Occupational Medicine Advance Access originally published online on July 30, 2008
Occupational Medicine 2008 58(7):509-511; doi:10.1093/occmed/kqn092
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Short Reports |
Employment in a cohort of breast cancer patients
1 Department of Oncology, Hospital Principe de Asturias, Madrid, Spain
2 Department of Oncology, Hospital La Paz, Madrid, Spain
3 Department of Rheumatology, Hospital La Paz, Madrid, Spain
4 Department of Statistic, Hospital La Paz, Madrid, Spain
Correspondence to: Raquel Molina Villaverde, Departamento de Oncología Médica, Universidad de Alcalá de Henares, Hospital Universitario Principe de Asturias, Carretera Alcalá-Meco s/n, Alcalá de Henares 28805, Madrid, Spain. Tel: +34 918878100 ext 2363; fax: +34 915791279; e-mail: mvraq{at}hotmail.com
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Abstract |
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Background Breast cancer survivors can have problems in returning to work. However, the importance of work to cancer survivors has until recently received little attention.
Aims To investigate employment- and work-related disability in a cohort of breast cancer patients to identify possible discrimination and other obstacles to remaining in work.
Methods Questionnaire study of breast cancer patients employed at diagnosis and where diagnosis had been confirmed at least 6 months before the interview. Participants completed a questionnaire concerning cancer-related symptoms and work-related factors and clinical details were obtained from their medical records.
Results The study included 96 consecutive patients with breast cancer aged between 18 and 65 years. In total, 80% of patients were unable to work after diagnosis, but 56% returned to work at the end of treatment. The sequelae of the disease or its treatment and the stage of disease were independently associated with the ability to work after the end of treatment. Only one patient did not tell his/her employers and coworkers about his/her disease. In total, 29% noticed changes in their relation with co-workers and managers, usually in the sense that they tried to be helpful. None reported job discrimination.
Conclusion Breast cancer survivors in this study encountered some problems in returning to work, mainly linked to the sequelae of their disease and its treatment rather than to discrimination by employers or colleagues.
Keywords Cancer; occupation; rehabilitation; return to work
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Introduction |
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Breast cancer is the most common cancer among women accounting for approximately one-third of all newly diagnosed malignancies. Decreasing mortality rates mean that more women are becoming long-term survivors.
All types of cancer affect many aspects of quality of life, including work. Returning to work symbolizes a resumption of daily activities and is a major step toward recovery and rehabilitation, so it is important to identify any barriers that prevent survivors from achieving this [1].
In two recent studies, >80% of breast cancer patients returned to work and 87% reported that their employers supported them in doing so [2,3].
The purpose of this study was to identify different factors influencing return to work in a varied group of breast cancer survivors who had been working until the time of diagnosis.
Methods
Patients with a diagnosis of breast cancer were consecutively recruited in the oncology departments of La Paz and Principe de Asturias hospitals, both in Madrid. The study was approved by the Ethical Committee of La Paz Hospital. All patients gave consent to participate.
Eligibility criteria included age between 18 and 65 years, diagnosis of breast cancer at least 6 months earlier and active full-time employment at the time of diagnosis. The upper age limit (65 years) is the normal age of retirement.
Patient assessment involved a questionnaire detailing personal information, cancer-related symptoms and work-related factors and a face-to-face interview in which patients could describe their ideas and experiences. Clinical details were obtained from the medical records.
Potential precdictors of returning to work were chosen from a pilot study performed in La Paz hospital [4].
Completed questionnaires were transferred into a database for statistical analysis. Calculations were performed with Statistical Package for the Social Sciences for PC, version 9.0. Categorical variables were analysed by the chi-squared test or Fisher test and continuous variables were analysed by the Mann–Whitney test. The significance level was set at P < 0.05 and all tests were two tailed.
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Results |
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The questionnaire was completed by 96 consecutive patients.
The mean time since diagnosis was 32.5 months (standard deviation = 26.5 months). The mean age at time of diagnosis was 47 years (range 22–65 years). In total, 62% of patients had some sequelae of the illness or its treatment, most commonly fatigue in 29% of subjects. Lymphedema was present in 22% of the patients. In total, 27% had comorbidity, most commonly endocrine diseases.
At the time of diagnosis, 20% of the patients had continued working. In the analysis, stage IV disease (P < 0.05) and the type of worker (employed versus self-employed) (P < 0.01) predicted sick leave at the beginning of treatment. In contrast, education level, comorbidity and type of job were not related to the ability to keep working.
By the end of treatment, 56% had returned to work. The presence of any kind of sequelae of advanced-stage disease and an objective response to the treatment were significantly associated with continuing sick leave (P < 0.05), whereas gender, treatment, stage I and II disease, co-morbidity and job status were not.
Table 1 summarizes demographic and clinical information and the univariate analysis of returning to work after treatment.
