Work environment, symptom burden, and job satisfaction among employed cancer survivors: a national cross-sectional study

Research on cancer and work has centered on whether survivors are employed; far less is known about how well work goes for the employed majority, despite growing calls in cancer survivorship research to assess work outcomes beyond employment status. We estimated the relative contributions of sociodemographic, clinical, symptom, activity, personal, and work-environment factors to job satisfaction among employed US cancer survivors and tested theory-specified moderation and indirect pathways. We analyzed 2644 currently employed survivors from a national survey.

Hierarchical regression entered six blocks ordered by the International Classification of Functioning, Disability and Health; the relative importance of blocks was quantified with order-independent variance decomposition. Interaction terms tested whether perceived organizational support moderated the fatigue–satisfaction association, and bootstrapped path models estimated indirect associations of core self-evaluations and hope through perceived support and work autonomy. The final model explained 52% of the variance in job satisfaction.

The work-environment block contributed 63% of the explained variance, more than six times the combined contribution of symptoms and clinical characteristics; cancer and treatment history contributed under 1%. Perceived organizational support (B = 0.31 per scale point, 95% CI [0.27, 0.34]; β = 0.34) and work autonomy (B = 0.30, 95% CI [0.25, 0.35]; β = 0.26) were the strongest correlates. Fatigue was associated with lower satisfaction at low but not high organizational support.

Associations of core self-evaluations and hope with satisfaction were 84% and 68% indirect through support and autonomy. Non-Hispanic Black survivors (B = − 0.09) and survivors who had reduced hours or responsibilities after diagnosis (B = − 0.07) reported lower adjusted satisfaction. Among employed survivors, job satisfaction was associated primarily with the work environment, above all perceived organizational support and work autonomy, rather than with cancer history or symptom burden.

The cross-sectional design precludes causal inference. Satisfaction with work after cancer appears to depend more on workplace support and autonomy than on the diagnosis itself; conversations about workplace support and accommodations during survivorship care may matter as much for working life as symptom management. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Kessler Foundation, 120 Eagle Rock Avenue, East Hanover, NJ, 07936, USA Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, China The authors declare no conflicts of interest. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material.