Date of Award

6-1-2014

Document Type

Open Access Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Nursing

First Advisor

Jacqueline Fawcett

Second Advisor

Mary Cooley

Third Advisor

Debra Lerner

Abstract

Participation of colorectal cancer survivors (CRC) in the workforce has been described by clinicians, survivors, and researchers as a way to improve mood, quality of life (QOL), and survival. Maintaining self-esteem and financial independence have also been attributed to continued employment of the CRC survivor. The purpose of this cross-sectional survey was to describe patterns of employment of the CRC survivor and to examine the individual, disease, and work-related factors that influence presenteeism and perceived adequacy of sick pay (ASP) policy. The Conceptual Model of Nursing and Health Policy and the Pathways to Work Life Recovery guided the design, selection of variables, and specification of the relationship between variables. The study included 97 CRC survivors who were employed at the time of diagnosis and who had completed treatment ≥ 6 months and < 7 years to survey. Among working subjects, at-work limitations ("presenteeism") were measured by the Work Limitations Questionnaire (WLQ) consisting of four scales: Time Management, Physical Tasks, Mental-Interpersonal Tasks, and Output Tasks scales. The EORTC QLQ-C30 V3 was used to measure quality of life and the PHQ-9 for depression. The majority of gaps in employment occurred within the first year of diagnosis (21%) and attributed to poor health (56%), having been fired or laid off due to cancer (11%) or retirement (33%). A total of 27% had gaps in employment by 3 years; 13% were intermittent. The unemployment rate for cancer survivors in this study was 18.6% at the time of survey. Slightly over 25% of those who experienced a gap in employment did so involuntarily. Higher education (OR = 0.346, p=.006) was the only variable that significantly associated with a gap in employment. Having insurance (p=.03), QOL (p=.01), and depression (p=.003) significantly contributed to increased presenteeism. Earlier stage (OR=0.330, p=.050) and professional occupation (OR=3.281, p=.040) significantly contributed to perceptions of having an ASP policy. The importance of measuring continued employment of CRC survivors is supported in this study. The provision of an ASP policy may avoid disruption of work and create an easier transition for continued employment of the CRC survivor.

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