{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T16:38:32Z","timestamp":1791909512807,"version":"4.3.4"},"reference-count":104,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2024,4,23]],"date-time":"2024-04-23T00:00:00Z","timestamp":1713830400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["acsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["CA A Cancer J Clinicians"],"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>The rising costs of cancer care and subsequent medical financial hardship for cancer survivors and families are well documented in the United States. Less attention has been paid to employment disruptions and loss of household income after a cancer diagnosis and during treatment, potentially\u00a0resulting in lasting financial hardship, particularly for working\u2010age adults not yet age\u2010eligible for Medicare coverage and their families. In this article, the authors use a composite patient case to illustrate the adverse consequences of cancer diagnosis and treatment for employment, health insurance coverage, household income, and other aspects of financial hardship. They summarize existing research and provide nationally representative estimates of multiple aspects of financial hardship and health insurance coverage, benefit design, and employee benefits, such as paid sick leave, among working\u2010age adults with a history of cancer and compare them with estimates among working\u2010age adults without a history of cancer from the most recently available years of the National Health Interview Survey (2019\u20132021). Then, the authors identify opportunities for addressing employment and health insurance coverage challenges at multiple levels, including federal, state, and local policies; employers; cancer care delivery organizations; and nonprofit organizations. These efforts, when informed by research to identify best practices, can potentially help mitigate the financial hardship associated with cancer.<\/jats:p>","DOI":"10.3322\/caac.21837","type":"journal-article","created":{"date-parts":[[2024,4,23]],"date-time":"2024-04-23T11:00:25Z","timestamp":1713870025000},"page":"341-358","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["Cancer diagnosis and treatment in working\u2010age adults: Implications for employment, health insurance coverage, and\u00a0financial hardship in the United States"],"prefix":"10.3322","volume":"74","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0644-5572","authenticated-orcid":false,"given":"K. Robin","family":"Yabroff","sequence":"first","affiliation":[{"name":"Surveillance and Health Equity Science Department American Cancer Society  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanna F.","family":"Doran","sequence":"additional","affiliation":[{"name":"Triage Cancer  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2733-2000","authenticated-orcid":false,"given":"Jingxuan","family":"Zhao","sequence":"additional","affiliation":[{"name":"Surveillance and Health Equity Science Department American Cancer Society  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0498-488X","authenticated-orcid":false,"given":"Fumiko","family":"Chino","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Memorial Sloan Kettering Cancer Center  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7290-3864","authenticated-orcid":false,"given":"Ya\u2010Chen Tina","family":"Shih","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of California\u2010Los Angeles Jonsson Comprehensive Cancer Center School of Medicine  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuesong","family":"Han","sequence":"additional","affiliation":[{"name":"Surveillance and Health Equity Science Department American Cancer Society  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7665-3564","authenticated-orcid":false,"given":"Zhiyuan","family":"Zheng","sequence":"additional","affiliation":[{"name":"Surveillance and Health Equity Science Department American Cancer Society  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9429-6567","authenticated-orcid":false,"given":"Cathy J.","family":"Bradley","sequence":"additional","affiliation":[{"name":"University of Colorado Comprehensive Cancer Center and Colorado School of Public Health  Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-7183-4467","authenticated-orcid":false,"given":"Monica F.","family":"Bryant","sequence":"additional","affiliation":[{"name":"Triage Cancer  