October 29, 2019 / 7:39 PM / 2 months ago

Breast cancer takes heavier financial toll on black and rural women

(Reuters Health) - Black women and women in rural areas are more likely to lose their jobs or face pay cuts after being diagnosed with breast cancer than white or urban women, a new study suggests.

The study authors surveyed more than 2,000 women in North Carolina who’d been diagnosed with breast cancer about two years earlier. The women, nearly half of whom were black, answered questions such as ‘did you lose your job due to your diagnosis?’ and ‘has there been a decrease in your family income since your diagnosis?’

Job loss rates following breast cancer diagnosis were similar for rural and urban women.

But 43.6% of women in rural areas reported a loss of income that they linked to their diagnosis, compared to 35.4% of urban women, the researchers found.

Just over 38% of the women reported employment changes after being diagnosed with breast cancer. But that was the case for 37.1% of urban women, compared to 45.6% of rural women.

Urban white women were least likely to see their jobs affected by their diagnosis, compared to rural white women and black women in either rural or urban areas.

Coauthor Jennifer Spencer of the University of North Carolina noted that breast cancer treatment is often tiring and time-consuming.

“Chemotherapy and radiation, we know, make women feel tired and sick (and) surgery may require you to be out of work for some time,” she said in a phone call. “Not everyone has a full-time job with benefits and sick time.”

Spencer said the study took into account socio-economic factors like whether the women had health insurance, their income levels and what sort of jobs they worked.

Differences in those factors explained the disparities between urban and rural women, “but we still see a significant difference in urban black women compared to urban white women which suggests that something else is going on, “ she said.

Spencer speculates this discrepancy could be due to a difference in assets held by black and white women.

“If you have savings, which is different than income, you may be more able to cope with something major like cancer,” she said. “And we know, for example, that white women may be more likely to have family support or family assets that they can tap into.”

Jay Kaufman, an epidemiologist at McGill University in Montreal, who was not involved in the study, wasn’t surprised that black or rural women were hit hardest.

“These women in general face more precarious forms of labor, fewer employment options, less flexible working hours, greater barriers in access to care,” he said.

Spencer’s study, published in the Journal of the National Cancer Institute, used information from the Carolina Breast Study, a well-known data resource that surveyed thousands of women with breast cancer from 2008 to 2013. The fact that it did not examine responses from people of other races, besides black or white, and that it was conducted in a single state, North Carolina, caps the extent to which its findings can be generalized.

Even so, said Robin Yabroff of the American Cancer Society, it adds to a growing body of literature that raises questions about the impact of employer benefits - such as type of health insurance offered, paid and unpaid sick leave and workplace accommodations - on patient well-being.

“(A) better understanding of the role of employer benefits on health outcomes can inform workplace policies,” she said.

Kaufman sees potential for the data to inform more than just office benefits.

“Policies on paid sick leave are set by state and local governments,” he said. “Bankruptcies and debt due to illness are common in the United States, but rare in other developed economies. This is a problem that can be dealt with by improving medical insurance and labor laws to offer the same kinds of reasonable protections that exist throughout the developed world.”

SOURCE: bit.ly/2No4MWU Journal of the National Cancer Institute, online October 10, 2019.

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