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Employment disruption among women with gynecologic cancers
  1. Roni Nitecki1,
  2. Shuangshuang Fu2,
  3. Kirsten A Jorgensen1,
  4. Lauren Gray3,
  5. Carolyn Lefkowits4,
  6. Benjamin D Smith5,
  7. Larissa A Meyer1,
  8. Alexander Melamed6,
  9. Sharon H Giordano2,
  10. Pedro T Ramirez1 and
  11. Jose Alejandro Rauh-Hain1
  1. 1Department of Gynecologic Oncology and Reproductive Medicine, MD Anderson Cancer Center, Houston, Texas, USA
  2. 2Department of Health Services Research, Division of Cancer Prevention and Population Sciences, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  3. 3Baylor College of Medicine, Houston, Texas, USA
  4. 4Department of Gynecologic Oncology, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
  5. 5Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  6. 6Department of Obstetrics and Gynecology and Herbert Irving Comprehensive Cancer Center, Columbia University, New York Presbyterian Hospital, New York, New York, USA
  1. Correspondence to Dr Roni Nitecki, Gynecologic Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA; rnitecki{at}; Dr Jose Alejandro Rauh-Hain; jarauh{at}


Background Adverse employment outcomes pose significant challenges for cancer patients, though data patients with gynecologic cancers are sparse. We evaluated the decrease in employment among patients in the year following the diagnosis of a gynecologic cancer compared with population-based controls.

Methods Patients aged 18 to 63 years old, who were diagnosed with cervical, ovarian, endometrial, or vulvar cancer between January 2009 and December 2017, were identified in Truven MarketScan, an insurance claims database of commercially insured patients in the USA. Patients working full- or part-time at diagnosis were matched to population-based controls in a 1:4 ratio via propensity score. Multivariable Cox proportional hazards models were used to evaluate the risk of employment disruption in patients versus controls.

Results We identified 7446 women with gynecologic cancers (191 vulvar, 941 cervical, 1839 ovarian, and 4475 endometrial). Although most continued working following diagnosis, 1579 (21.2%) changed from full- or part-time employment to long-term disability, retirement, or work cessation. In an adjusted model, older age, the presence of comorbidities, and treatment with surgery plus adjuvant therapy versus surgery alone were associated with an increased risk of employment disruption (p<0.0003, p=0.01, and p<0.0001, respectively) among patients with gynecologic cancer. In the propensity-matched cohort, patients with gynecologic cancers had over a threefold increased risk of employment disruption relative to controls (HR 3.67, 95% CI 3.44 to 3.95).

Conclusion Approximately 21% of patients with gynecologic cancer experienced a decrease in employment in the year after diagnosis. These patients had over a threefold increased risk of employment disruption compared with controls.

  • cervical cancer
  • quality of life (PRO)/palliative care
  • uterine cancer
  • vulvar and vaginal cancer
  • ovarian cancer

Data availability statement

Data may be obtained from a third party and are not publicly available. NA.

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Data availability statement

Data may be obtained from a third party and are not publicly available. NA.

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  • Presented at This study was partially presented at the Society of Gynecologic Oncology virtual annual meeting on women’s cancer, March 19-25, 2021.

  • Contributors All listed authors contributed to the conception, design, analysis, or interpretation of this study’s data; assisted in manuscript revision; provided approval for publication of this manuscript version; and agree to be accountable to this work. Conceptualization: RN, JAR-H. Data curation: SHG, SF. Formal analysis: SF, RN, JAR-H. Supervision: CL, BDS, LAM, AM, SHG, PTR. Writing - original draft: RN. Writing - review and editing: all authors. Dr. Rauh-Hain is responsible for the overall content as the guarantor.

  • Funding Supported by The National Institutes of Health’s National Cancer Institute grant (K08CA234333; JARH), a National Cancer Institute Cancer Center Support Grant (P30 CA016672), and a National Institutes of Health T32 grant (5T32 CA101642; RN). The NIH/NCI Cancer Core Support Grant (CA016672) supports the Biostatistics Resource Group at MD Anderson Cancer Center. The T32 training grant (CA101642) supports research training of postdoctoral gynecologic oncology fellows.

  • Disclaimer The grant providers were not involved in the development of the research hypothesis, study design, data analysis, or manuscript writing.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.