Employment changes among Chinese family caregivers of long-term cancer survivors
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Abstract
Background: Family caregivers (FCGs) play a key role in the plan of care provision for long-term cancer survivors, yet few studies have been conducted on the impact of long-term caregiving on FCGs and their employment patterns. This study aims to further our understanding of the effect that caregiving role has on FCGs by identifying what cancer-related characteristics influence reduction of employment hours among FCGs in the post-treatment phase in China. Methods: A total of 1155 cancer survivors participated in this study. Patients reported changes in the employment patterns of their FCGs. Descriptive analysis looked at demographic and cancer-related characteristics of cancer survivors and types of FCGs’ employment changes in both primary- and post-treatment phases. Chi-square test was used to statistically test the association between survivors’ characteristics and changes in FCGs’ hours of labor force work in post-treatment phase. Separate multivariable logistic regression models were used to examine the relationship between cancer-related characteristics of participants and employment reduction patterns among FCGs in post-treatment phase while controlling for demographic factors. Results: In the primary-treatment phase, 45.6% of all FCGs reduced their working hours and 17.4% stopped working altogether. In the post-treatment phase, 25.2% of FCGs worked fewer hours and 6.6% left the workforce completely. The results show that a higher probability of change in employment hours among FCGs is associated with the following patient characteristics: having comorbidities, receiving chemotherapy treatment, limited ability to perform physical tasks, limited ability to perform mental tasks, and diagnosis of stage II of cancer. Conclusions: Care for cancer patients in both primary- and post- treatment phases may have substantial impacts on hours of formal employment of Chinese FCGs. Interventions helping FCGs balance caregiving duties with labor force work are warranted.
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Many participants were part of the 'sandwich generation,' simultaneously caring for ageing parents, supporting children, and maintaining employment.
“Many participants were part of the “sandwich generation” simultaneously caring for ageing parents, supporting children, and maintaining employment”
From The burdens, coping strategies, and unmet needs of family caregivers of Chinese patients with lymphoma receiving commercial CAR-T-cell therapy: A qualitative study (2026) · cites this paper as [52]
The Discussion reports that family caregivers changed their working hours to care for cancer survivors, and the Conclusions describe the difficulty of balancing caregiving with employment. The paper does not establish that many caregivers also supported children while caring for ageing parents, or identify them as a “sandwich generation.” Its Limitations section says caregiver demographic information was lacking. (LLM, conf=0.85)
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Cites
van der Togt, H. (2003) · Journal of Network and Computer Applications · doi:10.1016/s1084-8045(02)00061-9 · Cited by 302,548
Bray, F., Ferlay, J., Soerjomataram, I., Siegel, R. L., Torre, L. A., & Jemal, A. (2018) · CA: A Cancer Journal for Clinicians · doi:10.3322/caac.21492 · Cited by 84,109 · cited 1× · see citing works
“1 million new cancer cases all over the world in 2018 with approximately 24% of them residing in China [1].”
BackgroundCancer statistics in China, 2015
Chen, W., Zheng, R., Baade, P. D., Zhang, S., Zeng, H., Bray, F., Jemal, A., Yu, X. Q., & He, J. (2016) · CA: A Cancer Journal for Clinicians · doi:10.3322/caac.21338 · Cited by 17,038 · see citing works
Cancer treatment and survivorship statistics, 2016
Miller, K. D., Siegel, R. L., Lin, C. C., Mariotto, A. B., Kramer, J. L., Rowland, J. H., Stein, K. D., Alteri, R., & Jemal, A. (2016) · CA: A Cancer Journal for Clinicians · doi:10.3322/caac.21349 · Cited by 6,066 · see citing works
Cancer treatment and survivorship statistics, 2019
Miller, K. D., Nogueira, L., Mariotto, A. B., Rowland, J. H., Yabroff, K. R., Alfano, C. M., Jemal, A., Kramer, J. L., & Siegel, R. L. (2019) · CA A Cancer Journal for Clinicians · doi:10.3322/caac.21565 · Cited by 4,252 · see citing works
Caregiver Burden: A Clinical Review
Adelman, R. D., Tmanova, L. L., Delgado, D., Dion, S., & Lachs, M. S. (2014) · JAMA · doi:10.1001/jama.2014.304 · Cited by 2,002 · see citing works
Physical and mental health effects of family caregiving
Schulz, R., & Sherwood, P. R. (2008) · AJN, American Journal of Nursing · doi:10.1097/01.naj.0000336406.45248.4c · Cited by 1,375 · cited 1× · see citing works
“A great number of FCGs may have to pay high medical expenses for their sick family member, lose wages or savings, provide time-consuming care without professional direction or support, experience overwhelming mental pressure, and/or suffer from deteriorations in their own quality of life [15-17].”
