Age-related differences in employment, insurance, and financial hardship among colorectal cancer patients: a report from the ColoCare Study

Purpose: Employmentand financial hardships are common issues for working-age colorectal cancer patients. We surveyed colorectal cancer survivors to investigate employment, insurance, and financial outcomes by age at diagnosis. Methods: Cross-sectional survey of six ColoCare Study sites regarding employment, insurance, and financial hardship outcomes. Eligible participants were 1 to 5 years from colorectal cancer diagnosis. Diagnosis age (18–49, 50–64, 65+ years) with outcomes of interest were compared using chi-square and t-tests. Multivariable logistic and Poisson regressions were fit to examine association of demographic factors with any material/psychological hardship (yes/no) and the count of hardships. Results: N = 202 participants completed the survey (age: 18–49 (n = 42, 20.8%), 50–64 (n = 79, 39.1%), 65+ (n = 81, 40.1%)). Most diagnosed age < 65 worked at diagnosis (18–49: 83%; 50–64: 64%; 65+ : 14%, p < 0.001) and continued working after diagnosis (18–49: 76%; 50–64: 59%; 65+ : 13%; p < 0.001). Participants age 18–49 reported cancer-related difficulties with mental (81.3%) and physical (89%) tasks at work more than those working in the older age groups (45%-61%). In regression models, among those reporting any hardship, the rates of material and psychological hardships were higher among those age 18–64 (Incidence Rate Ratios (IRR) range 1.5–2.3 vs. age 65+) and for those with < college (IRR range 1.3–1.6 vs. college +). Conclusions: Younger colorectal cancer patients are more likely to work after a cancer diagnosis and during cancer treatment, but report higher levels of financial hardship than older patients. Implications for Cancer Survivors: Younger colorectal cancer patients may encounter financial hardship, thus may feel a need to work during and after treatment.