Exploring long-term cancer survivors’ experiences in the career and financial domains: Interviews with hematopoietic stem cell transplantation recipients

Abstract

Using semi-structured interviews with 50 hematopoietic stem cell transplantation (HSCT) recipients who were 2 to 22 years post-transplant, this study investigates cancer survivors’ interpretations of their economic and work-related experiences during and after treatment. Survivors described a variety of challenges in these areas, including job insecurity, discrimination, career derailment, the lack of career direction, delayed goals, financial losses, insurance difficulties, constraints on job mobility, and physical/mental limitations. Survivors described the ways these challenges were offset by external factors that helped them to navigate these difficulties and buffered the negative financial and career-related impacts. Good health insurance, favorable job characteristics, job accommodations, and financial buffers were prominent offsetting factors. Most survivors, however, were also forced to rely on individual behavioral and interpretative strategies to cope with challenges. Behavioral strategies included purposeful job moves, retraining, striving harder, and retiring. Some strategies were potentially problematic, such as acquiring large debt. Interpretive strategies included reprioritizing and value shifts, downplaying the magnitude of cancer impact on one's life, denying the causal role of cancer in negative events, making favorable social comparisons, and benefit finding. Post-treatment counseling and support services may assist survivors in identifying available resources and useful strategies to improve long-term adaptation in the career and financial realms.

KEYWORDS:

• cancer survivorship
• economic adaptation
• hematopoietic stem cell transplantation
• work and career

Acknowledgments

We would like to acknowledge the efforts of the study participants, the dedication of our undergraduate research assistants, and the extensive support and guidance of the late Dr. Karl Blume, who worked with us to get this study going and was the inspiration behind it.

Funding

This research was supported by a Stanford Cancer Center Internal Grant.

Notes

1. Most interviews were conducted by two researchers, a young adult and a middle-aged adult. This added some age balance to the interview process, which we considered important given potentially different experiences among survivors in different age groups. Each interview was followed by an analytical debriefing, in which the two researchers discussed the interview and shared insights and notes.

2. Of the nine individuals who did not report an income, three reported their work status as “keeping house,” three were retired, one was a student, and two were currently unemployed. For those who did not report an income, seven were women and two were men.

3. Income of individuals who reported having no incomes and respondents who reported that they were not in the labor force at the time of interview was coded as $0.