BackgroundGrunfeld, E. (2004) · Canadian Medical Association Journal · doi:10.1503/cmaj.1031205 · Cited by 963 · see citing works
Review of the literature on the effects of caring for a patient with cancer
Stenberg, U., Ruland, C. M., & Miaskowski, C. (2010) · Psycho-Oncology · doi:10.1002/pon.1670 · Cited by 786 · cited 1× · see citing works
“A majority of FCGs face stressors from many different directions [11-14].”
BackgroundCaring for caregivers and patients: Research and clinical priorities for informal cancer caregiving
Kent, E. E., Rowland, J. H., Northouse, L., Litzelman, K., Chou, W. S., Shelburne, N., Timura, C., O'Mara, A., & Huss, K. (2016) · Cancer · doi:10.1002/cncr.29939 · Cited by 564 · see citing works
Caregiver burden—a critical discussion
Bastawrous, M. (2013) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2012.10.005 · Cited by 440 · see citing works
Lifestyle interference and emotional distress in family caregivers of advanced cancer patients
Cameron, J., Franche, R., Cheung, A., & Stewart, D. (2002) · Cancer · doi:10.1002/cncr.10212 · Cited by 346 · see citing works
Trends and advances in cancer survivorship research: challenge and opportunity.
Aziz, N., & Rowland, J. (2003) · Seminars in Radiation Oncology · doi:10.1016/s1053-4296(03)00024-9 · Cited by 331 · see citing works
Time costs associated with informal caregiving for cancer survivors
Yabroff, K. R., & Kim, Y. (2009) · Cancer · doi:10.1002/cncr.24588 · Cited by 303 · see citing works
Kim, Y., & Schulz, R. (2008) · Journal of Aging and Health · doi:10.1177/0898264308317533 · Cited by 299 · see citing works
Estimating the cost of informal caregiving for elderly patients with cancer.
Hayman, J., Langa, K., Kabeto, M. U., Katz, S., Demonner, S., Chernew, M., Slavin, M., & Fendrick, A. (2001) · Journal of Clinical Oncology · doi:10.1200/jco.2001.19.13.3219 · Cited by 221 · see citing works
Neath, N., & Mccluskey, U. (2018) · To Be Met as a Person at Work · doi:10.4324/9780429397974-6 · Cited by 212
Fletcher, B. S., Paul, S. M., Dodd, M. J., Schumacher, K., West, C., Cooper, B., Lee, K., Aouizerat, B., Swift, P., Wara, W., et al. (2008) · Journal of Clinical Oncology · doi:10.1200/jco.2007.12.2838 · Cited by 198 · see citing works
Effect of Financial Costs on Caregiving Burden of Family Caregivers of Older Adults
Lai, D. (2012) · SAGE Open · doi:10.1177/2158244012470467 · Cited by 173 · see citing works
Tools for measuring the impact of informal caregiving of the elderly: a literature review.
