Work Status, Absenteeism, Presenteeism, and Quality of Life in Young Adult Cancer Survivors

Importance Current literature lacks information on the association between the work status and performance of young adult cancer survivors and their quality of life (QOL). Objective To assess self-reported work status, missed time at work (absenteeism), and performance (presenteeism) and their associations with QOL among young adult cancer survivors. Design, Setting, and Participants This cross-sectional survey study was performed from October 18, 2020, to September 17, 2022, at a single cancer center in Seattle, Washington. Participants included young adult cancer survivors (aged 18 to 39 years at diagnosis) who were 1 year or more from completion of cancer therapy. Data were analyzed from May 1, 2023, to February 1, 2025. Exposures Cancer therapy. Main Outcomes and Measures Unemployment rate compared with the age-, sex-, and calendar year–matched general population; standardized absolute and relative absenteeism and presenteeism scores; standardized scores for domains of anxiety, depression, physical function, fatigue, sleep disturbance, pain, social role, and cognition; and adjusted linear regressions to study factors associated with higher QOL scores. Results A total of 198 survivors, with a median age at diagnosis of 31 (IQR, 26-35) years and a median age at survey of 39 (IQR, 35-44) years were included (142 71.7% female). The unemployment rate (14 7.1%) did not differ from that of the general population (4.7%) ( P = .13). Compared with employed survivors, unemployed survivors reported significantly higher depression scores (coefficient, 5.11; 95% CI, 0.92-9.30) and lower scores for satisfaction with social roles and activities (coefficient, −6.59; 95% CI, −11.34 to −1.84) and physical function (coefficient, −6.63; 95% CI, −11.38 to −1.87). Higher absolute presenteeism score was associated with lower scores for anxiety (coefficient, −0.19; 95% CI, −0.26 to −0.11), depression (coefficient, −0.17; 95% CI, −0.24 to −0.10), fatigue (coefficient, −0.20; 95% CI, −0.30 to −0.10), pain interference (coefficient, −0.11; 95% CI, −0.21 to −0.02), and sleep disturbance (coefficient, −0.12; 95% CI, −0.21 to −0.03) and higher scores for physical function (coefficient, 0.08; 95% CI, 0.008-0.17), cognitive function (coefficient, 0.19; 95% CI, 0.11-0.27), and satisfaction in social roles and activities scores (coefficient, 0.16; 95% CI, 0.08-0.24). Additionally, a higher absolute absenteeism score was associated with a higher anxiety (coefficient, 0.03; 95% CI, 0.004-0.07) and lower cognitive function (coefficient, −0.04; 95% CI, −0.07 to −0.004). Conclusions and Relevance In this cross-sectional study of young adult cancer survivors, associations were found between survivors’ self-reported work status and performance and their QOL affecting their mental, physical, and social health. These findings call for the development of effective communication strategies with employers to balance work expectations with survivors’ treatment-related complications to achieve better performance and in turn higher QOL.