A new study has found that loss of paid employment after a diagnosis of early-stage breast cancer may be common and potentially related to the type of treatment patients received. Published early online in Cancer, a peer-reviewed journal of the American Cancer Society, the findings support efforts to reduce the side effects and burden of treatments for breast cancer and to identify patients who may forego certain treatments, particularly when the expected benefit is low.
Many women with early-stage breast cancer are working at the time of diagnosis and survive without cancer recurrence. Therefore, it's important to understand the impacts of chemotherapy on early-stage breast cancer survivors' employment. Reshma Jagsi, MD, of the University of Michigan Health System, and her colleagues studied 2290 women in the Los Angeles and Detroit areas who were diagnosed with nonmetastatic breast cancer between 2005 and 2007 and who completed surveys soon after diagnosis; 1536 of the women also completed a four-year follow-up questionnaire.
Of the 1026 patients under age 65 at diagnosis whose breast cancer did not recur and who responded to both surveys, 746 (76 percent) worked for pay before diagnosis. Of these, 236 (30 percent) were no longer working at follow-up. Women who received chemotherapy as part of initial treatment were less likely to be working at the four-year follow-up than women who were not treated with chemotherapy (38 percent vs 27 percent). Calculations showed that women who received chemotherapy at the time of diagnosis were 1.4-times more likely to be subsequently unemployed. Many women who were not employed after treatment wanted to work: 50 percent reported that it was important for them to work and 31 percent were actively seeking work.
"Many clinicians believe that although patients may miss work during treatment, they will 'bounce back' in the longer term. The results of this study suggest otherwise and highlight a possible long-term adverse consequence to adjuvant chemotherapy that may not have been fully appreciated to date," said Dr. Jagsi. She stressed the need to continue to develop strategies to identify patients who receive little benefit from chemotherapy and might be able to avoid it. "We also need to ensure that patients who are deciding on whether to receive chemotherapy understand the potential long-term consequences of receiving treatment, including possible implications for their employment and financial outcomes," she said.
"Impact of adjuvant chemotherapy on long-term employment of early-stage breast cancer survivors." Reshma Jagsi, Sarah T. Hawley, Paul Abrahamse, Yun Li, Nancy K. Janz, Jennifer J. Griggs, Cathy Bradley, John J. Graff, Ann S. Hamilton, and Steven J. Katz. Cancer; Published Online: April 28, 2014 DOI: 10.1002/cncr.28607