Durme, T. V., Macq, J., Jeanmart, C., & Gobert, M. (2012) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2011.10.011 · Cited by 166 · see citing works
Occupational segregation and earnings inequality: Rural migrants and local workers in urban China
Zhang, Z., & Wu, X. (2016) · Social Science Research · doi:10.1016/j.ssresearch.2016.06.020 · Cited by 156 · see citing works
Covinsky, K. E., Eng, C., Lui, L., Sands, L., Sehgal, A., Walter, L., Wieland, D., Eleazer, G., & Yaffe, K. (2001) · The journals of gerontology. Series A, Biological sciences and medical sciences · doi:10.1093/gerona/56.11.m707 · Cited by 152 · see citing works
Lund, L., Ross, L., Petersen, M. A., & Grøenvold, M. (2014) · BMC Cancer · doi:10.1186/1471-2407-14-541 · Cited by 131 · see citing works
Work productivity and health of informal caregivers of persons with advanced cancer
Mazanec, S. R., Daly, B. J., Douglas, S. L., & Lipson, A. R. (2011) · Research in Nursing & Health · doi:10.1002/nur.20461 · Cited by 130 · see citing works
Lubberding, S., van Uden-Kraan, C. V., Velde, E. A. T., Cuijpers, P., Leemans, C., & Leeuw, I. V. V.-D. (2015) · Journal of Clinical Nursing · doi:10.1111/jocn.12753 · Cited by 122 · see citing works
Dyadic effects of fear of recurrence on the quality of life of cancer survivors and their caregivers
Kim, Y., Carver, C. S., Spillers, R. L., Love-Ghaffari, M., & Kaw, C.-K. (2012) · Quality of Life Research · doi:10.1007/s11136-011-9953-0 · Cited by 121 · see citing works
Psychosocial Aspects of Caregiving: Perceptions of Cancer Patients and Family Caregivers
Deshields, T., Rihanek, A., Potter, P., Zhang, Q., Kuhrik, M., Kuhrik, N., & O’Neill, J. (2011) · Supportive Care in Cancer · doi:10.1007/s00520-011-1092-1 · Cited by 109 · cited 1× · see citing works
“A previous study suggested that more than 80% of FCGs need to assist other family members in processing complex emotions [19].”
BackgroundHow Illness Affects Family Members: A Qualitative Interview Survey
Wittenberg, E., Saada, A., & Prosser, L. A. (2013) · Patient · doi:10.1007/s40271-013-0030-3 · Cited by 108 · see citing works
Yang, X., Hao, Y., George, S. M., & Wang, L. (2012) · Health and Quality of Life Outcomes · doi:10.1186/1477-7525-10-143 · Cited by 105 · see citing works
Quality of life in Chinese family caregivers for elderly people with chronic diseases
Xie, H., Cheng, C., Tao, Y.-S., Zhang, J., Robert, D., Jia, J., & Su, Y.-G. (2016) · Health and Quality of Life Outcomes · doi:10.1186/s12955-016-0504-9 · Cited by 103 · see citing works
Employment implications of informal cancer caregiving
de Moor, J. S., Dowling, E. C., Ekwueme, D. U., Guy, G. P., Rodriguez, J., Virgo, K. S., Han, X., Kent, E. E., Li, C., Litzelman, K., et al. (2017) · Journal of Cancer Survivorship · doi:10.1007/s11764-016-0560-5 · Cited by 100 · see citing works
The Medical Expenditure Panel Survey (MEPS) Experiences with Cancer Survivorship Supplement
Yabroff, K., Dowling, E. C., Rodríguez, J., Ekwueme, D., Meissner, H., Soni, A., Lerro, C., Willis, G., Forsythe, L. P., Borowski, L., et al. (2012) · Journal of cancer survivorship · doi:10.1007/s11764-012-0221-2 · Cited by 96 · see citing works
Wang, M.-L., Liu, J.-E., Wang, H.-Y., Chen, J., & Li, Y.-Y. (2014) · European Journal of Oncology Nursing · doi:10.1016/j.ejon.2014.04.012 · Cited by 77 · see citing works
Predictors of employment and lost hours from work in cancer caregivers
Sherwood, P. R., Donovan, H. S., Given, C. W., Lü, X., Given, B. A., Hricik, A. J., & Bradley, S. (2007) · Psycho-Oncology · doi:10.1002/pon.1287 · Cited by 76 · see citing works
Economic and Social Changes Among Distressed Family Caregivers of Lung Cancer Patients
Mosher, C. E., Champion, V., Azzoli, C., Hanna, N., Jalal, S., Fakiris, A., Birdas, T., Okereke, I. C., Kesler, K., Einhorn, L., et al. (2012) · Supportive Care in Cancer · doi:10.1007/s00520-012-1585-6 · Cited by 63 · see citing works
Economic Burden for Lung Cancer Survivors in Urban China
Zhang, X., Liu, S., Liu, Y., Du, J., Fu, W.-Q., Zhao, X.-W., Huang, W., Zhao, X.-M., Liu, G.-X., Mao, Z.-Z., et al. (2017) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph14030308 · Cited by 61 · cited 1× · see citing works
“In the rst year after cancer diagnosis, even after attaining medical insurance reimbursement, the nancial burden for lung cancer for a family amounted to nearly 107% of the whole annual household income in China [28].”
