Many women wish to continue with paid employment after being diagnosed with early stage breast cancer. But a new study suggests that a large number of breast cancer patients lose employment after diagnosis and that the type of treatment they receive may be to blame.
According to the research team, led by Dr. Reshma Jagsi of the University of Michigan Health System, more than 225,000 women are diagnosed with invasive breast cancer in the US every year. Most of these women are working age and survive through retirement age.
In the short-term, employment loss is common among breast cancer patients, as treatment schedules and side effects can take their toll. But the researchers say there is little known about the long-term effects of cancer treatment on paid employment.
To investigate further, the team analyzed 2,290 women who had been diagnosed with nonmetastatic breast cancer between 2005 and 2007.
All patients completed surveys shortly after diagnosis, which asked them about paid employment, financial issues and other quality-of-life factors. Of these women, 1,536 completed an additional 4-year follow-up questionnaire, of which 1,026 were under the age of 65.
Initial chemotherapy 'puts patients at higher risk of unemployment'
The researchers found that of the patients under 65 who completed both surveys and whose breast cancer did not recur, 746 (76%) were in paid employment prior to their breast cancer diagnosis.
But from the 4-year follow up survey, it was revealed that 236 (30%) of these patients were no longer working.
From looking at the cancer treatment these women received, those who had chemotherapy as part of their initial treatment were less likely to be in paid employment at the 4-year follow-up, compared with those who did not receive chemotherapy as their first treatment.
The researchers calculated that women who underwent chemotherapy at the time of breast cancer diagnosis were 1.4 times more likely to be unemployed following treatment.
The team found that of the women who were not in paid employment after receiving chemotherapy, 50% said that they felt it was important for them to work and 31% said they were actively seeking work.
Commenting on these findings, Dr. Jagsi says:
"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."
She says it is important to create strategies that identify breast cancer patients who may gain little benefit from chemotherapy, and therefore, may be able to avoid the treatment.
"We also need to ensure that patients who are deciding on whether to receive chemotherapy understand the potential long-term consequences of receiving treatment," she adds, "including possible implications for their employment and financial outcomes."
However, the team points out that their study has several limitations. For example, they focused on patients from two large metropolitan areas in the US - Los Angeles and Detroit. This could limit the generalizability of their findings to other populations, particularly to those who reside in more rural areas.
The researchers note that their findings were based on patients' self reporting, which could have been biased. But they note that because of the study context, "evidence supports the validity of self-report."
In addition, the team says they did not have access to full chemotherapy regimens of patients, meaning they were unable to determine whether certain approaches may have had a greater impact on employment than others.
This is not the first study to raise concerns about employment for cancer patients. In 2009, a study published in JAMA found that survivors of breast and gastrointestinal cancers are less likely to be employed, compared with healthy control participants.