Objective This study aimed to explore cancer survivors' level of patient activation, ie, their knowledge, skills, and confidence for self‐management, and to examine its relations to their participation in paid work and work‐related problems. Methods A total of 524 Dutch cancer survivors, 208 younger than 65 years, completed the Patient Activation Measure (PAM‐13) and the Research and Development (RAND‐36) General Health scale. Cancer survivors younger than 65 years also reported on their participation in paid work and work‐related problems. Results The mean PAM‐13 score of cancer survivors was 58.1, and of those younger than 65 years 58.7. Patient activation was not associated with participation in paid work. Employed cancer survivors with a low level of patient activation experienced more problems working accurately (34% vs 17%), finishing their work (47% vs 22%), and concentrating (59% vs 31%) than those with a higher level of patient activation. The former group also reported more work stress (62% vs 28%). Conclusions Patient activation of cancer survivors deserves more attention, as a substantial proportion of these survivors have low activation levels, which relate to more work‐related problems. Longitudinal studies are needed to explore the development of patient activation over time and its potential to improve important outcomes for people living with cancer in both the health and work domains.