Lack of Paid Sick Leave Places Huge Financial Burden on Patients With Cancer

A survey of more than 1300 patients with stage 3 colorectal cancer found that only 55% who were employed at the time of diagnosis retained their jobs after cancer treatment. Patients who had paid sick leave were nearly twice as likely to retain their jobs as patients without paid sick leave, the survey results showed.

Christine Veenstra, MD, MSHP, clinical lecturer in internal medicine at the University of Michigan Medical School, and colleagues published the findings in a Research Letter in the Journal of the American Medical Association.

“Paid sick leave could reduce the need to take unpaid time off during treatment,” Dr Veenstra and colleagues wrote. “However, 40% of US workers have no paid sick leave. Its provision is not mandated under the Affordable Care Act or the Family Medical Leave Act, nor is it part of health insurance coverage.”

There were 567 survey respondents who were employed at the time of their cancer diagnosis. Fifty-eight percent were men; 68% were white; 28% had less than a high school education; 35% reported annual household income of less than $50,000; and 56% had access to paid sick leave.

Dr Veenstra explained that financial burden occurs in many different ways. Costs such as how much patients pay for prescriptions or doctor visits can be measured, she said, but there are also unmeasured costs of cancer care: Did the patient take unpaid time off from work and lose pay? Where they unable to return to work after cancer treatment?

Dr Veenstra’s group found that patients without paid sick leave were more likely to report higher personal financial burden, such as borrowing money, difficulties making credit card payments, reduced spending for food or clothing, or reduced recreational spending.

“Lack of paid sick leave may be a proxy for low-wage jobs or low socioeconomic status,” the authors wrote. “However, our data show that the association with paid sick leave was robust to education, income, and health insurance.”

After adjusting for factors such as income, education, and health insurance, 59% of patients with paid sick leave retained their jobs, whereas only 33% of those without paid sick leave did.

“Paid sick leave allows patients to take needed sick time off to get cancer treatment but still keep getting a paycheck,” Dr Veenstra pointed out. Approximately 40% of American workers do not have paid sick leave.

The study was funded by the American Cancer Society.