To our knowledge, this is the first study that investigates jointly the risk of early dropping out of the labor market due to unemployment, partial retirement and permanent disability after a sickness absence episode due to a malignant neoplasm compared to other non-malignant diagnoses.
In our study the most women and men who had a SA due to malignant neoplasm continue working within the year after the episode. Our results are consistent with previous studies showing return to work rates between 25% and over 90% [4, 6, 7], according to cancer site, stage or type of treatment, the time after the end of treatment or symptoms related to the disease [17, 18].
Compared to other non-malignant pathologies, we did not find unemployment as a pathway to drop out the labor market after a malignant neoplasm. This result is inconsistent with prior findings showing cancer survivors to have 40% more risk to be unemployed. A prior study on breast cancer survivors, found duration of prior unemployment as the main determinant for future unemployment [11]. Nevertheless, most prior studies have used a healthy population as a reference group [4,5,6, 17] instead of a working population that were on sickness absence. On the other hand, our results suggest that women who had a malignant neoplasm are more likely to exit the labor market because of partial retirement and permanent disability that those with other pathologies. These results are in line with prior studies that have assessed the risk of dropping out comparing with healthy working populations [12,13,14, 19, 20]. Compared to other disabling diagnoses (e.g. musculoskeletal disorders), malignant neoplasms may result in health-related problems and functional (physical and mental) limitations, due to its severity and treatment, that might reduce considerably working ability making unfeasible to continue active in labor market.
Partial retirement could be considered as a workplace adjustment by reducing working hours. Previous studies showed that one in four of cancer survivors who continue in the labor market experience a deterioration of their physical and mental capacity to work and need to make work adjustments [21]. Reducing or adapting the work schedule are among the most common worksite adjustment strategies [21,22,23,24,25]. Reducing working hours and tailoring work tasks, their functional capacity and health status, could improve their own perception and expectations about their ability to perform at work, facilitating their continuity in the labor market [26].
One of the strongest predictors to return to work is workers’ own perception and expectations once back to work [4, 21, 27]. Factors related to work and employment conditions, work environment and social support from colleagues and supervisors also determine the return to work as it could modify the perception of their capacity to perform at work [4, 17, 21, 28], hampering the return to work process, or reducing their expectations to continue engaged in the labor market after a malignant neoplasm [26, 29]. Previous studies suggest that keeping contact with coworkers during treatment and maintaining a positive relationship with them could facilitate the continuity in the labor market [4, 26].
Our results must be interpreted with caution considering some limitations. It is possible that a year of follow-up after the first SA episode is insufficient to measure the long-term effect of the disease on continuing active into the labor market. In the case of unemployment, it is feasible to be a later option for those who returned to work after a SA episode, therefore we could be underestimating the risk. Previous studies show that of the total of cancer survivors who returned to work during the first year, 11% stop working for reasons related to the disease in the next 3 years [29]. This might be also the case for partial retirement and permanent disability. Eligibility for a benefit from a disability pension comprises a complex and long-lasting process, and requires a minimum time having paid into the social security system. Therefore, we might consider that workers with temporary contracts may not have accumulated enough time to qualify for those benefits and, in turn, they had no access to permanent disability pension. In addition, it is possible there were cases already enrolled into the permanent disability recognition process during the year of follow-up. In Spain, permanent disability pension allows to return to work, to a different occupation of the former one at the time of diagnosis, depending on the degree of disability. Therefore, it is possible that some workers had returned to work after the follow up period. Likewise, we had no available information about interventions potentially carried out in the workplace aimed to facilitate the return to work.
Finally, we had no information related to health status or aspects related to the disease, such as the stage, type of treatment, side effects or the most frequent complications that could reduce the work functioning or to fully incapacitate. However, we have included the duration of the SA episode as measure of prior health status as a proxy for the severity of the pathology. Nevertheless, our study population belongs to a large representative sample of the Spanish working population affiliated to the Social Security System, and covers a wide range of economic activities and occupations, which strengthen the external validity of the results. Moreover, data comes from reliable administrative records, which allows to avoid memory biases and reduces associated costs.