BackgroundSelf-citationHu, X.-L., Peng, X.-C., Su, Y.-L., & Huang, W.-X. (2018) · European Journal of Oncology Nursing · doi:10.1016/j.ejon.2018.11.003 · Cited by 60 · see citing works
Miao, Y.-D., Gu, J.-Q., Zhang, L., He, R., Sandeep, S., & Wu, J. (2018) · International Journal for Equity in Health · doi:10.1186/s12939-018-0799-8 · Cited by 56 · cited 1× · see citing works
“As a result, Chinese cancer patients prefer receiving chemotherapy treatment in a hospital setting [32].”
BackgroundOutpatient Chemotherapy Administration: Decreasing Wait Times for Patients and Families
Hendershot, E., Murphy, C., Doyle, S., Van-Clieaf, J., Lowry, J., & Honeyford, L. (2005) · Journal of Pediatric Oncology Nursing · doi:10.1177/1043454204272539 · Cited by 56
Tolbert, E., Bowie, J., Snyder, C., Bantug, E., & Smith, K. (2018) · Journal of cancer survivorship · doi:10.1007/s11764-017-0652-x · Cited by 45 · see citing works
Health-related quality of life among cancer survivors in rural China
Su, M.-Z., Hua, X., Wang, J.-L., Yao, N., Zhao, D.-L., Liu, W., Zou, Y., Anderson, R. T., & Sun, X. (2018) · Quality of Life Research · doi:10.1007/s11136-018-2038-6 · Cited by 43 · see citing works
Self-citationEffects of Caregiving on Employment and Economic Costs of Chinese Family Caregivers in Canada
Lai, D., & Leonenko, W. L. (2007) · Journal of Family and Economic Issues · doi:10.1007/s10834-007-9073-8 · Cited by 42 · see citing works
Unique characteristics of informal hospice cancer caregiving
Washington, K. T., Pike, K. C., Demiris, G., & Oliver, D. P. (2015) · Supportive Care in Cancer · doi:10.1007/s00520-014-2570-z · Cited by 34 · see citing works
Hanly, P., Céilleachair, A., Skally, M., o'Leary, E., Staines, A., Kapur, K., Fitzpatrick, P., & Sharp, L. (2013) · Applied Health Economics and Health Policy · doi:10.1007/s40258-013-0013-5 · Cited by 24 · see citing works
Sampling in population-based cancer caregivers research
Kim, Y., Kashy, D., Kaw, C., Smith, T., & Spillers, R. L. (2009) · Quality of Life Research · doi:10.1007/s11136-009-9518-7 · Cited by 23
Kizza, I., & Maritz, J. E. (2018) · Supportive Care in Cancer · doi:10.1007/s00520-018-4504-7 · Cited by 19 · cited 1× · see citing works
“A great number of FCGs may have to pay high medical expenses for their sick family member, lose wages or savings, provide time-consuming care without professional direction or support, experience overwhelming mental pressure, and/or suffer from deteriorations in their own quality of life [15-17].”
BackgroundXie, B., Su, Z., Liu, Y.-H., Wang, M., & Zhang, M. (2015) · Supportive Care in Cancer · doi:10.1007/s00520-015-2651-7 · Cited by 19 · see citing works
Experiences with cancer survey in China
Yao, N., Zhang, N., Wang, J.-L., Anderson, R. T., Liu, X.-T., Lyu, J., Du, X.-W., & Sun, X. (2019) · Cancer · doi:10.1002/cncr.32164 · Cited by 11 · see citing works
Self-citation
Flagged first, then by citations
3 of the 51 references couldn’t be matched to a known paper.
Research works printed but not linked: 1
- [28]Kurtz ME Kurtz JC Given CW Given BA Depression and physical health among family caregivers of geriatric patients with cancer - a longitudinal view Med Sci Monitor 2004 10 8 Cr447 Cr456 15277994
Cited by
Sorted by citations
Cancer caregivers unmet needs and emotional states across cancer treatment phases
Yang, W. F. Z., Lee, R. Z. Y., Kuparasundram, S., Tan, T., Chan, Y. H., Griva, K., & Mahendran, R. (2021) · PLoS ONE · doi:10.1371/journal.pone.0255901 · Cited by 37 · see citing works
“For example, FCCs reduced their working hours or quit their jobs to care more for their loved ones, eventually affecting their work-life-caregiving balance [16].”
