Risk of employment separation among workers with head and neck cancer: a longitudinal cohort study in Turin

Returning to work after cancer offers important psychological and economic benefits. However, individuals with head and neck (H&N) cancer face a higher risk of leaving the workforce due to the functional consequences of treatments. This study examined the association between H&N cancer and job separation within 2 years of diagnosis and identified patient profiles at higher risk.

An integrated database was created by linking the Turin Longitudinal Study, the regional Mandatory Communications archive, and the national INPS archive. Incident H&N cancer cases were identified through hospital discharge records, and employment status was defined using occupational data. Each worker with H&N cancer was matched with four cancer-free workers of similar sociodemographic characteristics (non-cases). Patient profiles were defined through latent class analysis. Robust Poisson models were used to estimate the risk of job separation.

Between 2008 and 2020, 255 employed individuals were diagnosed with H&N cancer. They showed a twofold higher risk of job separation compared with matched non-cases (RR = 2.00, 95% CI: 1.59-2.51). Some profiles were more likely to exit the workforce, particularly workers with more severe disease (RR = 2.14, 95% CI: 1.04-4.42) or with lower education and higher socioeconomic deprivation (RR = 1.74, 95% CI: 1.02-2.95).

H&N cancer diagnosis substantially increases the likelihood of job separation, particularly among socioeconomically disadvantaged workers.

Identifying vulnerability profiles is essential for developing targeted return-to-work strategies. Integrated health and administrative data can support tailored interventions that better address survivors' long-term employment needs.