Barriers to employment of Australian cancer survivors living with geographic or socio‐economic disadvantage: A qualitative study

Abstract

Background Opportunities for cancer survivors’ employment can both reflect and perpetuate health inequities, as employment is an important social determinant of health. Socio‐economic and geographic disadvantage is associated with greater difficulty finding work, but little is known about work needs of Australian cancer survivors living with disadvantage. Objective This study examined survivor and health‐care professional (HCP) perspectives on barriers experienced by Australian cancer survivors experiencing disadvantage when attempting to remain at or return to work. Method Focus groups and individual interviews were held with cancer survivors (N = 15) and oncology and primary HCPs (N = 41), focusing on communities at risk of disadvantage. Participants were asked about employment barriers and facilitators in general and in the context of disadvantage. Themes were identified using framework analysis. Results Geographic and socio‐economic disadvantage resulted in specific individual‐ and system‐level barriers. These related to distance from treatment and support services and limited availability and suitability of work for survivors living with geographic disadvantage, and limited availability, security, and flexibility of work and previous unemployment for survivors living with socio‐economic disadvantage. Identified needs included system‐level changes such as public and workplace‐level education, legislative and policy changes, and better access to resources. Conclusions Cancer survivors living with disadvantage experience limited access to flexible employment opportunities and resources, further perpetuating their disadvantage. Promotion of health equity for cancer survivors living with disadvantage requires systemic changes to support attempts to remain at/return to work. Patient or public contribution This study included cancer survivors and HCPs as investigators, authors and participants.

What are the post‐treatment information needs of rural cancer survivors in Australia? A systematic literature review

“…Participants in two qualitative studies described unforeseen side effects of treatment affecting cognitive functioning, hearing, and fertility and a lack of information about adverse effects of medications upon returning home from treatment 30,32 . Information regarding how to aid recovery through self‐management was identified as a need for rural cancer survivors in four studies 35–38 . In three studies, there was evidence that this need was unmet for many living in a rural setting 35,36,38 .…”

“…Self‐sourced survivorship information made available to rural survivors online was noted as important in one study examining the support service use of rural men living with cancer 64 and another with GPs treating skin cancer in rural areas 65 . In a 2021 study examining barriers to employment in Australian cancer survivors living in disadvantaged areas, participants recommended that employers should receive education about the needs of cancer survivors returning to work, via workplace‐specific education, and public education and awareness campaigns 35 …”

“…30,32 Information regarding how to aid recovery through self-management was identified as a need for rural cancer survivors in four studies. [35][36][37][38] In three studies, there was evidence that this need was unmet for many living in a rural setting. 35,36,38 For example, Minstrel and colleagues reported that approximately 20% of their sample of rural breast cancer patients (n = 15/83) were not informed about things they could do to help themselves 'get well'.…”

“…[35][36][37][38] In three studies, there was evidence that this need was unmet for many living in a rural setting. 35,36,38 For example, Minstrel and colleagues reported that approximately 20% of their sample of rural breast cancer patients (n = 15/83) were not informed about things they could do to help themselves 'get well'.…”

“…33,44,48,[56][57][58] Four of the 52 included studies identified other unmet information needs including practical and financial advice, information on returning to work, and after-hours medical contacts. 20,35,49,59 No comparisons were made between rural and metropolitan samples regarding these needs.…”