Inequality in income change among cancer survivors five years after diagnosis: Evidence from a French national survey

Autoři: Caroline Alleaume aff001;  Marc-Karim Bendiane aff001;  Patrick Peretti-Watel aff002;  Anne-Déborah Bouhnik aff001
Působiště autorů: Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France aff001;  Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France aff002;  ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France aff003
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article


Worldwide, around 18 million people receive a cancer diagnosis each year, most of whom survive long enough to face additional cancer-related costs. In France, most costs directly related to cancer are covered by the National Health Insurance Fund, and cancer patients can receive treatments without paying advance fees. In this context, the costs faced by cancer survivors are mostly social costs. Drawing on fundamental cause theory, this study aimed to explore the socially-differentiated evolution of cancer survivor’s income five years after diagnosis. Our study draws on the findings of VICAN5, a French national survey that was conducted in 2015/2016 in a representative sample of 4,174 cancer survivors to obtain information on living conditions five years after diagnosis, and that was restricted to 12 tumour sites accounting for 88% of global cancer incidence in France. We used the multiple imputation method and the Heckman selection model to identify the factors associated with a decrease in household income per consumption unit (HICU), while accounting for missing data. Among survivors still working five years after diagnosis, 17.6% reported lower income at survey than at diagnosis. After adjustment for socio-demographic and medical characteristics, the decrease in HICU was more frequent in women, singles, low educated survivors, and survivors with reduced working time. Finally, subjective measures of income variation and economic well-being were a useful complement to objective measures since 31.6% of cancer survivors still working five years after diagnosis reported a perceived decrease in household income. In conclusion, inequalities in economic well-being persist long after diagnosis in France, and this despite the fact that most cancer-related costs are covered by the French National Health Insurance Fund. Consequently, more attention should be paid to cancer patients with low socio-economic status to help reduce inequalities in post-diagnosis living conditions.

Klíčová slova:

Cancer detection and diagnosis – Economics – Educational attainment – Employment – France – Health insurance – Jobs – Socioeconomic aspects of health


1. Paalman CH, van Leeuwen FE, Aaronson NK, de Boer AGEM, van de Poll-Franse L, Oldenburg HSA, et al. Employment and social benefits up to 10 years after breast cancer diagnosis: a population-based study. British Journal of Cancer. janv 2016;114(1):81‑7. doi: 10.1038/bjc.2015.431 26757424

2. Syse A, Tønnessen M. Cancer’s unequal impact on incomes in Norway. Acta Oncologica. avr 2012;51(4):480‑9. doi: 10.3109/0284186X.2011.640710 22150076

3. Lee MK, Lee KM, Bae J-M, Kim S, Kim Y-W, Ryu KW, et al. Employment status and work-related difficulties in stomach cancer survivors compared with the general population. British Journal of Cancer. févr 2008;98(4):708‑15. doi: 10.1038/sj.bjc.6604236 18283298

4. Zajacova A, Dowd JB, Schoeni RF, Wallace RB. Employment and income losses among cancer survivors: Estimates from a national longitudinal survey of American families: Economic Losses Among Cancer Survivors. Cancer. 15 déc 2015;121(24):4425‑32. doi: 10.1002/cncr.29510 26501494

5. Lauzier S, Maunsell E, Drolet M, Coyle D, Hébert-Croteau N. Validity of information obtained from a method for estimating cancer costs from the perspective of patients and caregivers. Quality of Life Research. mars 2010;19(2):177‑89. doi: 10.1007/s11136-009-9575-y 20094806

6. Jeon S-H. The Long-Term Effects of Cancer on Employment and Earnings: The Long-Term Effects of Cancer on Employment and Earnings. Health Economics. mai 2017;26(5):671‑84. doi: 10.1002/hec.3342 27045223

7. Fenn KM, Evans SB, McCorkle R, DiGiovanna MP, Pusztai L, Sanft T, et al. Impact of Financial Burden of Cancer on Survivors’ Quality of Life. Journal of Oncology Practice. sept 2014;10(5):332‑8. doi: 10.1200/JOP.2013.001322 24865220

8. Short PF, Mallonee EL. Income Disparities in the Quality of Life of Cancer Survivors: Medical Care. janv 2006;44(1):16‑23. doi: 10.1097/01.mlr.0000188986.84819.3a 16365608

9. Timmons A, Gooberman-Hill R, Sharp L. « It’s at a Time in Your Life When You Are Most Vulnerable »: A Qualitative Exploration of the Financial Impact of a Cancer Diagnosis and Implications for Financial Protection in Health. Suzuki H, éditeur. PLoS ONE. 11 nov 2013;8(11):e77549. doi: 10.1371/journal.pone.0077549 24244279

10. Jensen LS, Overgaard C, Bøggild H, Garne JP, Lund T, Overvad K, et al. The long-term financial consequences of breast cancer: a Danish registry-based cohort study. BMC Public Health [Internet]. déc 2017 [cité 23 sept 2018];17(1). Disponible sur:

11. Link BG, Phelan J. Social conditions as fundamental causes of disease. J Health Soc Behav. 1995;Spec No:80‑94.

12. Phelan JC, Link BG, Diez-Roux A, Kawachi I, Levin B. “Fundamental Causes” of Social Inequalities in Mortality: A Test of the Theory. Journal of Health and Social Behavior. sept 2004;45(3):265‑85. doi: 10.1177/002214650404500303 15595507

13. Roth RS, Geisser ME. Educational achievement and chronic pain disability: mediating role of pain-related cognitions. Clin J Pain. oct 2002;18(5):286‑96.

