OBJECTIVES: The total economic burden of cancer reflects direct and indirect costs, including productivity loss due to employment change, absenteeism, presenteeism, and premature death of patients and impacts on caregivers. This study estimated the magnitude of employment decrease among employees newly diagnosed with early (non-metastatic) versus late-stage (metastatic) cancer in the US.

METHODS: IBM MarketScan^® Commercial Claims and Encounters Database was used to identify employees aged 18–64 and newly diagnosed with any cancer from 2009-2019. Employment decrease was defined as changing from “active full time” to “part time” or “quit job”, or from “part time” to “quit job” after cancer diagnoses. Baseline characteristics, proportions of employees with employment decrease during months 1-3, 4-6, and 7-12 after cancer diagnosis, and time to employment decrease, were summarized descriptively, stratifying by metastatic status at diagnosis.

RESULTS: 1,226,830 employees newly diagnosed with cancer were identified (mean age: 54 years, female: 52%, metastatic: 9.2%). Mean duration of follow up was shorter for employees with metastatic (20.9 [SD 22.1] months) vs. non-metastatic (31.7 [27.6] months) (p<0.001) disease. During the month prior to cancer diagnoses, 53% of metastatic and 55% non-metastatic employees were identified as “active full time” or “part time”. During all the time periods assessed post diagnosis, a higher cumulative proportion of employees with metastasis had employment decrease vs. without metastases (month 1-3: 13% vs. 6%, month 4-6: 17% vs. 8%, month 7-12: 22% vs. 11%, full post diagnosis: 30% vs. 23%, all p<0.001). The median time to an employment decrease was significantly shorter for employees with metastatic vs. non-metastatic disease (4.3 vs. 14.7 months, p<0.001).

CONCLUSION: Cancers diagnosed at late stage are associated with higher likelihood and earlier onset of employment decrease than cancers diagnosed at early stage. Earlier detection of cancer may attenuate productivity loss and associated costs to employers and employees.