This study is designed to answer the following research questions: (1) What changes in employment, earnings, and health insurance do cancer patients experience shortly after diagnosis and treatment?; (2) What is the effect of cancer survival on trajectories of employment, earnings, and health insurance over the long term?; (3) How do the economic effects of cancer vary by type of cancer, patient characteristics, and pre-diagnosis employment and insurance?; (4) What adjustments in the employment and health insurance of spouses are made to accommodate changes in the health employment, and health insurance of married cancer survivors?; and (5) What are the implications of these economic adjustments for the psycho-social well-being and quality of life of cancer survivors? We will identify a cohort of cancer survivors from four tumor registries in the Mid-Atlantic region, which together draw patients from inner-city, small urban, suburban, and rural areas. We will conduct a computer-assisted telephone interview with the subjects one to three years after diagnosis and re-interview them annually (a total of four times) until about half have survived to five years. The first interview will include retrospective questions about employment, insurance, and health just prior to cancer diagnosis. Each cancer patient's employment and insurance will be compared pre- and post-diagnosis and treatment, identifying factors that differentially protect or expose cancer survivors to economic changes. We also will compare cancer cohort experiences to those of a comparison group without cancer, drawn from either or both of two national panel surveys covering the same time period (the Health and Retirement Survey and the Survey of Income and Program Participation). By emphasizing hazard modeling as our main analytic approach, we will estimate and project both short-term and long-term effects of cancer on survivors' economic well-being.
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