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. 2020 Oct;28(10):4677-4686.
doi: 10.1007/s00520-020-05312-4. Epub 2020 Jan 18.

A longitudinal analysis of phenotypic and symptom characteristics associated with inter-individual variability in employment interference in patients with breast cancer

Raymond Javan Chan  1   2   3 , Bruce Cooper  4 , Bogda Koczwara  5 , Alexandre Chan  6   7 , Chia Jie Tan  6   7 , Steven M Paul  4 , Laura B Dunn  8 , Yvette P Conley  9 , Kord M Kober  4 , Jon D Levine  10 , Christine Miaskowski  11
Affiliations

A longitudinal analysis of phenotypic and symptom characteristics associated with inter-individual variability in employment interference in patients with breast cancer

Raymond Javan Chan et al. Support Care Cancer. 2020 Oct.

Abstract

Purpose: A breast cancer diagnosis has a substantial economic impact. Study aims were to evaluate for inter-individual differences in cancer's level of interference with employment and identify phenotypic and symptom characteristics associated with higher levels of interference.

Methods: Patients (n = 387) were enrolled prior to breast cancer surgery and followed for 12 months. Interference with employment was measured using a 0 (no problem) to 10 (severe problem) numeric rating scale. Hierarchical linear modeling (HLM) was used to evaluate for inter-individual differences in trajectories of employment interference and characteristics associated with employment interference at enrollment and over 12 months.

Results: Patients' mean age was 55.0 (±11.7) years and the majority underwent breast conservation surgery (80.6%). Mean employment interference score was 3.2 (±3.7). Unconditional model for employment interference demonstrated a decreasing linear trend (-.076/month). Younger age, lower income, higher pain intensity, and having an axillary lymph node dissection were associated with higher pre-surgical interference scores. Having a sentinel lymph node biopsy was associated with ongoing employment interference scores. Higher sleep disturbance scores were associated with both initial and ongoing employment interference scores. Receipt of chemotherapy, use of complementary or alternative therapies, and re-excision or mastectomy following surgery were significant time varying covariates.

Conclusion: This study is the first to use HLM to describe inter-individual differences in the trajectories of cancer's interference with employment and associated factors prior to and for 12 months following breast cancer surgery. Patients with the identified risk factors warrant ongoing assessments of employment interference and appropriate referrals.

Keywords: Breast cancer; Employment; Financial toxicity; Hierarchical linear modeling; Interference; Symptom burden.

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Conflict of interest statement

Conflict of Interest - The authors declare no conflicts of interest. The authors had full control over the data and will allow the journal to review our data if requested to do so.

Figures

Figure 1.
Figure 1.
Trajectory of cancer’s interference with employment (A) and influence of age (B), income (C), axillary lymph node dissection (D), and pain (E) on inter-individual differences in the intercept parameters for cancer’s interference with employment.
Figure 2.
Figure 2.
Influence of sentinel lymph node biopsy (A) and sleep disturbance (B) on inter-individual differences in the slope parameters for cancer’s interference with employment.
See this image and copyright information in PMC

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