Description of characteristics of cancer survivors
As presented in Table 1, 1155 survivors were ultimately included in this study. Only a few (6.8%) of the participants were recorded with stage III-IV cancer. Types of treatment included chemotherapy (68.7%), radiation therapy (11.6%), and surgery (88.9%). 26.9% of participants were accompanied by chronic diseases. In the post-treatment phase, over half (55.3%) of participants in the survey reported that their ability to perform physical tasks was limited, and approximately one-third (31.3%) of participants reported their ability to perform mental tasks was limited.
Table 1 Characteristics of cancer survivors (N=1155)
Characteristics
|
N (%)
|
Residence area
|
|
Urban
|
379(32.8)
|
Rural
|
776(67.2)
|
Age group(years)
|
|
≤40
|
45(3.9)
|
40-55
|
299(25.9)
|
56-65
|
384(33.2)
|
>65
|
427(37.0)
|
Gender
|
|
Male
|
496(42.9)
|
Female
|
659(57.1)
|
Marital status
|
|
Married
|
1037(89.8)
|
Others
|
118(10.2)
|
Educational level
|
|
Uneducated
|
185(16.0)
|
Elementary school
|
403(34.9)
|
Middle school
|
377(32.6)
|
High school and above
|
190(16.5)
|
Annual household income†,Chinese Yuan
|
|
<5,000
|
182(15.8)
|
5,000-20,000
|
417(36.1)
|
20,000-50,000
|
376(32.6)
|
>50 000
|
172(14.9)
|
Missing
|
8(0.7)
|
Cancer site
|
|
Breast
|
406(35.2)
|
Lung
|
163(14.1)
|
Stomach
|
284(24.6)
|
Colorectal
|
302(26.1)
|
Stage at diagnosis
|
|
0- I
|
497(43.0)
|
II
|
405(35.1)
|
III-IV
|
78(6.8)
|
Missing
|
175(15.2)
|
Type of treatment‡
|
|
Chemotherapy
|
794(68.7)
|
Surgery
|
1027(88.9)
|
Radiation therapy
|
134(11.6)
|
Comorbidity
|
|
Yes
|
311(26.9)
|
No
|
813(70.4)
|
Missing
|
31(2.7)
|
Limited ability to perform physical tasks
|
|
Yes
|
639(55.3)
|
No
|
123(10.6)
|
Not applicable§
|
393(34.0)
|
Limited ability to perform mental tasks
|
|
Yes
|
362(31.3)
|
No
|
425(36.8)
|
Not applicable§
|
368(31.9)
|
Duration of disease since diagnosis
|
|
2-3 years
|
745(64.5)
|
4-5 years
|
410(35.5)
|
† 10,000 Chinese Yuan ≈1,541 US dollars as of December 31, 2015;
‡ Categories are not mutually exclusive because most patients received a combination of treatments;
§ Participants who were retired or unemployed by the time they were diagnosed with cancer can be identified as “Not applicable”.
Employment changes experienced by FCGs
Figure 1 described the individual proportions of different types of employment change among FCGs. In the primary treatment phase, nearly half of FCGs (45.6 %) reduced their working hours, and 17.4% of FCGs even stopped working due to care provision. In contrast, only a small percentage (3.0%) increased their working hours. In the post-treatment phase, nearly a quarter (25.2%) reduced their working hours due to care provision, and there was still a small percentage (6.6%) of FCGs who stopped working. There was a statistically significant difference between the employment status of FCGs in the primary treatment phase and in the post-treatment phase (P<0.01).
The result for the association between patients’ characteristics and FCGs’ employment change was presented in Table 2. In the post-treatment phase, among demographic variables, different residence areas (P<0.001), gender (P=0.014), marital status (P=0.014), educational level (P<0.001), and annual household income (P<0.001) registered as statistically significant, revealing their impact on the employment status of FCGs. As for cancer-related characteristics, comorbidity (P=0.004), chemotherapy treatment (P=0.001), limited ability to perform physical tasks (P<0.001), limited ability to perform mental tasks (P=0.025), and duration of disease since diagnosis (P=0.001) were statistically significant.