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,4,23]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1200\/jco.2017.72.3742"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1200\/jco.2014.58.2320"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djac141"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/oncolo\/oyad179"},{"issue":"2","key":"e_1_2_11_6_1","first-page":"80","article-title":"Financial toxicity, part I: a new name for a growing problem","volume":"27","author":"Zafar SY","year":"2013","journal-title":"Oncology (Williston Park)"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1158\/1055\u20109965.epi\u201019\u20100460"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1158\/1055\u20109965.epi\u201018\u20100617"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1200\/jco.2015.62.0468"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.31913"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21730"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.6004\/jnccn.2019.7359"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djac134"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2022.0143"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djac173"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1200\/jop.19.00736"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1200\/jco.2015.63.2232"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1200\/jop.2014.001542"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1200\/jco.2015.64.6620"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djac044"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1200\/op.22.00276"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1200\/jco.19.01856"},{"key":"e_1_2_11_23_1","unstructured":"National Cancer Institute; Surveillance Epidemiology and End Results Program.Cancer Stat Facts: Cancer of Any Site. Percent of New Cases by Age Groupe. Accessed October 23 2023.https:\/\/seercancer.gov\/statfacts\/html\/all.html"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21731"},{"key":"e_1_2_11_25_1","unstructured":"Henry J. Kaiser Family Foundation.Medicaid Income Eligibility Limits for Adults as a Percent of the Federal Poverty Level. Accessed March 30 2024.https:\/\/www.kff.org\/affordable\u2010care\u2010act\/state\u2010indicator\/medicaid\u2010income\u2010eligibility\u2010limits\u2010for\u2010adults\u2010as\u2010a\u2010percent\u2010of\u2010the\u2010federal\u2010poverty\u2010level\/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22 %22sort%22:%22asc%22%7D"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2020.0742"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhealeco.2013.06.008"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21708"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.6004\/jnccn.2022.7058"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606\u2010019\u201005002\u2010w"},{"key":"e_1_2_11_31_1","volume-title":"High\u2010Deductible Health Plan Enrollment Among Adults Aged 18\u201364 With Employment\u2010Based Insurance Coverage","author":"Cohen RA","year":"2018"},{"key":"e_1_2_11_32_1","volume-title":"Average Annual Deductible per Enrolled Employee in Employer\u2010Based Health Insurance for Single and Family Coverage","author":"Kaiser Family Foundation","year":"2022"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.11014"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.1200\/JOP.18.00699"},{"key":"e_1_2_11_35_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2017.75.2501"},{"key":"e_1_2_11_36_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2013.52.9123"},{"key":"e_1_2_11_37_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.30560"},{"key":"e_1_2_11_38_1","volume-title":"Report on the Economic Well\u2010Being of U.S. Households in 2018","year":"2019"},{"key":"e_1_2_11_39_1","volume-title":"60% of Americans Now Living Paycheck to Paycheck, Down from 64% a Month Ago [press release]","author":"LendingClub","year":"2023"},{"key":"e_1_2_11_40_1","doi-asserted-by":"publisher","DOI":"10.1093\/djaa084"},{"key":"e_1_2_11_41_1","doi-asserted-by":"publisher","DOI":"10.1158\/2767\u20109764.CRC\u201023\u20100157"},{"key":"e_1_2_11_42_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2004.00.4929"},{"key":"e_1_2_11_43_1","doi-asserted-by":"publisher","DOI":"10.1177\/0019793915586974"},{"key":"e_1_2_11_44_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2013.49.1241"},{"key":"e_1_2_11_45_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djk001"},{"key":"e_1_2_11_46_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0000000000000151"},{"key":"e_1_2_11_47_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djab192"},{"key":"e_1_2_11_48_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.38182"},{"key":"e_1_2_11_49_1","doi-asserted-by":"publisher","DOI":"10.1111\/1475\u20106773.13861"},{"key":"e_1_2_11_50_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.21.02810"},{"key":"e_1_2_11_51_1","unstructured":"Triage