Impact of Breast Cancer Treatment on Employment: Results of a Multicenter Prospective Cohort Study (CANTO)

Abstract

PURPOSE Adverse effects of breast cancer treatment can negatively affect survivors’ work ability. Previous reports lacked detailed clinical data or health-related patient-reported outcomes (PROs) and did not prospectively assess the combined impact of treatment and related sequelae on employment. METHODS We used a French prospective clinical cohort of patients with stage I-III breast cancer including 1,874 women who were working and ≥ 5 years younger than legal retirement age (≤ 57 years) at breast cancer diagnosis. Our outcome was nonreturn to work (non-RTW) 2 years after diagnosis. Independent variables included treatment characteristics as well as toxicities (Common Toxicity Criteria Adverse Events [CTCAE] v4) and PROs (European Organization for Research and Treatment of Cancer [EORTC] Quality of life Questionnaires, Breast cancer module [QLQ-BR23] and Fatigue module [QLQ-FA12], Hospital Anxiety and Depression Scale) collected 1 year after diagnosis. Logistic regression models assessed correlates of non-RTW, adjusting for age, stage, comorbidities, and socioeconomic covariates. RESULTS Two years after diagnosis, 21% of patients had not returned to work. Odds of non-RTW were significantly increased among patients treated with combinations of chemotherapy and trastuzumab (odds ratio [OR] v chemotherapy-hormonotherapy: for chemotherapy-trastuzumab, 2.01; 95% CI, 1.18 to 3.44; for chemotherapy-trastuzumab-hormonotherapy, 1.62; 95% CI, 1.10 to 2.41). Other significant associations with non-RTW included grade ≥ 3 CTCAE toxicities (OR v no, 1.59; 95% CI, 1.15 to 2.18), arm morbidity (OR v no, 1.59; 95% CI, 1.19 to 2.13), anxiety (OR v no, 1.47; 95% CI, 1.02 to 2.11), and depression (OR v no, 2.29; 95% CI, 1.34 to 3.91). CONCLUSION Receipt of systemic therapy combinations including trastuzumab was associated with increased odds of non-RTW. Likelihood of unemployment was also higher among patients who reported severe physical and psychological symptoms. This comprehensive study identifies potentially vulnerable patients and warrants supportive interventional strategies to facilitate their RTW.

Boosting return to work after breast cancer: The mediator role of perceived emotional intelligence

“…This effect seems to be even more significant in BC survivors, given the physical and psychological comorbidities derived from the disease impact and the administered treatments. 2,3 However, our results were confirmed regardless of the effect of age, suggesting that WA is impaired in BC survivors independently of age. Other direct effects indicated that age decreases EA levels and increase EC values.…”

“…These results are consistent with most of the research that indicates that BC patients present lower RTW rates, especially after chemotherapy. [1][2][3] Mean differences in WA attending to work status seem to corroborate these results. In this way, we did not find differences in WA of the total sample in employed workers and self-employed conditions.…”

“…Our results confirmed previous research indicating that BC survivors who received adjuvant chemotherapy show negative health and functional consequences that remain up to 10 years, undermining the ability to work. 1,3 Regarding sample work status, less than a third of the BC survivors were at the time of the evaluation working. However, 70% of the healthy controls were self-employed and employed workers.…”

Sickness absence and disability pension among swedish women prior to breast cancer relapse with a special focus on the roles of treatment and comorbidity

“…Along with the morbidity of the disease itself, these side effects can impair the physiological and psychological wellness of patients, leading to limitations in their abilities to execute daily activities and participate in social events (Campbell et al, 2012;Shapiro, 2018;Zaidi et al, 2017). In addition, long-term sequelae associated with BC and its treatment, such as anxiety and depression, fatigue, chronic pain, cognitive impairment and peripheral neuropathy, are known to reduce physical, mental and emotional capacity (Bjerkeset et al, 2020;Colombino et al, 2020;De Iuliis et al, 2015;Dumas et al, 2020;Hedayati et al, 2012;Landeiro et al, 2018;Lundh et al, 2014;Rivera et al, 2018;Wefel et al, 2014;Zomkowski et al, 2018). Deterioration in the sense of physical and emotional well-being, and limitations in the functional capacity of patients with BC, negatively affects their quality of life and ability to work (Zaidi et al, 2017).…”

Identification of Robust Immune‐Associated lncRNAs Signature for Immune Checkpoint Blockade and Prognosis in Breast Cancer

“…Breast cancer (BRCA) whose mortality rate ranks second among female malignancies is one of the most common malignancy in women worldwide [1][2][3]. On the basis of the latest global cancer statistics, there was almost 2.1 million newly diagnosed breast cancer patients in 2018, amount to nearly one forth women cancer cases [1].…”