Cancer, comorbidity and workplace discrimination: The US experience

The role of financial security in loneliness or sadness among Medicare-enrolled cancer survivors during the COVID-19 pandemic

INTRODUCTION

This study aims to estimate the relative decreased rate of financial security and increased rate of loneliness or sadness during the COVID-19 pandemic and investigate the association between financial security and loneliness or sadness among Medicare beneficiaries with a cancer history.

MATERIAL AND METHODS

We examined population-based, cross-sectional data from the Medicare Current Beneficiary Survey COVID-19 Winter 2021 survey. The study cohort included 1,632 Medicare beneficiaries (aged ≥65 years) with self-reported cancer history. The outcome was feelings of loneliness or sadness, and the independent variable was financial security during the 2020-2021 winter surge of COVID-19. We conducted weighted descriptive statistics, a cross-tabulation analysis, and multivariable logistic regression analyses.

RESULTS

Overall, 18.8% of cancer survivors reported increased feelings of loneliness or sadness and 11.2% reported decreased financial security during the 2020-2021 winter surge of COVID-19. Cancer survivors who reported decreased financial security had 93% higher odds of increased feelings of loneliness or sadness compared to those who reported feeling more or about the same financial security (Adjusted odds ratio [AOR] = 1.93; 95% Confidence Interval [CI] 1.25-3.01; p <0.004).

DISCUSSION

Decreased financial security and increased feelings of loneliness or sadness were prevalent among cancer survivors. Additional screenings and interventions beyond what are currently available are needed to ease the socioeconomic vulnerabilities experienced by cancer survivors.

Evaluation of Usability and Satisfaction of Two Online Tools to Guide Return to Work for Cancer Survivors on the Cancer and Work Website

Prompt services and work-focused support systems are needed to aid cancer survivors returning to work or finding work. Purpose This knowledge translation and implementation project focused on the knowledge users' experience and need for refinement of three work-focused tools to support return to work and maintain work following cancer through their participation in a hands-on workshop. The tools assessed for their utility are a Job Analysis Tool (JAT), a Return to Work (RTW) tool, and a bilingual Canadian website on Cancer and Work. Methods Four workshops took place in three Canadian cities. Participants included cancer survivors, healthcare professionals, and employer representatives. Following an overview of the website and tools, workshop participants (N = 28) completed qualitative and quantitative satisfaction and usability questionnaires using the System Usability Scale and open-ended questions. Qualitative data was analyzed using content analyses from the think-aloud data and from the four open-ended questions collected during the users' use of the tools and website. Results Overall, most study participants reported high satisfaction with the JAT and RTW tools, the Cancer and work website and the workshop. Good usability scores were reported for the RTW planner (73.65 ± 12.61) and the website (74.83 ± 12.36), and only acceptable usability scores for the JAT (68.53 ± 11.90). Conclusion Overall, the study documented the value of the tools and the website to support the RTW process as assessed by several key knowledge user groups. The JAT is considered a helpful procedure to identify job demands in order to guide job accommodations. Given participants' responses that the tool is useful, the next steps are to implement the recommendations for improvement and knowledge dissemination to increase its uptake and the use of job analysis overall.

Diversity and inclusion in the legal profession: disclosure of cancer and other health conditions by lawyers with disabilities and lawyers who identify as LGBTQ +

PURPOSE

Given the training and experience of lawyers, we assumed that a study of lawyers' willingness to disclose disability in the workplace would provide an example of the actions of a group knowledgeable about disability law. The current study accounts for the effect of visibility of disability, onset and type of disability, and whether the lawyer has made an accommodation request. We also investigate the role of other individual characteristics, such as sexual orientation, gender identity, race/ethnicity, age, and job-related characteristics, in willingness to disclose.

METHODS

We use data from the first phase of a longitudinal national survey of lawyers in the USA to estimate the odds of disclosing disability to co-workers, management, and clients using proportional odds models.

RESULTS

Lawyers with less visible disabilities, those with mental health disabilities, and those who work for smaller organizations have lower odds of disclosing to co-workers, management, and clients as compared to their counterparts. Attorneys who have requested accommodations are more willing to disclose as compared to those who have not, but only to co-workers and management. Women are less likely than men to disclose to management and clients. However, gender is not a significant determinant of disclosure to co-workers. Older attorneys are more likely to disclose to clients, whereas attorneys with children are less likely to disclose to co-workers. Lastly, lower perceived prejudice and the presence of co-workers with disabilities are associated with higher disclosure scores, but not for all groups.

CONCLUSIONS

Individuals who acquired a disability at a relatively early point in life and those with more visible disabilities are more likely to disclose. However, such willingness is affected by the intersection of disability with other individual and firm-level characteristics.

IMPLICATIONS FOR CANCER SURVIVORS

The findings imply that those with less visible disabilities and with health conditions acquired later in life are less likely to disclose. The relevance of the findings is heightened by the altered work conditions and demands imposed by the COVID-19 pandemic for cancer survivors.

