There are 10 million adult cancer survivors in the U.S. population. Thanks to better diagnosis, improved treatment, and increased cancer incidence as the population ages, the number of survivors will grow further in the future. Improving the quality of life among the survivors and their families is a prominent public health issue and one of the top priorities of the National Cancer Institute. The survivors and their families face multiple challenges resulting from cancer and its treatment, including economic issues. While researchers, policy makers, and clinical practitioners understand that cancer is often financially devastating to the families of patients and survivors, the effects have never been adequately described. Previous studies are few, and often use small, non-representative samples, focus only on older adults, and employ subjective reports of financial need. This project will provide the first set of exact, causal, objective estimates of the changes in economic well-being that occur in families as a result of cancer. This study is innovative in several key aspects. We use the Panel Study of Income Dynamics (PSID), a large, nationally-representative longitudinal survey of over 8,400 families, widely regarded as the most prominent source of reliable information on the economic behavior of American families. This data source allows us to study changes in the survivors'and spouses'employment, taxable and transfer incomes, medical expenditures, and household wealth. The PSID cancer information was collected repeatedly in 4 waves. The quality of the health reporting is excellent and the longitudinal structure of the survey adds additional strength because it provides multiple retrospective reports of the disease onset. The first specific aim is to evaluate the reporting consistency and accuracy across the multiple reports over time. This type of analysis has never been conducted and will offer insight into the reliability of self-reported health conditions. Using the results, the second specific aim is to assess how the diagnosis affects the survivors'and their spouses'employment, income, medical expenditures, and wealth, as well as what family and cancer-specific characteristics ameliorate the economic impact of the disease. Previous studies have used only the survivors'reports or compared the survivors with healthy controls. In contrast, we employ a unique mixed-effects model structure developed in econometrics to isolate the changes in economic indicators that occur within individuals (or within families) after the diagnosis, compared to before the diagnosis. This analytic model also has the potential to change the cancer- survivorship research because it is applicable to examining a wide range cancer's effects on the family, including marital status dynamics or outcomes of children whose parents have been diagnosed with cancer.

Public Health Relevance

PROJECT NARRATIVE There are over 10 million adult cancer survivors in the US population. Improving their quality of life is one of the strategic objectives of the National Cancer Institute and an important public health issue. This project will provide the first comprehensive and objective estimates of employment, income, and wealth changes caused by cancer for survivors and their families. Understanding the economic impact of this disease will contribute information critical to understanding and meeting the survivors'needs.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Small Research Grants (R03)
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Special Emphasis Panel (ZCA1-SRLB-D (J2))
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Yabroff, Robin
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University of Wyoming
Social Sciences
Schools of Arts and Sciences
United States
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Zajacova, Anna; Dowd, Jennifer B; Schoeni, Robert F et al. (2015) Employment and income losses among cancer survivors: Estimates from a national longitudinal survey of American families. Cancer 121:4425-32
Zajacova, Anna; Dowd, Jennifer Beam; Schoeni, Robert F et al. (2010) Consistency and precision of cancer reporting in a multiwave national panel survey. Popul Health Metr 8:20