Disability identity, ADA knowledge, and self-advocacy among cancer survivors

Cancer survivors often experience persistent functional limitations that meet legal definitions of disability in the USA; yet many do not self-identify as disabled or access disability-related supports. In this study, disability rights knowledge, functional impairment, social environment, disability identification, and support-seeking behavior were examined.

A Qualtrics survey distributed through national cancer organizations, support groups, and social media platforms yielded responses from 409 adult cancer survivors. Measures assessed functional disability using American Community Survey (ACS) indicators, disability identity, ADA knowledge, perceived stigma, and accommodation use. Factors associated with disability identity and accommodation-seeking behavior were examined using multivariate regression models.

43.8% of participants met ACS disability criteria, yet disability identity did not directly align with functional status. Functional disability burden was most strongly linked to disability identity (AOR = 3.07 per additional domain, p < 0.001). Survivor's ADA knowledge was largely accurate but was not associated with disability identity or accommodation use. Disability identity was the sole independent factor associated with accommodation-seeking behavior (adjusted OR = 1.65 per one-point increase, p < 0.001), with functional burden attenuated after accounting for identity, suggesting a potential mediating pathway.

Disability identity represents a key mechanism linking functional impairment to survivors' self-advocacy, while legal knowledge alone is insufficient to result in accommodation-seeking behavior without identity recognition and social validation.

Survivorship care might benefit from including ADA education with identity-affirming, survivor-centered resources that address stigma, legitimacy concerns, and barriers to disclosure, particularly for survivors with invisible or fluctuating impairments.