Over 40% of people are working age when they are diagnosed with cancer¹ and this proportion is increasing due to a growing emphasis on early diagnosis, improved treatment outcomes, and rising retirement ages.² When someone stops working because of cancer, society loses their contribution to the economy. 

People contribute to the economy through paid work and through unpaid activities such as housework, caring for relatives or volunteering. This loss is known as lost productivity, and can be valued in monetary terms to provide an important perspective on the burden of disease in society. 

Previous research has estimated the lost productivity due to cancer in Ireland to be €510 million annually.³ However, patterns of cancer are changing in Ireland and worldwide. For example, the ageing population means that cancers common in older people will become more prevalent. At the same time, people will continue working longer, and so cancer in the workplace will become more common.  

Therefore it is important to not only understand the burden of disease in the current population, but also the burden of disease in the future, in order to implement policies and allocate resources that meet the challenges of these projected changes.

Counting the cost

Our study estimated the lost productivity due to cancer in Ireland between 2011 and 2030. We estimated the years that people would have been able to continue in paid work or doing unpaid activities if they had not died of cancer, and valued them using the average wage. 

Our study included people dying from all adult cancers, as well as from the 20 highest mortality adult cancers in Ireland in 2011. We then repeated this analysis for each year to 2030, taking into account predicted future trends in cancer mortality, population demographics and economic indicators such as wages and unemployment levels using data from the Central Statistics Office.

We estimate that there will be approximately 233,000 deaths from cancer in Ireland between 2011 and 2030. These deaths will result in lost productivity valued at €73 billion in total, rising from €2.3 billion in 2011 to €5.4 billion in 2030 (see Figure 1). 

To put these losses into perspective, they represent approximately 1.4% of Ireland’s gross domestic product (GDP) and the annual productivity losses are almost double those estimated for cardiovascular disease in Ireland. These projections can inform investment decisions at a time of ageing populations, increasing cancer incidence and later retirement.

Figure 2 shows that lung (€14.4 billion), colorectal and breast cancer (€8.3 billion each) were the most expensive cancers overall, because they are the most common.

Lung cancer results in the highest paid productivity losses (€2.4 billion), which is almost twice as costly as the next cancers – colorectal and breast cancers (€1.3 billion each). The same cancers are most costly for household production: lung (€12 billion), breast and colorectal (€7 billion each).

However, when the number of people affected was taken into account, cancers of the testis (€364,000 per death), cervix (€155,000 per death) and brain (€136,000 per death) were the most expensive because they affect younger people who are often in the workforce. 

These results highlight that measures of lost productivity can be a valuable complement to estimates of incidence and mortality when considering priorities for cancer care, as less common cancers may still place a significant burden of disease on society.

Reducing the €73 billion lost

Of the total loss, only 18% (€13 billion) was a result of lost paid work. The remaining €60 billion was attributable to unpaid activities, such as housework, caring for relatives and volunteering activities. These unpaid activities have rarely been included in estimates of the cancer burden in Europe, and we highlight the importance of these roles in obtaining a complete picture of lost productivity.

Dr Alison Pearce, lead researcher on the study, explains, “We know cancer places a large burden on individual patients and their families. This work shows that there is also a burden for the Irish economy. By estimating how much productivity is lost because of cancer we can inform policymakers and health services about priorities for cancer care and research in the future.”

One of the unique aspects of this study is the projection of productivity losses into the future. This is particularly useful for cancer where prevention is a key component of control. Estimating future productivity loss highlights the importance of prevention, to inform the healthcare resource allocation debate. 

The study found that if Ireland could reduce cancer deaths by 1% per year then the economy would save €8.5 billion over 20 years. This 1% reduction would be consistent with trends over the past 20 years in Ireland.⁴ Ireland needs to do more than rely on continuing improvements in cancer treatment outcomes. 

A number of strategies to reduce cancer mortality through prevention, early detection and reduced inequalities are possible. In terms of prevention, Ireland continues to have higher rates of tobacco use than many other European countries. Our research suggests that further work to prevent people taking up smoking, and encouraging people to quit smoking could result in significant economic benefits for the community. 

In addition, the recently launched school-based HPV vaccine programme has had high uptake in Ireland. This should result in a significant reduction in cervical cancer rates in Ireland in the future, particularly if the programme was extended to also cover boys.⁵

Recent developments in cancer screening programmes within Ireland also show promise for reducing cancer mortality rates. National breast screening is relatively new in Ireland, so the full benefits have not yet been realised. A new screening programme for colorectal cancer has also recently been introduced⁶ and there is potential for spiral CT to be used for high-risk lung cancer screening.⁷

Finally, reducing inequalities in cancer diagnosis, management and prevention for those in lower socio-economic groups, with lower education levels or with comorbidities could significantly improve cancer mortality.^8,9

Looking to the future

Ireland is changing rapidly in many ways, including demographics, economics, and health. In this context, it is no longer enough for policymakers to understand what is happening now; it is also vital to think about what will happen in the future. 

Cancer rates are increasing as the population ages and cancer will become increasingly common in the workplace. This means that cancers that are less common overall but affect people during their working years will increasingly be important targets for prevention and control activities. 

Although our study only examined the loss associated with cancer mortality, individuals who take time off work during or after their cancer treatment also result in lost productivity to the economy. As the MacMillan report on specialist work support for people with cancer notes, for cancer survivors, returning to work can be an integral part of rehabilitation.²

As well as being a financial necessity for many, work can provide confidence and a sense of normalcy. Returning to the workforce provides opportunities for social relationships, and can give cancer patients and survivors a sense of satisfaction and an improved quality of life. 

As well as being good for the individual, it is also good for the economy. However, returning to work can be difficult due to issues such as ongoing side-effects of cancer or its treatment, and a lack of support from employers. 

Despite this, less than 2% of cancer patients access specialist return to work services.² Further work examining lost productivity among cancer survivors is certainly warranted. Measures of disease burden, such as incidence, mortality and lost productivity, can be used to inform how resources are allocated to cancer prevention and control. By considering the likely changes of cancer burden in the future, such as the increasing burden of cancer in older people, and the rise of cancer in the workplace, policymakers can plan programmes accordingly.

This work was funded by the Health Research Board Ireland, through an Interdisciplinary Capacity Enhancement Award to Alison Pearce.

References

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2. Macmillan Cancer Support. Making the shift: Providing specialist work support to people with cancer. Macmillan Cancer Support [Internet]; 2013. Available from: http://www.macmillan.org.uk/documents/getinvolved/campaigns/workingthroughcancer/making-the-shift-specialist-work-support-for-people-with-cancer.pdf
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