Table 2 Employment changes among FCGs by cancer survivors’ characteristics in post treatment Phase
Variables
|
Reduced
|
Not change
|
c2
|
P- value
|
N
|
N
|
Residence area
|
|
|
52.542
|
<0.001
|
Urban
|
65
|
290
|
|
|
Rural
|
293
|
432
|
|
|
Age group (years)
|
|
|
4.819
|
0.186
|
≤40
|
8
|
33
|
|
|
40-55
|
102
|
179
|
|
|
56-65
|
119
|
240
|
|
|
>65
|
129
|
270
|
|
|
Gender
|
|
|
6.075
|
0.014
|
Male
|
171
|
288
|
|
|
Female
|
187
|
434
|
|
|
Marital status
|
|
|
6.002
|
0.014
|
Married
|
333
|
637
|
|
|
Others
|
25
|
85
|
|
|
Educational level
|
|
|
41.948
|
<0.001
|
Uneducated
|
60
|
114
|
|
|
Elementary school
|
160
|
223
|
|
|
Middle school
|
113
|
233
|
|
|
High school and above
|
25
|
152
|
|
|
Annual household income †,
Chinese Yuan
|
|
|
22.662
|
<0.001
|
<5000
|
73
|
99
|
|
|
5000-20000
|
143
|
257
|
|
|
20000-50000
|
112
|
234
|
|
|
>50000
|
29
|
127
|
|
|
Cancer site
|
|
|
2.374
|
0.499
|
Breast
|
115
|
264
|
|
|
Lung
|
50
|
100
|
|
|
Stomach
|
90
|
173
|
|
|
Colorectal
|
103
|
185
|
|
|
Stage at diagnosis
|
|
|
3.203
|
0.202
|
0-Ⅰ
|
159
|
301
|
|
|
II
|
112
|
275
|
|
|
III-IV
|
24
|
46
|
|
|
Comorbidity
|
|
|
8.356
|
0.004
|
Yes
|
74
|
205
|
|
|
No
|
278
|
493
|
|
|
Chemotherapy
|
|
|
10.205
|
0.001
|
Yes
|
272
|
480
|
|
|
No
|
86
|
242
|
|
|
Surgery
|
|
|
0.278
|
0.598
|
Yes
|
316
|
645
|
|
|
No
|
42
|
77
|
|
|
Radiation therapy
|
|
|
0.063
|
0.802
|
Yes
|
41
|
79
|
|
|
No
|
317
|
643
|
|
|
Limited ability to perform physical tasks
|
|
|
49.151
|
<0.001
|
Yes
|
274
|
331
|
|
|
No
|
14
|
109
|
|
|
Limited ability to perform mental tasks
|
|
|
5.020
|
0.025
|
Yes
|
148
|
194
|
|
|
No
|
145
|
266
|
|
|
Duration of disease since diagnosis
|
|
|
10.758
|
0.001
|
2-3 years
|
255
|
441
|
|
|
4-5 years
|
103
|
281
|
|
|
† 10,000 Chinese Yuan ≈1,541 US dollars as of December 31, 2015;
As displayed in Table 3, in the analysis which controlled for all patient demographic characteristics, for survivors of stage II cancer (OR=1.481; 95CI%: 1.083, 2.024), the probability that their FCGs’ employment status would change was higher than that of the comparison group. For survivors who had already undergone chemotherapy treatment (OR=1.638; 95CI%: 1.202, 2.232) and were accompanied by another chronic disease (OR =1.593; 95CI%: 1.148, 2.210), their FCGs were more likely to have made employment changes. In addition, for survivors whose ability to perform physical tasks (OR =1.742, 95%CI: 3.154, 10.339) and mental tasks (OR=1.513, 95CI%: 1.100, 2.081) was limited, their FCGs also were more likely to have changed their employment status.
