Breast cancer survivors are less likely to have jobs, says a new study published in JAMA (Journal of the American Medical Association) . The report explains that this is especially the case for breast and gastrointestinal cancer survivors.

The authors explain that the long-term effects of cancer and its treatment may impair social functioning, including getting or keeping employment. Nearly a half of all cancer survivors are under 65.

"Many cancer survivors want and are able to return to work after diagnosis and treatment. Relatively few studies have assessed the association of cancer survivorship with unemployment," the researchers write. Several factors can make unemployment more probable, including job discrimination, finding it hard to work while receiving treatment at the same time, as well as physical and/or mental limitations.

Angela G. E. M. de Boer, Ph.D., Coronel Institute of Occupational Health, Academic Medical Center, Amsterdam, The Netherlands, and team carried out a meta-analysis to identify unemployment risks for cancer survivors, compared to healthy control participants.

Alter looking through several databases, they found 26 articles which reported the results from 36 studies - all of them met the criteria in the analysis. This included 16 studies from the USA, 15 from Europe and 5 from other parts of the world. All the studies involved 177,969 participants, 20,366 of whom were cancer survivors, while 157,603 were healthy control participants.

Cancer survivors were 1.37 times more likely to be without a job, compared to the healthy control participants, according to the study (33.8% vs 15.2%). Here are some further figures showing a higher risk of unemployment for cancer survivors, according to cancer type:

-- Breast cancer (35.6% compared to 31.7%)
-- Gastrointestinal cancer ( 48.8% compared to 33.4%)
-- Cancers of the female reproductive organs (49.1% compared to 38.3%)

The researchers did not gather any data on survivors of blood, prostate and testicular cancers.

In countries with a fairly high background unemployment rate, the diference between cancer survivors and healthy participants is smaller.

Seven of the studies indicated that the main factor limiting a survivor´s chances of finding or keeping a job was disability - in fact, disability increased the risk of unemployment by a factor of three.

The authors write "..the mechanism behind the higher unemployment rate among cancer survivors is likely to be a higher disability rate."

The researchers added that physical limitation(s), and/or cancer-related symptoms were the main reasons for survivors not keeping or finding employment.

"Apart from the effects on employment, there are probably long-term effects of cancer on work ability, work capacity, and wage losses for a large group of survivors. Employment outcomes can be improved with innovations in treatment and with clinical and supportive services aimed at better management of symptoms, rehabilitation, and accommodation for disabilities. Moreover, workplace interventions are needed that are aimed at realizing workplace accommodations and paid sick leave during treatment. The development and evaluation of such interventions is urgently needed because they could mitigate the economic impact of surviving cancer and improve the quality of life for survivors," the researchers concluded.

JAMA. 2009;301[7]:753-762.

Written by - Christian Nordqvist and Stephanie Brunner