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Multicenter Study
. 2017 Dec 15;123(24):4791-4799.
doi: 10.1002/cncr.30959. Epub 2017 Oct 9.

Treatment decisions and employment of breast cancer patients: Results of a population-based survey

Reshma Jagsi  1 , Paul H Abrahamse  2 , Kamaria L Lee  1 , Lauren P Wallner  3 , Nancy K Janz  4 , Ann S Hamilton  5 , Kevin C Ward  6 , Monica Morrow  7 , Allison W Kurian  8 , Christopher R Friese  9 , Sarah T Hawley  10 , Steven J Katz  11
Affiliations
Multicenter Study

Treatment decisions and employment of breast cancer patients: Results of a population-based survey

Reshma Jagsi et al. Cancer. .

Abstract

Background: Many patients with breast cancer work for pay at the time of their diagnosis, and the treatment plan may threaten their livelihood. Understanding work experiences in a contemporary population-based sample is necessary to inform initiatives to reduce the burden of cancer care.

Methods: Women who were 20 to 79 years old and had been diagnosed with stage 0 to II breast cancer, as reported to the Georgia and Los Angeles Surveillance, Epidemiology, and End Results registries in 2014-2015, were surveyed. Of the 3672 eligible women, 2502 responded (68%); 1006 who reported working before their diagnosis were analyzed. Multivariate models evaluated correlates of missing work for >1 month and stopping work altogether versus missing work for ≤1 month.

Results: In this diverse sample, most patients (62%) underwent lumpectomy; 16% underwent unilateral mastectomy (8% with reconstruction); and 23% underwent bilateral mastectomy (19% with reconstruction). One-third (33%) received chemotherapy. Most (84%) worked full-time before their diagnosis; however, only 50% had paid sick leave, 39% had disability benefits, and 38% had flexible work schedules. Surgical treatment was strongly correlated with missing >1 month of work (odds ratio [OR] for bilateral mastectomy with reconstruction vs lumpectomy, 7.8) and with stopping work altogether (OR for bilateral mastectomy with reconstruction vs lumpectomy, 3.1). Chemotherapy receipt (OR for missing >1 month, 1.3; OR for stopping work altogether, 3.9) and race (OR for missing >1 month for blacks vs whites, 2.0; OR for stopping work altogether for blacks vs whites, 1.7) also correlated. Those with paid sick leave were less likely to stop working (OR, 0.5), as were those with flexible schedules (OR, 0.3).

Conclusions: Working patients who received more aggressive treatments were more likely to experience substantial employment disruptions. Cancer 2017;123:4791-9. © 2017 American Cancer Society.

Keywords: breast cancer; chemotherapy; employment; job; mastectomy; work.

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Figures

Figure 1
Figure 1
Flow diagram of study participants
Figure 2
Figure 2
Amount of work lost by breast cancer surgical treatment This figure depicts marginal probabilities of missed work by surgical treatment, derived from a multivariable model adjusting for age, stage, co-morbidities, health status, chemotherapy, radiotherapy, ALND, race, education, marital status, geographic site, employment status, job benefits, income, and household size, weighted to reflect sampling and response rates.
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