Financial Status, Employment, and Insurance Among Older
Marie Norredam, MD1,2, Ellen Meara, PhD2, Mary Beth Landrum, PhD2, Haiden A. Huskamp, PhD2,
and Nancy L. Keating, MD, MPH2,3
1Department of Health Services Research, Institute of Public Health, University of Copenhagen, Denmark, Copenhagen C, Denmark;
2Department of Health Care Policy, Harvard Medical School, Boston, MA, USA;
Women’s Hospital, Boston, MA, USA.
3Division of General Internal Medicine, Brigham and
BACKGROUND: Few data are available about the
socioeconomic impact of cancer for long-term cancer
OBJECTIVES: To investigate socioeconomic outcomes
among older cancer survivors compared to non-ancer
DATA SOURCE: 2002 Health and Retirement Study.
STUDY DESIGN: We studied 964 cancer survivors of >
4 years and 14,333 control patients who had never had
cancer from a population-based sample of Americans
ages ≥ 55 years responding to the 2002 Health and
MEASURES: We compared household income, housing
assets, net worth, insurance, employment, and future
ANALYSES: Propensity score methods were used to
control for baseline differences between cancer survi-
vors and controls.
RESULTS: Female cancer survivors did not differ from
non-cancer patients in terms of income, housing assets,
net worth, or likelihood of current employment (all P>
0.20); but more were self-employed (25.0% vs. 17.7%;
P=0.03), and fewer were confident that if they lost their
job they would find an equally good job in the next few
months (38.4% vs. 45.9%; P=0.03). Among men, cancer
survivors and noncancer patients had similar income
and housing assets (both P≥0.10) but differed some-
what in net worth (P=0.04). Male cancer survivors were
less likely than other men to be currently employed
(25.2% vs. 29.7%) and more likely to be retired (66.9%
vs. 62.2%), although the P value did not reach statisti-
cal significance (P=0.06). Men were also less optimistic
about finding an equally good job in the next few
months if they lost their current job (33.5% vs.
46.9%), although this result was not significant (P=
CONCLUSIONS: Despite generally similar socioeconom-
ic outcomes for cancer survivors and noncancer
patients ages ≥55 years, a better understanding of
employment experience and pessimism regarding work
prospects may help to shape policies to benefit cancer
KEY WORDS: cancer survivors; employment; financial status;
J Gen Intern Med 24(Suppl 2):438–45
© Society of General Internal Medicine 2009
More than two-thirds of all newly diagnosed cancers occur in
individuals over 55 years of age1. Given a 5-year survival rate
for all cancers exceeding 65%2and a 50% chance of surviving
population of cancer survivors.
Although the physical and psychological consequences of
cancer survivorship are becoming better understood
data are available about the socioeconomic impact of cancer.
In a cohort of near elderly individuals, those who develop a new
major chronic condition suffered large reductions in labor
income and savings within 2 years of diagnosis
studies suggest that cancer survivors may have lower employ-
ment rates than others; however, these studies mostly exam-
ine recently diagnosed cancer survivors and focus on specific
and prostate cancer
term socioeconomic indicators5. Existing evidence that income
losses reduce quality of life among cancer survivors13raise the
question of how aging cancer survivors fare as they near or pass
We studied a population-based sample of older Americans
to compare socioeconomic outcomes for long-term survivors
(>4 years) of cancers of all types with that of a matched
cohort of individuals who were never diagnosed with cancer.
In addition to employment status, we also examined house-
hold income, assets, net worth, insurance, and future work
expectations. We hypothesized that a history of cancer and
its treatment may have a long-lasting negative effect on work
opportunities and future socioeconomic status. Because of
the growing numbers of cancer survivors, it becomes
increasingly important for general internists to understand
how cancer effects the life and opportunities of these
individuals, as negative effects on socioeconomic status can
also influence physical and psychological health.
3, older individuals comprise a large and growing
12. Few data are available about long-
leave the workforce for retirement and had less generous
prescription drug coverage. Among women, cancer survivors
and others were equally likely to be employed, but employed
women cancer survivors more often opted for self-employment.
Both men and women cancer survivors were less optimistic
than others about their future work. A better understanding of
cancer survivors’ labor market experience and pessimism
regarding work prospects would help to shape labor market
policies that might help cancer survivors and all individuals
with chronic conditions, to maintain work longer. Examples of
such policies might include antidiscrimination policies, poli-
cies limiting or prohibiting the exclusion of individuals with
pre-existing conditions, changes in the structure of health
insurance that might contain costs of employer sponsored
health insurance coverage, or policies to foster flexible work-
place conditions and access to resources such as employee
Conflict of Interest Statement: There is no conflict of interest.
Corresponding Author: Marie Norredam, MD, Department of
Health Services Research, Institute of Pubic Health, University of
Copenhagen, Denmark, Østre Farimagsgade 5, building 5, 1014,
Copenhagen C, Denmark (e-mail: email@example.com).
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Norredam et al.: Socioeconomic Impact of Cancer Survivorship