The report, appearing Wednesday in The Journal of the American Medical Association, is an analysis of previously published studies. After accounting for variations in data among those studies, it concluded that cancer survivors in the United States and Europe were 37 percent more likely to be unemployed than healthy peers. In the United States, where it is particularly critical for survivors to hold on to jobs, because they provide health insurance, cancer patients may be at even greater risk of unemployment than patients in Europe, the study suggested.

Lori Siegel did not even wait for her hair to grow back. Still feeling the effects of radiation treatments, she sent her résumé to potential employers, bought a new suit and a wig that does not look like a wig, and started going on job interviews.

But so far there have been no offers, and she is convinced that the nine-month gap in her work history gives her away. "It's like I'm hiding something awful because I got sick," said Ms. Siegel, 51, who lives on Long Island and is recovering from breast cancer. "I don't want to bring it up, but I don't want to lie."

For Ms. Siegel and many other cancer survivors, money is tight and going back to work a financial necessity. But one of the first big analyses to examine employment rates among American and European cancer survivors has found that they are at significantly higher risk for joblessness than healthy counterparts.

The report, appearing Wednesday in The Journal of the American Medical Association, is an analysis of previously published studies. After accounting for variations in data among those studies, it concluded that cancer survivors in the United States and Europe were 37 percent more likely to be unemployed than healthy peers. In the United States, where it is particularly critical for survivors to hold on to jobs, because they provide health insurance, cancer patients may be at even greater risk of unemployment than patients in Europe, the study suggested.

"This issue is so important to patients, because they often regard returning to work as indicative of complete recovery," said the study's chief author, Angela G.E.M. de Boer of the Coronel Institute of Occupational Health, in Amsterdam. "Employment is associated with a higher quality of life, and encouraging survivors to return to work also benefits aging societies economically."

Although the study did not explore the reasons for high unemployment, Dr. de Boer speculated that disability played a leading role. Many survivors, she said, may simply be unable to return to work.

She urged businesses and other employers to adopt policies more accommodating to cancer survivors, like additional breaks and flexibility in work hours and tasks.

Nancy Redwine, a 49-year-old cancer survivor in Santa Cruz, Calif., said she had to quit her job at a local newspaper a few years ago after being diagnosed with metastatic breast cancer. "I was just really sick," she said. "I had a really stressful job, and I just couldn't do it. I was totally overwhelmed, and I didn't know how much longer I had to live."

She lived on credit cards for several years and eventually had to declare bankruptcy, she said.

"Cancer used to be a disease that occurred after you retired, because that's when you were diagnosed," said Cathy J. Bradley, a health economist at Virginia Commonwealth University Massey Cancer Center who has studied employment among cancer patients. "Now patients are getting that diagnosis early on, which is a good thing. . . .But I don't think they or their employers are prepared for the tradeoff, which is that someone may be out of work for a long time."

The new study is one of several recent reports focusing on the financial burdens of cancer. A report earlier this month by the American Cancer Society and the Kaiser Family Foundation reported that even privately insured patients struggle to pay for cancer care and often end up in debt, declaring bankruptcy, and foregoing or postponing needed treatment. They may face steep out-of-pocket costs because of annual caps on benefits and co-pays from frequent doctors' visits. And if patients have to stop working, they often have to make a steep monthly payment for extended coverage, which can easily cost $1,000 a month, at the same time their income is reduced.

"You think you're okay when you have insurance, but then when you get something like cancer, you discover there are a lot of holes in your insurance," said Christie Schmidt, senior director of policy with the American Cancer Society and a co-author of the report.

For example, an insurance policy may cover up to ten radiation treatments over the course of a year, Ms. Schmidt noted, while the course of therapy for breast cancer may involve seven weeks of treatment.

According to the University Medical Center at the University
of Groningen in the Netherlands researchers, the damage to
the heart from some cancer drugs is a well known fact but
this is the first long-term study to track the effects of cancer
drugs on the heart that might occur years later.

As a resut of this study, researchers recommend that all
patients treated with drugs known as anthracyclines have
life-long heart function monitoring. They emphasis, even
with the study findings, that doxorubicin is a highly effective
cancer treatment. In addition, today's cancer patients tend
to receive lower doses of these cancer drugs, and
cardioprotective drugs, such as dexrazoxane, were not
available to cancer patients in the past.