Breast Cancer Survivors Vulnerable to Long-Term Work Loss

Breast cancer survivors who stop working during chemotherapy may face the loss of long-term employment for several years after their diagnosis, according to the preliminary findings of a Surveillance Epidemiology and End Results (SEER) registry survey presented at ASCO.

The researchers found that missed paid work during breast cancer treatment is common. They reported that 24% of patients from a population-based sample in Los Angeles missed more than 1 month of work and 32% stopped working altogether after their diagnosis.

The team surveyed a diverse, population-based sample of 2245 women with nonmetastatic breast cancer reported to the Detroit and Los Angeles SEER registries over a 19-month period (7/05-2/07) and merged these data to SEER.

The patients were initially surveyed 9 months after diagnosis and again 4 years later. The survey data were then merged with SEER. The team examined patterns and correlates of paid work for a preliminary sample of 760 patients aged <65 years whose cancer did not recur using chi-squared tests and logistic regression.

“Our principal dependent variable was long-term work loss, which we defined as working prior to diagnosis but not working four years later,” noted the study’s lead author, Reshma Jagsi, MD, DPhil, associate professor in the Department of Radiation Oncology at the University of Michigan in Ann Arbor.

Nurses Perspective

Increased Survivorship Introduces Challenges With Cancer in the Workplace

Sandra Magee-Evans, RN, MSN, OCN®

Clinical Breast Nurse Specialist

Mercy Suburban Hospital, Norristown, PA

Breast care management and breast cancer detection have undergone dramatic changes over the last 20 to 30 years. Survivorship has increased because women are increasingly diagnosed with early-stage disease. Treatment is focused on curing the disease and preventing relapse due to metastatic disease. According to the American Cancer Society, the overall 5-year survival rate for local/regional disease is now >80%. Additionally, women are taking better care of themselves overall through improved nutrition, exercise, and rehabilitation. All of this and the increase in technology have led to the treatment of women who are more likely to be part of the workforce.

For some women, the diagnosis of breast cancer may impose an economic hardship because they often need to take a leave of absence from work, especially during chemotherapy treatment. This will affect not only the cancer survivor, but her entire family as well. Return to work after breast cancer is important, not only from a societal point of view, but also for the rehabilitation of the cancer survivor. Moreover, returning to or maintaining employment after a cancer diagnosis is important for survivors’ quality of life, including physical, spiritual, and emotional. It seems clear from the study presented at ASCO that further development and evaluation is needed to support women with breast cancer returning to work and the obstacles they will encounter.

A total of 539 patients (71%) reported working prior to diagnosis. Of this group, 172 (33%) were not working 4 years later.

The researchers univariate analysis uncovered that long-term work loss was significantly associated with chemotherapy during initial treatment (40% with chemotherapy vs 26% without), as well as those who were older, Latina, less educated, had comorbidities, or received mastectomy. Jagsi reported that tumor behavior (in situ vs invasive), marital status, and radiation receipt were not associated with work loss.

The researchers’ multivariate analysis— controlling for age, marital status, tumor behavior, comorbidity, race, mastectomy receipt, and radiation receipt&mdash;found that chemotherapy receipt at the time of diagnosis was independently associated with work loss (odds ratio, 2.4; P = .004). The excess long-term work loss observed for women who received chemotherapy began soon after diagnosis: Compared with women who did not get chemotherapy, women who did were much more likely to report stopping work 2 years ago or more (34% vs 16%).

Jagsi said that breast cancer survivors were more likely to experience long-term work loss if they were older, had 2 or more comorbidities, lacked employment support, received chemotherapy at the time of diagnosis, and they lived in Detroit as opposed to Los Angeles. She noted that most women who were not working at the time of re-interview wanted to work: 59% (97/165) reported that it was important for them to work and 27% (46/168) were actively looking for work.

“The oncology community may wish to explore targeted employment support interventions for patients who plan to receive chemotherapy and whose jobs do not include sick leave or flexible scheduling,” said Jagsi. Abstract 9007