Workforce participation in relation to cancer diagnosis, type and stage: Australian population-based study of 163,556 middle-aged people

Purpose: To quantify the relationship of cancer diagnosis to workforce participation in Australia, according to cancer type, clinical features and personal characteristics. Methods: Questionnaire data (2006–2009) from participants aged 45–64 years (n=163,556) from the population-based 45 and Up Study (n=267,153) in New South Wales, Australia, were linked to cancer registrations to ascertain cancer diagnoses up to enrolment. Modified Poisson regression estimated age- and sex-adjusted prevalence ratios (PRs) for non-participation in the paid workforce—in participants with cancer (n=8,333) versus without (n=155,223), for 13 cancer types. Results: Overall, 42% of cancer survivors and 29% of people without cancer were out of the workforce (PR=1.18; 95%CI=1.15–1.21). Workforce non-participation varied substantively by cancer type, being greatest for multiple myeloma (1.83; 1.53–2.18), oesophageal (1.70; 1.13–2.58) and lung cancer (1.68; 1.45–1.93) and moderate for colorectal (1.23; 1.15–1.33), breast (1.11; 1.06–1.16) and prostate cancer (1.06; 0.99–1.13). Long-term survivors, 5 or more years post-diagnosis, had 12% (7–16%) greater non-participation than people without cancer, and non-participation was greater with recent diagnosis, treatment or advanced stage. Physical disability contributed substantively to reduced workforce participation, regardless of cancer diagnosis. Conclusions: Cancer survivors aged 45–64 continue to participate in the workforce. However, participation is lower than in people without cancer, varying by cancer type, and is reduced particularly around the time of diagnosis and treatment and with advanced disease. Implications for Cancer Survivors: While many cancer survivors continue with paid work, participation is reduced. Workforce retention support should be tailored to survivor preferences, cancer type and cancer journey stage.