Cancer.Quick Guide to State Paid Family Leave Programs. Accessed October 23 2023.https:\/\/triagecancer.org\/quick\u2010guides\/state\u2010paid\u2010family\u2010leave"},{"key":"e_1_2_11_52_1","unstructured":"California Code Government Code\u2014\u00a712945.2 et seq. (California Family Rights Act of 1993)."},{"key":"e_1_2_11_53_1","unstructured":"Triage Cancer.Quick Guide to State Disability Insurance 2023. Accessed October 23 2023.https:\/\/triagecancer.org\/quick\u2010guides\/state\u2010disability\u2010insurance#ca"},{"key":"e_1_2_11_54_1","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2021.690454"},{"key":"e_1_2_11_55_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.33190"},{"key":"e_1_2_11_56_1","doi-asserted-by":"publisher","DOI":"10.1093\/jncics\/pkab0224"},{"key":"e_1_2_11_57_1","volume-title":"Annual Statistical Report on the Social Security Disability Insurance Program","author":"Social Security Office of Retirement and Disability Policy","year":"2020"},{"key":"e_1_2_11_58_1","volume-title":"Social Security Disability: Information on Wait Times, Bankruptcies, and Deaths Among Applicants Who Appealed Benefit Denials. GAO\u201020\u2010641R","author":"US Government Accountability Office","year":"2020"},{"key":"e_1_2_11_59_1","unstructured":"Washington Group on Disability Statistics.Washington Group Disability Indicator. Accessed January 23 2024.https:\/\/www.washingtongroup\u2010disability.com\/"},{"key":"e_1_2_11_60_1","doi-asserted-by":"publisher","DOI":"10.1093\/jncics\/pkad059"},{"key":"e_1_2_11_61_1","unstructured":"US Department of Labor.Continuation of Health Coverage (COBRA). Accessed February 18 2024.https:\/\/www.dol.gov\/general\/topic\/health\u2010plans\/cobra"},{"key":"e_1_2_11_62_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21604"},{"key":"e_1_2_11_63_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2018.3467"},{"key":"e_1_2_11_64_1","doi-asserted-by":"publisher","DOI":"10.1093\/jncics\/pkad067"},{"key":"e_1_2_11_65_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djac077"},{"key":"e_1_2_11_66_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.22.01742"},{"key":"e_1_2_11_67_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djz218"},{"key":"e_1_2_11_68_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11764\u2010022\u201001280\u201002"},{"key":"e_1_2_11_69_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11764\u2010019\u201000761\u20101"},{"key":"e_1_2_11_70_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00520\u2010018\u20104418\u20104"},{"key":"e_1_2_11_71_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11764\u2010017\u20100669\u20101"},{"key":"e_1_2_11_72_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2020.02.016"},{"key":"e_1_2_11_73_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11764\u2010016\u20100560\u20105"},{"key":"e_1_2_11_74_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11764\u2010023\u201001462\u20106"},{"key":"e_1_2_11_75_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00520\u2010015\u20102840\u20104"},{"key":"e_1_2_11_76_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.5897"},{"key":"e_1_2_11_77_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.35070"},{"key":"e_1_2_11_78_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2022.0494"},{"key":"e_1_2_11_79_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.19359"},{"key":"e_1_2_11_80_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00520\u2010020\u201005620\u20109"},{"key":"e_1_2_11_81_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.22310"},{"key":"e_1_2_11_82_1","unstructured":"Organisation for Economic Co\u2010operation and Development (OECD).Universal Health Coverage. Accessed February 18 2024.https:\/\/www.oecd.org\/els\/health\u2010systems\/universal\u2010health\u2010coveragehtm"},{"key":"e_1_2_11_83_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetwowrkopoen.2023.2332353"},{"key":"e_1_2_11_84_1","unstructured":"U.S. Bureau of Labor Statistics.Paid