Changes in Work Status After Cancer Diagnosis and Their Associations with Depressive Symptoms Among Cancer Survivors: Findings from the Korean Longitudinal Study of Ageing

Purpose: Cancer survivors encounter significant psychological suffering and are prone to develop depressive symptoms. Work contributes to personal fulfillment and social connections, and by doing so, enhances a cancer survivor's resilience against adversities. However, maintaining employment can be challenging for some cancer survivors. This research aimed to identify the association between changes in work status and depressive symptoms among cancer survivors in South Korea.

Methods: This study used the panel data from the Korean Longitudinal Study of Ageing (KLoSA) and included 199 cancer survivors-799 observations-aged 65 or younger, between 2005 and 2018. Changes in work status consisted of continuous unemployment or employment, quitting a job, and getting a job. We defined depressive symptoms as a CES-D-10 score of 10 or higher and a cut-off of 4 was utilized for sensitivity analysis. Multivariable generalized estimating equation was employed to estimate the odds ratio (OR), adjusting for the number of household members, education level, sex, age, marital status, occupations, cancer treatment, cancer type, catastrophic healthcare expenditure (CHE), and survivorship. Subgroup analysis and interaction between changes in work and cancer types were further explored.

Results: For depressive symptoms, the OR of the continuous unemployment group was 2.27 (95% CI = 1.10-4.69), and the OR of the group that quit a job was 2.20 (95% CI = 1.03-4.72), compared to the continuous employment group. As survivorship increased, the odds of depressive symptoms decreased (OR = 0.94, 95% CI = 0.89-1.00). CHE was associated with depressive symptoms (OR = 2.23, 95% CI = 1.18-4.20). In cancer types with a low tendency to depression, continuous unemployment was associated with depressive symptoms (OR = 3.19, 95% CI = 1.12-9.06). In sensitivity analysis, changes in work, survivorship, and CHE were consistently associated with depressive symptoms.

Conclusions: Cancer survivors who quit a job or continued unemployment were more likely to experience depressive symptoms. The findings of this study imply that assistance for cancer survivors to continue a job or return to employment, including adjustment of workload and hours, may be helpful. Psychological care may be crucial, particularly in the early stage of cancer survivorship. Furthermore, support may be needed to alleviate the burden of healthcare expenditure.