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Multicenter Study
. 2014 Jun 15;120(12):1854-62.
doi: 10.1002/cncr.28607. Epub 2014 Apr 28.

Impact of adjuvant chemotherapy on long-term employment of survivors of early-stage breast cancer

Reshma Jagsi  1 , Sarah T Hawley, Paul Abrahamse, Yun Li, Nancy K Janz, Jennifer J Griggs, Cathy Bradley, John J Graff, Ann Hamilton, Steven J Katz
Affiliations
Multicenter Study

Impact of adjuvant chemotherapy on long-term employment of survivors of early-stage breast cancer

Reshma Jagsi et al. Cancer. .

Abstract

Background: Many women with early-stage breast cancer are working at the time of diagnosis and survive without disease recurrence. The short-term impact of chemotherapy receipt on employment has been demonstrated, but the long-term impact merits further research.

Methods: The authors conducted a longitudinal multicenter cohort study of women diagnosed with nonmetastatic breast cancer between 2005 and 2007, as reported to the population-based Los Angeles and Detroit Surveillance, Epidemiology, and End Results program registries. Of 3133 individuals who were sent surveys, 2290 (73%) completed a baseline survey soon after diagnosis and of these, 1536 (67%) completed a 4-year follow-up questionnaire.

Results: Of the 1026 patients aged < 65 years at the time of diagnosis whose breast cancer did not recur and who responded to both surveys, 746 (76%) worked for pay before diagnosis. Of these, 236 (30%) were no longer working at the time of the follow-up survey. Women who received chemotherapy as part of their initial treatment were less likely to be working at the time of the follow-up survey (38% vs 27%; P = .003). Chemotherapy receipt at the time of diagnosis (odds ratio, 1.4; P = .04) was found to be independently associated with unemployment during survivorship in a multivariable model. Many women who were not employed during the survivorship period wanted to work: 50% reported that it was important for them to work and 31% were actively seeking work.

Conclusions: Unemployment among survivors of breast cancer 4 years after diagnosis is often undesired and appears to be related to the receipt of chemotherapy during initial treatment. These findings should be considered when patients decide whether to receive adjuvant chemotherapy, particularly when the expected benefit is low.

Keywords: Epidemiology; Surveillance; and End Results (SEER); breast cancer; chemotherapy; employment; survey; survivorship; work.

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Figures

Figure 1
Figure 1. Flow of Patients into the Study
This figure depicts the flow of patients into the study from those initially identified to the final analytic sample.
Figure 2
Figure 2. Employment Outcomes
This figure depicts the proportion of women working prior to diagnosis, at the time of the baseline survey (approximately 9 months after diagnosis, “the initial treatment period”), and at the time of the follow-up survey (approximately four years later, “the survivorship period”), by chemotherapy receipt.
Figure 3
Figure 3. Impact of Employment Status
This figure demonstrates, by current employment status, the perceptions of long-term breast cancer survivors regarding their insurance status and financial status. Bars represent the proportion of survivors who report being worse off at the time of the follow-up survey (approximately four years after diagnosis).
See this image and copyright information in PMC

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