Table 3 Associated factors of employment changes among FCGs from separate multivariable logistic regression analyses
|
Odd Ratio, OR
|
|
Model 1
|
Model 2
|
Model 3‡
|
Model 4
|
Model 5
|
Model 6
|
Model 7
|
Model 8
|
Model 9
|
Model 10
|
Age at time of survey†
|
0.992
|
0.997
|
0.998
|
0.995
|
0.995
|
0.992
|
0.993
|
0.993
|
1.003
|
0.993
|
Residence area
|
Urban
|
Ref
|
Rural
|
2.191***
|
2.136***
|
2.314***
|
2.534***
|
2.082***
|
2.259***
|
2.223***
|
2.078***
|
1.965**
|
2.252***
|
Gender
|
Male
|
Ref
|
|
|
Female
|
0.720*
|
0.704*
|
|
0.730*
|
0.701*
|
0.722*
|
0.718*
|
0.730*
|
0.821
|
0.697*
|
Marital status
|
Others
|
Ref
|
Married
|
2.051**
|
2.176**
|
2.098**
|
1.860*
|
1.994**
|
2.105**
|
2.049**
|
2.052**
|
1.862
|
2.229*
|
Education
|
Uneducated
|
Ref
|
Elementary school
|
1.204
|
1.148
|
1.276
|
1.093
|
1.204
|
1.220
|
1.207
|
1.240
|
1.119
|
1.230
|
Middle school
|
0.802
|
0.766
|
0.896
|
0.751
|
0.786
|
0.810
|
0.803
|
0.822
|
0.626
|
0.695
|
High school and above
|
0.385**
|
0.351*
|
0.433**
|
0.363**
|
0.384**
|
0.388**
|
0.391**
|
0.395**
|
0.388*
|
0.306**
|
Yearly household income, Chinese Yuan
|
<5,000 CNY
|
Ref
|
5,000-19,999 CNY
|
0.685
|
0.675
|
0.683
|
0.778
|
0.685
|
0.693
|
0.681
|
0.682
|
0.776
|
0.728
|
20,000-50,000 CNY
|
0.742
|
0.744
|
0.728
|
0.873
|
0.692
|
0.748
|
0.741
|
0.734
|
0.976
|
0.927
|
>50,000 CNY
|
0.578
|
0.600
|
0.569
|
0.584
|
0.536*
|
0.593
|
0.575
|
0.573
|
0.976
|
0.921
|
Comorbidity
|
0
|
|
Ref
|
|
≥1
|
1.593**
|
Cancer site
|
Colorectal
|
|
Ref
1.021
0.933
0.992
|
Female breast
|
Lung
|
Stomach
|
Cancer stage at diagnosis
|
0-Ⅰ
|
|
Ref
1.481*
1.394
|
Ⅱ
|
Ⅲ-Ⅳ
|
Chemotherapy
|
No
|
|
Ref
1.638**
|
Yes
|
Surgery
|
No
|
|
Ref
0.736
|
Yes
|
Radiation therapy
|
No
|
|
Ref
1.187
|
Yes
|
Duration of disease since diagnosis
|
2-3 years
|
|
Ref
1.249
|
4-5 years
|
Limited ability to perform physical tasks
|
No
|
|
Ref
5.710***
|
Yes
|
Limited ability to perform mental tasks
|
No
|
|
Ref
|
Yes
|
1.513*
|
|
|
|
|
|
|
|
|
|
|
|
|
† Age was entered as a continuous variable in the regression model.
‡ The model 3 for cancer site adjusted for residence area, age, marital status, annual household income, and educational level. Models 2, 4-10 adjusted for residence area, age, gender, marital status, annual household income, and educational level.
***, **, * indicates P<0.001, P < 0.01; P < 0.05, respectively.