BackgroundJiang, L., Zhang, A., Wang, M., Yang, L., & Ma, L. (2021) · European Journal of Oncology Nursing · doi:10.1016/j.ejon.2021.102084 · Cited by 27 · see citing works
Alnaeem, M., Qadire, M. A., & Nashwan, A. (2025) · Psychology, Health & Medicine · doi:10.1080/13548506.2025.2482954 · Cited by 13 · see citing works
“This inevitably disrupts their ability to maintain a healthy balance between work, personal life, and caregiving duties (Liu et al., 2020; Wang et al., 2018).”
Zhang, Y.-Y., Ding, X.-P., Liu, Y.-L., Han, Y.-H., Wang, G., Cai, M.-J., Zhang, Y., & Hu, D.-Y. (2023) · Cancer Nursing · doi:10.1097/ncc.0000000000001202 · Cited by 12 · see citing works
Liu, Y., Li, P., Liu, B., Qi, Y., Guan, W., Zhang, N., & Lu, Y. (2025) · Cancer Medicine · doi:10.1002/cam4.71083 · Cited by 10 · see citing works
“Moreover, reduced productivity during recovery and the escalating costs of long-term care further exacerbate the financial strain on patients and their families [6].”
Self-citationThe cost of caring: How advanced cancer patients affect Caregiver's employment in Singapore
Su, J., & Malhotra, C. (2022) · Psycho-Oncology · doi:10.1002/pon.5903 · Cited by 8 · see citing works
“Other studies have taken cross‐sectional snapshots of caregivers' employment at certain points in the disease trajectory.(3,7,8,12,21) However, less is known about how caregiver's employment changes throughout the caregiving trajectory, in response to patient condition.”
BackgroundMethodResultInfluentialPandya, B. J., Young, C., Packnett, E., Xie, B., Lillehaugen, T., Block, A., Bernacki, K., Touya, M., & LeBlanc, T. W. (2024) · Expert Review of Pharmacoeconomics & Outcomes Research · doi:10.1080/14737167.2024.2311305 · Cited by 5 · see citing works
“…to a study from China, 46% of the familial caregivers of patients with cancer reduced their working hours to accommodate the primary treatment phase; 17% also stopped working altogether at this time, and one-quarter of caregivers reduced their working hours after treatment was complete [20].”
BackgroundLin, X., Liu, J., Chen, J., Tang, J., Huang, Z., Wang, Y., & Shi, S. (2026) · Asia-Pacific Journal of Oncology Nursing · doi:10.1016/j.apjon.2025.100850 · Cited by 1 · see citing works
“52 The intensive demands of CAR-T-cell care — often requiring full-time, hands-on involvement — exacerbated this tension.”
Bao, S., Chen, Y., & Cheng, S. (2026) · European Journal of Oncology Nursing · doi:10.1016/j.ejon.2026.103192
Yamauchi, K., Nakashima, M., & Nakao, M. (2026) · Supportive Care in Cancer · doi:10.1007/s00520-026-10626-w
- Authors
- Liu, S., Su, M., Yao, N., Zhang, N., Wang, J., Anderson, R. T., & Sun, X.
- Affiliations
- Shandong University (CN)
- Shandong Tumor Hospital (CN)
- University of Virginia (US)
- Corresponding author
- Sun, Xiaojie
- Venue
- BMC Public Health
- Published
- 2020-11-25
- Volume
- 20
- Issue
- 1
- Pages
- 1787-1787
- ISSN
- 1471-2458 (ISSN-L)
- PMC
- PMC7690119
- OpenAlex
- W3110572605
- Cited by
- 13
- References
- 51
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 2 · 2023: 2 · 2022: 2 · 2021: 2
- FWCI
- 0.54
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Public Health (publishedVersion, cc-by)
- Research Square (acceptedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- China Medical Board (CMB 13-160)
- Shandong University Multidisciplinary Research and Innovation Team of Young Scholars (2020QNQT019)
- Topics
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Health Sciences › Health Professions › Pharmacy › Nursing care and research
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Economic and Financial Impacts of Cancer
- Keywords
- family caregivers, long-term cancer survivors, employment change, working time reduction, caregiver employment, comorbidities, chemotherapy, tumor stage, caregiver burden, Chinese caregivers
- MeSH terms
- Cancer Survivors, Adult, Aged, China, Employment, Female, Humans, Long-Term Care, Male, Middle Aged, Neoplasms, Caregivers
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