Compared with their counterparts in cities, cancer patients living in rural areas tend to retire early after a cancer diagnosis, and are less likely to go on paid disability leave while undergoing treatment. These are some of the insights drawn from research that sought to determine if living in a rural or urban area influences the impact of cancer diagnosis on employment.

The study by Michelle Sowden, DO, and colleagues of the University of Vermont in Burlington was published in the Journal of Cancer Survivorship (2013; doi:10.1007/s11764-013-0317-3).  The findings are based on surveys done among 1,155 cancer survivors in Vermont who had been working at the time of their diagnosis. This is one of the largest surveys to date to address employment issues in cancer survivors.

The research team found no significant differences in the proportion of rural and urban survivors working fewer hours, experiencing a career change, or who were unable to work. However, rural cancer patients were 66% more likely to retire early as a result of their diagnosis than were their urban counterparts.

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This disparity is ascribed to the fact that rural populations tend to engage in more physically demanding jobs, for instance, in construction, agriculture, forestry, and mining. They are unable to pursue these jobs after their cancer treatment.

Another finding is that cancer survivors in rural areas were 33% less likely to go on paid disability while receiving cancer treatment compared with their urban counterparts of similar age, education, and cancer stage. The types of manual labor available in rural areas rarely offer disability benefits and therefore increase the impact of cancer diagnosis for this population. According to the Department of Labor, only 33% of persons employed in manual labor jobs (natural resources, construction, and maintenance) are offered short-term disability and only 21% are offered long-term disability as part of their benefits. In contrast, more than half of all management or professional workers are offered some form of disability.

The research team believes it is imperative for clinicians to recognize the impact that a cancer diagnosis might have on America’s rural population, which makes up 20% of the country’s inhabitants.

“Providers who care for rural patients must recognize that these patients may be at an increased risk for financial impact. Cancer care for these patients should incorporate counseling services related to returning to work after active treatment and assistance related to disability,” wrote Sowden. “It is possible that survivorship programs could lead this charge, with employment counseling becoming a standard part of this posttreatment phase of care.”