14. Barbareschi G, Sanderman R, Tuinstra J, van Sonderen E, Ranchor AV. A prospective study on educational level and adaptation to cancer, within one year after the diagnosis, in an older population. Psycho-Oncology. avr 2008;17(4):373‑82. doi: 10.1002/pon.1243 17623830

15. Mehnert A. Employment and work-related issues in cancer survivors. Critical Reviews in Oncology/Hematology. févr 2011;77(2):109‑30. doi: 10.1016/j.critrevonc.2010.01.004 20117019

16. Syse A, Tretli S, Kravdal Ø. Cancer’s impact on employment and earnings—a population-based study from Norway. Journal of Cancer Survivorship. sept 2008;2(3):149‑58. doi: 10.1007/s11764-008-0053-2 18792789

17. Singh SR, Eghdami MR, Singh S. The Concept of Social Vulnerability: A Review from Disasters Perspectives. 2014;1:12.

18. the French Network of Cancer Registries (FRANCIM), Colonna M, Mitton N, Bossard N, Belot A, Grosclaude P. Total and partial cancer prevalence in the adult French population in 2008. BMC Cancer [Internet]. déc 2015 [cité 23 sept 2018];15(1). Disponible sur:

19. INCa. Les cancers en France. 2015. (Les Données).

20. La Ligue contre le cancer. Données de la campagne de collecte 2015–2016. Impact social du cancer. févr 2016;8.

21. La Ligue contre le cancer. Rapport de l’Observatoire sociétal des cancers. 2011;140.

22. INCa. La vie deux ans après un diagnostic de cancer—De l’annonce à l’après-cancer [Internet]. 2014 [cité 27 sept 2018]. (Etude & enquêtes). Disponible sur:

23. Bouhnik A-D, Bendiane M-K, Cortaredona S, Sagaon Teyssier L, Rey D, Berenger C, et al. The labour market, psychosocial outcomes and health conditions in cancer survivors: protocol for a nationwide longitudinal survey 2 and 5 years after cancer diagnosis (the VICAN survey). BMJ Open. 24 mars 2015;5(3):e005971‑e005971. doi: 10.1136/bmjopen-2014-005971 25805526

24. Little RJ, Rubin DB. Statistical analysis with missing data. John A Wiley & Sons, Inc, New York. 1987;

25. Rubin DB. Multiple Imputation for Nonresponse in Surveys. John Wiley & Sons; 2004. 326 p.

26. Schomaker M, Heumann C. Bootstrap inference when using multiple imputation. Stat Med. 30 juin 2018;37(14):2252‑66. doi: 10.1002/sim.7654 29682776

27. Heckman JJ. Sample Selection Bias as a Specification Error. Econometrica. janv 1979;47(1):153.

28. Hagenaars AJM, Communities SO of the E, Eng L (Luxembourg), De Vos K, Asghar Zaidi M. Poverty statistics in the late 1980s: research based on micro-data. 1994 [cité 27 sept 2018]; Disponible sur:

29. Insee. Taux d’inflation en 2017—Données annuelles de 1991 à 2017 [Internet]. 2018 [cité 29 sept 2018]. Disponible sur:

30. O’Prey S. La non-réponse partielle aux variables financières de l’enquête Logement 2006: mise en oeuvre de nouvelles procédures de redressement et comparaison de méthodes d’imputation. INSEE; 2008.

31. INSEE. Écart de salaires entre les hommes et les femmes en 2015—Données annuelles de 2000 à 2015 [Internet]. INSEE Chriffres-Clés. 2017 [cité 27 sept 2018]. Disponible sur:

32. Morin T, Remila N. Le revenu salarial des femmes reste inférieur à celui des hommes—Insee Première—1436. mars 2013 [cité 27 sept 2018]; Disponible sur:

33. Syse A, Tretli S, Kravdal Ø. The impact of cancer on spouses’ labor earnings: A Population-Based Study. Cancer. 15 sept 2009;115(S18):4350‑61.

34. INCa. La vie cinq ans après un diagnostic de cancer. 2018. Etat des lieux et des connaissances / Recherche.

35. Torp S, Syse J, Paraponaris A, Gudbergsson S. Return to work among self-employed cancer survivors. J Cancer Surviv. avr 2017;11(2):189‑200. doi: 10.1007/s11764-016-0578-8 27837444

36. Bower JE, Meyerowitz BE, Desmond KA, Bernaards CA, Rowland JH, Ganz PA. Perceptions of positive meaning and vulnerability following breast cancer: Predictors and outcomes among long-term breast cancer survivors. Annals of Behavioral Medicine. 1 juin 2005;29(3):236‑45. doi: 10.1207/s15324796abm2903_10 15946118

37. Tiedtke C, Donceel P, de Rijk A, Dierckx de Casterlé B. Return to work following breast cancer treatment: the employers’ side. J Occup Rehabil. sept 2014;24(3):399‑409.

38. Franc C, Pierre A. Restes à charge élevés: profils d’assurés et persistance dans le temps. Questions d’économie et de la Santé IRDES. avr 2016;(217):6.

39. Paraponaris A, Teyssier LS, Ventelou B. Job tenure and self-reported workplace discrimination for cancer survivors 2 years after diagnosis: Does employment legislation matter? Health Policy. déc 2010;98(2‑3):144‑55.

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