at: https://www.shrm.org/resourcesandtools/hr-topics/benefits/pages/high-value-care-and-workplace-flexibility-aid-employees-with-cancer.aspx

    • Search Google Scholar
    • Export Citation
  • 11.

    Northeast Business Group on Health. Cancer survivorship challenges and opportunities for employers. Accessed September 9, 2021. Available at: https://online.flippingbook.com/view/48119/

    • Search Google Scholar
    • Export Citation
  • 12.

    de Moor JS, Kent EE, McNeel TS, et al. Employment outcomes among cancer survivors in the United States: implications for cancer care delivery. J Natl Cancer Inst 2021;113:641644.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    US Department of Labor. Sick leave. Accessed April 20, 2020. Available at: https://www.dol.gov/general/topic/workhours/sickleave

  • 14.

    Raub A, Chung P, Batra P, et al. Paid leave for personal illness: a detailed look at approaches across OECD countries. Accessed October 4, 2021. Available at: https://www.worldpolicycenter.org/

    • Search Google Scholar
    • Export Citation
  • 15.

    US Department of Labor: Wage and Hour Division. Family and Medical Leave Act. Accessed April 20, 2020. Available at: https://www.dol.gov/agencies/whd/fmla

    • Search Google Scholar
    • Export Citation
  • 16.

    DeRigne L, Stoddard-Dare P, Collins C, et al. Paid sick leave and preventive health care service use among U.S. working adults. Prev Med 2017;99:5862.

  • 17.

    Peipins LA, Soman A, Berkowitz Z, et al. The lack of paid sick leave as a barrier to cancer screening and medical care-seeking: results from the National Health Interview Survey. BMC Public Health 2012;12:520.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Lamsal R, Napit K, Rosen AB, et al. Paid sick leave and healthcare utilization in adults: a systematic review and meta-analysis. Am J Prev Med 2021;60:856865.

  • 19.

    US Bureau of Labor Statistics. The economics daily: 94 percent of managers, 56 percent of construction and extraction workers had paid sick leave, 2019. Accessed April 20, 2022. Available at: https://www.bls.gov/opub/ted/2020/94-percent-of-managers-56-percent-of-construction-and-extraction-workers-had-paid-sick-leave.htm

    • Search Google Scholar
    • Export Citation
  • 20.

    US Bureau of Labor Statistics. Employee benefits survey: paid sick leave: what is available to workers? Accessed September 9, 2021. Available at: https://www.bls.gov/ncs/ebs/factsheet/paid-sick-leave.htm#ref1

    • Search Google Scholar
    • Export Citation
  • 21.

    Indeed Editorial Team. Career change report: an inside look at why workers shift gears. Accessed April 20, 2022. Available at: https://www.indeed.com/lead/career-change

    • Search Google Scholar
    • Export Citation
  • 22.

    Ramsey SD, Bansal A, Fedorenko CR, et al. Financial insolvency as a risk factor for early mortality among patients with cancer. J Clin Oncol 2016;34:980986.

  • 23.

    Ramsey SD, Blough D, Kirchhoff A, et al. Washington state cancer patients found to be at greater risk for bankruptcy than people without a cancer diagnosis. Health Aff (Millwood) 2013;32:11431152.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 24.

    Zheng Z, Jemal A, Tucker-Seeley R, et al. Worry about daily financial needs and food insecurity among cancer survivors in the United States. J Natl Compr Canc Netw 2020;18:315327.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Centers for Disease Control and Prevention, National Center for Health Statistics. NHIS data, questionnaires and related documentation. Accessed April 20, 2020. Available at: https://www.cdc.gov/nchs/nhis/data-questionnaires-documentation.htm

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Driscoll AK, Bernstein AB. Health and access to care among employed and unemployed adults: United States, 2009-2010. NCHS Data Brief 2012;83:18.

    • Search Google Scholar
    • Export Citation
  • 27.

    Park S, Pan L, Lankford T. Relationship between employment characteristics and obesity among employed U.S. adults. Am J Health Promot 2014;28:389396.

  • 28.

    US Bureau of Labor Statistics. May 2018. Accessed September 27, 2021. Available at: https://www.bls.gov/oes/tables.htm

  • 29.

    Han X, Zhao J, Zheng Z, et al. Medical financial hardship intensity and financial sacrifice associated with cancer in the United States. Cancer Epidemiol Biomarkers Prev 2020;29:308317.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Zheng Z, Han X, Zhao J, et al. Financial hardship, healthcare utilization, and health among U.S. cancer survivors. Am J Prev Med 2020;59:6878.

  • 31.

    Heymann J, Sprague A. Why adopting a national paid sick leave law is critical to health and to reducing racial and socioeconomic disparities—long past due. JAMA Health Forum 2021;2:e210514.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32.

    Chen SC, Pearson SD. Policy framework for covering preventive services without cost sharing: saving lives and saving money? JAMA Intern Med 2016;176:11851189.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33.

    DeRigne LA, Stoddard-Dare P, Quinn L. Workers without paid sick leave less likely to take time off for illness or injury compared to those with paid sick leave. Health Aff 2016;35:520527.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 34.

    Dyal JW, Grant MP, Broadwater K, et al. COVID-19 among workers in meat and poultry processing facilities — 19 states, April 2020. MMWR Morb Mortal Wkly Rep 2020;69:557561.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 35.

    American Cancer Society. Why people with cancer are more likely to get infections. Accessed September 12, 2021. Available at: https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/low-blood-counts/infections/why-people-with-cancer-are-at-risk.html

    • Search Google Scholar
    • Export Citation
  • 36.

    Jiang C, Yabroff KR, Deng L, et al. Prevalence of underlying medical conditions associated with severe COVID-19 illness in adult cancer survivors in the United States. J Natl Cancer Inst 2022;114:156159.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37.

    US Department of Labor, Wage and Hour Division. Families First Coronavirus Response Act: employer paid leave requirements. Accessed September 12, 2021. Available at: https://www.dol.gov/agencies/whd/pandemic/ffcra-employer-paid-leave

    • Search Google Scholar
    • Export Citation
  • 38.

    The White House. FACT SHEET: President Biden to call on all employers to provide paid time off for employees to get vaccinated after meeting goal of 200 million shots in the first 100 days. Accessed September 27, 2021. Available at: https://www.whitehouse.gov/briefing-room/statements-releases/2021/04/21/

    • Search Google Scholar
    • Export Citation
  • 39.

    Findlay S. Biden and Democrats propose national paid leave. Accessed October 4, 2021. Available at: https://www.healthaffairs.org/do/10.1377/forefront.20210617.789833/full/

    • Search Google Scholar
    • Export Citation
  • 40.

    Internal Revenue Service. COVID-19-related tax credits for paid leave provided by small and midsize businesses FAQs. Accessed October 4, 2021. Available at: https://www.irs.gov/newsroom/covid-19-related-tax-credits-for-paid-leave-provided-by-small-and-midsize-businesses-faqs

    • Search Google Scholar
    • Export Citation
  • 41.

    The White House. American Rescue Plan. Accessed October 4, 2021. Available at: https://www.whitehouse.gov/american-rescue-plan/

  • 42.

    Ko H, Glied SA. Associations between a New York City paid sick leave mandate and health care utilization among Medicaid beneficiaries in New York City and New York state. JAMA Health Forum 2021;2:e210342.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 43.

    Society for Human Resource Management. State by state: paid sick leave. Accessed September 12, 2021. Available at: https://www.shrm.org/resourcesandtools/legal-and-compliance/employment-law/pages/state-local-paid-sick-leave-chart.aspx

    • Search Google Scholar
    • Export Citation
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