Return to work after breast cancer diagnosis: An observational prospective study in Brazil

Abstract

BACKGROUND:In North America and Europe, return-to-work (RTW) rates vary among breast cancer (BC) survivors, from 24% to 66% and from 53% to 82% at 6 and 36 months after diagnosis, respectively. To date, there is a lack of data on RTW rates after BC diagnosis in Latin America. Therefore, the primary objectives of this study were to define RTW rates at 12 and 24 months after BC diagnosis and to identify the factors associated with RTW in this population. METHODS: In total, 125 employed women from a single institution with newly diagnosed BC were interviewed by telephone at 6, 12, and 24 months after diagnosis. Those who had inoperable or metastatic disease were excluded. RESULTS: Overall, RTW rates were 30.3% and 60.4% at 12 and 24 months after BC diagnosis, respectively. Most women reported that they received support from their employer, but only 29.1% reported having been offered work adjustments. In multivariate analysis, the factors associated with positive RTW outcomes included higher household income (odds ratio [OR], 17.76; 95% confidence interval [CI], 3.33-94.75; P = .001), breast-conserving surgery (OR, 9.77; 95% CI, 2.03-47.05; P = .004), and work adjustments (OR, 37.62; 95% CI, 2.03-47.05; P = .004). The factors associated with negative RTW outcomes included adjuvant endocrine therapy (OR, 0.11; 95% CI, 0.02-0.74; P = .023), and depression diagnosed after BC (OR, 0.07; 95% CI, 0.01-0.63; P = .017). CONCLUSIONS: RTW rates in the current study were lower than those observed in developed countries but similar to the rates among low-income Americans. Workplace adjustments, higher income, breast-conserving surgery, endocrine therapy, and depression after BC played an important role in the RTW decision. Cancer 2018;124:4700-4710.

Long-term work retention after treatment for cancer: a systematic review and meta-analysis

“…Of the 21 studies, six were undertaken in the USA [29,31,35,47,48,51], three in the Netherlands [43,54,56], two each in Brazil [39,55], Canada [36,40], France [44,52], and Norway [33,38], and one each in Ireland [46], Israel [34], Sweden [37], and UK [28]. Fourteen studies were cross-sectional [28, 31, 34, 38, 40, 43, 44, 46-48, 51, 52, 55, 56], five were prospective [29,33,35,36,39], and two contained both crosssectional and prospective elements [37,54]. Four studies included external comparison groups: one recruited controls matched to cases [40], two selected comparison populations from existing panel or labor market surveys [48,52], and one used administrative data to identify the population without cancer [36].…”

“…Eleven studies used a population-based cancer registry [28,31,35,40,43,46,47] or administrative data [34,36,44,52] as the sampling frame for survivors, with the other ten studies recruiting from hospital or clinical sources [29, 33, 37-39, 48, 51, 54-56]. In eight studies, survivors of a variety of cancers were included [28,31,36,43,44,48,51,52]; six studies included only breast cancer survivors [29,34,35,37,39,40] [46,55,56]; two included colorectal cancers only [47,54]; one included hematological cancers only [38]; and one included prostate cancer only [33]. Sample sizes ranged from 53 to 2597, with 14,207 survivors included in total.…”

“…The mean age of survivors varied from 42 to 61 years. Work retention was described in terms of working in 16 studies ("working" in 10 studies [28,29,33,34,36,39,43,44,46,51]; "returned to work" in three [37,48,56]; "paid labour resumption" in one [54]; "no longer working" in one [35]; "unable to work" in one [55]) and in terms of employment in five studies ("employed" in four studies [31,38,47,52]; and "unemployed" in one [40]).…”

“…Of the non-comparative studies, for which the maximum possible score was 16, ten scored ≤ 8 [28,34,38,43,44,46,47,51,55,56] and seven scored 9 or more [29,31,33,35,37,39,54] (Supplementary Table S2). The four studies with a comparison population scored in the range 12-15 out of a maximum score of 24 [36,40,48,52].…”

“…Seven studies investigated patient-related, clinical, and/or work-related risk factors for work retention among longterm cancer survivors and analyzed them in a multivariate analysis [28,29,35,39,40,52,55] (Table 2).…”