Everyday Lives of Middle-Aged Persons with Multimorbidity: A Mixed Methods Systematic Review

The healthcare burden of patients with multimorbidity may negatively affect their family lives, leisure time and professional activities. This mixed methods systematic review synthesizes studies to assess how multimorbidity affects the everyday lives of middle-aged persons, and identifies skills and resources that may help them overcome that burden. Two independent reviewers screened title/abstracts/full texts in seven databases, extracted data and used the Mixed Methods Appraisal Tool (MMAT) to assess risk of bias (RoB). We synthesized findings from 44 studies (49,519 patients) narratively and, where possible, quantitatively. Over half the studies provided insufficient information to assess representativeness or response bias. Two studies assessed global functioning, 15 examined physical functioning, 18 psychosocial functioning and 28 work functioning. Nineteen studies explored skills and resources that help people cope with multimorbidity. Middle-aged persons with multimorbidity have greater impairment in global, physical and psychosocial functioning, as well as lower employment rates and work productivity, than those without. Certain skills and resources help them cope with their everyday lives. To provide holistic and dynamic health care plans that meet the needs of middle-aged persons, health professionals need greater understanding of the experience of coping with multimorbidity and the associated healthcare burden.

The Impact of Socioeconomic Determinants on the Quality of Life of Moroccan Breast Cancer Survivors Diagnosed Two Years Earlier at the National Institute of Oncology in Rabat

Introduction

The objective of this study was to investigate the impact of socioeconomic determinants on the quality of life of Moroccan women with breast cancer two years after their diagnosis who are followed up at the National Institute of Oncology (INO) in Rabat.

Methods

This is a cross-sectional study that was conducted between May 2019 and September 2020. The sample size was 304 women. Data were collected using the EORTC QLQ-C30 and EORTC QLQ-BR 23 questionnaires in the Moroccan dialect.

Results

The mean age of participants was 53.5 ± 12.4 years, where the majority resided in urban areas and more than half were illiterate. Moreover, three-quarters of the survivors were not working, and almost all have basic medical coverage. Nearly one-third of the respondents had experienced discrimination from those around them, and nearly half attributed the decrease in income to their state of health. In addition, 38.2 percent of participants stated that they had great difficulty living on their monthly income after the illness, whereas more than half of the survivors had a good quality of life in terms of overall health (GHS/QOL). Besides, social function obtained the highest score, while emotional function obtained the lowest score. Furthermore, financial difficulty was the most distressing symptom. Indeed, income adjustment after the disease, discrimination, distance between home and treatment center, professional status, and medical coverage were correlated with GHS/QOL. Regression analysis revealed that income adjustment after illness and discrimination were significant predictors of GHS/QOL.

Conclusion

The data suggest establishing a financial support program and the development of education and awareness-raising policies to combat discrimination.

The Workplace Discrimination Experiences of Individuals with Cancer in the Americans with Disabilities Act Amendments Act Era

Background The purpose of this study was to investigate the patterns in allegations of workplace discrimination filed by individuals with cancer. Objective The goal of the research was to describe discrimination, both actual and perceived, that has occurred against individuals with cancer in comparison to a group of individuals with other general disabilities (GENDIS) through analyses of the United States Equal Employment Opportunity Commission (EEOC) Integrated Mission System (IMS) database. Methods An ex post facto, causal comparative quantitative design was used to examine Americans with Disabilities Act Amendments Act (ADAAA) Title I complaints received by the EEOC from people with cancer from 2009 through 2016 (n = 10,848) in comparison to the GENDIS group over the same time period (n = 13,338). Results Results revealed statistically significant differences in the patterns of issues alleged by the two groups. When compared to the GENDIS group, the cancer group was significantly older and had proportionally more individuals who identified as Asian than the GENDIS group. People with cancer were more likely to allege discrimination in the areas of unlawful discharge, demotion, wages, layoff, benefits, and referrals. They were less likely to allege discrimination in areas of reasonable accommodation, hiring, and suspension. Also, the cancer group was more likely than the GENDIS group to file allegations against smaller employers and employers in the Southeast region of the United States, while employers in the Mid-Atlantic and Rocky Mountain regions were less likely to be named in allegations by people with cancer. The cancer group was also significantly more likely than the GENDIS group to find that EEOC investigations of their allegations resulted in merit-based case resolution, that is, discrimination had indeed occurred. Owing to the large sample size, some of these between-group differences were small in magnitude. Conclusion The workplace discrimination experiences of people with cancer are substantially different from those of people with other disabilities.

Food insecurity among adult cancer survivors in the United States

PURPOSE

The purpose of this study was to examine the prevalence of food insecurity among US adults with a history of a cancer diagnosis and to understand if socio-demographic factors and cancer characteristics (i.e., time since diagnosis, cancer type) relate to food insecurity.

METHODS

This was a secondary analysis of cancer survivors drawn from the National Health and Nutrition Examination Surveys (NHANES) 2011-2014. Weighted analyses included descriptive, bivariate, and multinomial logistic regression.

RESULTS

Of the cancer survivors identified in the sample (n = 1,022), 8.36% were food insecure. In bivariate analysis, several factors were significantly associated with food insecurity among cancer survivors, including female gender, younger age, non-Hispanic black or Hispanic race/ethnicity, lower income, no insurance coverage, lower education, single relationship status, having children at home, having poor health or diet, and cancer characteristics (i.e., non-melanoma skin cancer, female reproductive cancer). In logistic regression analyses, odds of food insecurity decreased with older age and higher income and increased with poor health, although cancer type was no longer significant.

CONCLUSIONS

Though a low proportion of cancer survivors indicated being food insecure, food insecurity was evident, and this study identified socio-demographic factors related to food insecurity which may be important to consider in clinical and community health settings serving cancer survivors.

IMPLICATIONS FOR CANCER SURVIVORS

Nutrition is essential throughout the cancer care trajectory, including survivorship. Clinicians should consider processes for screening patients, especially younger and lower income patients, for food insecurity through all stages of treatment and particularly as part of survivorship planning. Furthermore, availability and referral to community partners for nutrition and food support is essential.