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

Emma Kemp; Vikki Knott; Paul Ward; Suzana Freegard; Ian Olver; Julia Fallon-Ferguson; Jon Emery; Chris Christensen; Monique Bareham; Bogda Koczwara

doi:10.1111/hex.13238

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

Health Expect. 2021 Jun;24(3):951-966. doi: 10.1111/hex.13238. Epub 2021 Apr 7.

Authors

Emma Kemp^{1

2}, Vikki Knott^{3

4}, Paul Ward¹, Suzana Freegard^{1

2

5}, Ian Olver⁶, Julia Fallon-Ferguson^{7

8}, Jon Emery⁹, Chris Christensen¹⁰, Monique Bareham¹⁰, Bogda Koczwara^{1

2}

Affiliations

¹ College of Medicine and Public Health, Flinders University, Adelaide, Australia.
² Flinders Centre for Innovation in Cancer, Bedford Park, Australia.
³ Australian College of Applied Psychology, Brisbane, Australia.
⁴ Menzies School of Health Research, Brisbane, Australia.
⁵ School of Health Sciences, University of South Australia, South Australia, Australia.
⁶ University of Adelaide, Adelaide, Australia.
⁷ School of Primary, Aboriginal, and Rural Health Care, University of Western Australia, Perth, Australia.
⁸ NHMRC Centre of Research Excellence in Cardiovascular Outcomes Improvement, Curtin University, Perth, Australia.
⁹ Department of General Practice and Centre for Cancer Research, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.
¹⁰ Cancer Voices South Australia, South Australia, Australia.

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.

Keywords: cancer survivors; employment; return to work; social determinants of health; vulnerable populations.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Australia
Cancer Survivors*
Employment
Humans
Neoplasms*
Return to Work
Survivors