sick leave paid vacation and consolidated leave plan provisions in the United States December 2022. Accessed February 18 2024.https:\/\/www.bls.gov\/ebs\/notices\/2023\/paid\u2010sick\u2010leave\u2010paid\u2010vacation\u2010and\u2010consolidated\u2010leave\u2010plan\u2010provisions\u2010in\u2010the\u2010united\u2010states\u2010december\u20102022.htm"},{"key":"e_1_2_11_85_1","unstructured":"European Commission.Germany\u2014Health insurance cash benefits in the event of illness. Accessed March 30 2024.https:\/\/ec.europa.eu\/social\/main.jsp?catId=1111&intPageId=4550&langId=en"},{"key":"e_1_2_11_86_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa2209197"},{"key":"e_1_2_11_87_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2015.12383"},{"key":"e_1_2_11_88_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2021.0342"},{"key":"e_1_2_11_89_1","doi-asserted-by":"publisher","DOI":"10.1377\/hithaff.2001.01876"},{"key":"e_1_2_11_90_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2021.01.009"},{"key":"e_1_2_11_91_1","unstructured":"U.S. Department of Veterans Affairs VA Caregiver Support Program.Program of Comprehensive Assistance for Family Caregivers (PCAFC). Accessed October 23 2023.https:\/\/www.caregiver.va.gov\/support\/support_benefits.asp"},{"key":"e_1_2_11_92_1","unstructured":"New York State Department of Health.Consumer Directed Personal Assistance Program (CDPAP). Accessed October 23 2023.https:\/\/www.health.ny.gov\/health_care\/medicaid\/program\/longterm\/cdpap.htm"},{"key":"e_1_2_11_93_1","volume-title":"Medicaid State Laws: Coverage & Navigation","author":"Triage Cancer","year":"2023"},{"key":"e_1_2_11_94_1","unstructured":"U.S. Bureau of Labor Statistics.Employer Costs for Employee Compensation. Accessed February 18 2024.https:\/\/www.bls.gov\/ecec\/factsheets\/ecec\u2010leave\u2010benefits\u2010factsheethtm#:~:text=Paid%20leave%20benefits%20cost%20employers percent%20of%20total%20co"},{"key":"e_1_2_11_95_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470\u20102045(23)00319\u20104"},{"key":"e_1_2_11_96_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2012.42.8375"},{"key":"e_1_2_11_97_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.22.00929"},{"key":"e_1_2_11_98_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11764\u2010018\u20100718\u20104"},{"key":"e_1_2_11_99_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.32382"},{"key":"e_1_2_11_100_1","volume-title":"Measuring and\u00a0addressing health\u2010related social needs in cancer: working group recommendations","author":"National Comprehensive Cancer Network (NCCN)\u00ae","year":"2023"},{"key":"e_1_2_11_101_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21653"},{"key":"e_1_2_11_102_1","unstructured":"American Cancer Society.How We're Providing Support. Accessed June 21 2023.https:\/\/www.cancer.org\/about\u2010us\/what\u2010we\u2010do\/providing\u2010support.html"},{"key":"e_1_2_11_103_1","unstructured":"American Cancer Society.Hope Lodge\u00ae. Accessed June 21 2023.https:\/\/www.cancer.org\/support\u2010programs\u2010and\u2010services\/patient\u2010lodging\/hope\u2010lodge.html"},{"key":"e_1_2_11_104_1","unstructured":"American Cancer Society.Road to Recovery\u00ae. Accessed June 21 2023.https:\/\/www.cancer.org\/support\u2010programs\u2010and\u2010services\/road\u2010to\u2010recovery.html"},{"key":"e_1_2_11_105_1","doi-asserted-by":"publisher","DOI":"10.6004\/jnccn.2022.7058"}],"container-title":["CA: A Cancer Journal for Clinicians"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/acsjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.3322\/caac.21837","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T09:21:18Z","timestamp":1762334478000},"score":1,"resource":{"primary":{"URL":"https:\/\/acsjournals.onlinelibrary.wiley.com\/doi\/10.3322\/caac.21837"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,23]]},"references-count":104,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2024,7]]}},"alternative-id":["10.3322\/caac.21837"],"URL":"https:\/\/doi.org\/10.3322\/caac.21837","archive":["Portico"],"relation":{},"ISSN":["0007-9235","1542-4863"],"issn-type":[{"value":"0007-9235","type":"print"},{"value":"1542-4863","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,23]]},"assertion":[{"value":"2023-11-28","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-03-05","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-04-23","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}