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In total, 18% of the participants kept working throughout cancer treatment and 13% had had some changes in their job or work schedule such as a reduction of hours. In total, 11% had retired after completing treatment.
Ninety-five patients (99%) had told their employers and co-workers about their disease. In total, 29% had noticed changes in their relation with co-workers and managers, usually in the sense that they tried to be helpful. None reported job discrimination.
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Discussion |
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TopAbstractIntroductionResultsDiscussionConflicts of interestReferences |
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Breast cancer can affect many aspects of quality of life, including work. However, the importance of work to cancer survivors has until now received little attention.
In our study of factors influencing return to work in breast cancer patients, the employment rate was 100% at diagnosis, 20% were in employment but on sick leave after cancer diagnosis and 56% had returned to work at the end of treatment. Although there is wide variation in these figures among different studies, our results are consistent with previous research [5,6]. In the review by Spelten et al. [6], the mean rate of return was 62%, ranging from 30% to 93%. In breast cancer patients, an 80% return-to-work rate has been described [3].
In total, 11% of our patients permanently retired after treatment (33% were still on sick leave but intended to resume work). This was associated with the severity of the illness and the sequelae. This percentage may vary depending on the national qualifying criteria for sickness benefits and ill-health retirement [5,7]. The Spanish health system enables people to retire because of a severe chronic disease at any age and this procedure has been prevailing practice, particularly among people approaching the age of 65 years.
Various side-effects were reported; fatigue was the most frequent symptom that resulted in difficulties at work. Fatigue may prevent patients from returning to work [8]. In the study by Spelten et al. [9], cancer-related symptoms had an impact on resumption of work, independent of other clinical and personal predictors.
Nearly all participants told their employers and coworkers about their cancer. Many patients found that their responses were helpful. A recent study concluded that coworkers and supervisor ignorance about cancer and lack of support made returning to work more stressful [10].
Cancer survivors may face problems at work and in order to achieve the best rehabilitation outcomes it is important to identify survivors with such problems and help them with a comprehensive range of clinical and supportive services aimed at better management of disabilities. In some countries, associations of occupational physicians have constructed guidelines for the management of return to work for specific disorders. Such guidelines might be of particular value in promoting best practice in the workplace rehabilitation of cancer patients.
The findings of this study should be interpreted within the scope of the limitations in design, measurement and sampling.
Firstly, although our sample was regional, it is the first study of its kind with breast cancer patients in Spain.
Secondly, the data on employment and social support were self-reported and might not fully reflect family and workplace characteristics. Questions regarding discrimination were subject to patient interpretation.
Finally, we do not have a non-cancer comparison group, so it is not possible to disentangle changes due to other factors from those due to cancer.
We believe, however, that these limitations do not diminish the value to occupational health practitioners and oncologists of the information that may be derived from this exploratory study.
Key points
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Conflicts of interest |
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None declared.
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References |
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- Drolet M, Maunsell E, Brisson J, et al. Not working 3 years after breast cancer: predictors in a population-based study. J Clin Oncol (2005) 23:8305–8312.
[Abstract/Free Full Text] - Maunsell E, Drolet M, Brisson J, et al. Work situation after breast cancer: results from a population-based study. J Natl Cancer Inst (2004) 96:1813–1822.
[Abstract/Free Full Text] - Bouknight RR, Bradley CJ, Luo Z. Correlates of return to work for breast cancer survivors. J Clin Oncol (2006) 24:345–353.
[Abstract/Free Full Text] - Jiménez A, Feliu J, Molina R, et al. Reinserción laboral del paciente neoplásico. Oncología (2000) 23:318–326.[CrossRef]
- Taskila-Abrandt T, Pukkala E, Martikainen R, et al. Employment status of finish cancer patients in 1997. Psychooncology (2005) 14:221–226.[CrossRef][Medline]
- Spelten ER, Spranglers AG, Verbeek J. Factors reported to influence the return to work cancer survivors: a literature review. Psychooncology (2002) 11:124–131.[CrossRef][Medline]
- Bradley CJ, Bednarek HL, Neumark D. Breast cancer survival, work and earnings. J Health Econ (2002) 21:757–759.[CrossRef][Web of Science][Medline]
- Kennedy F. Returning to work following cancer: a qualitative exploratory study into the experience of returning to work following cancer. Eur J Cancer Care (2007) 16:17–25.[CrossRef]
- Spelten ER, Verbeek JHAM, Uitterhoeve ALJ, et al. Cancer, fatigue and the return of patients to work-a prospective cohort study. Eur J Cancer (2003) 39:1562–1567.[CrossRef][Web of Science][Medline]
- Nachreiner NM, Dagher RK, McGovern PM, et al. Successful return to work for cancer survivors. AAOHN J (2007) 55:290–295.[Medline]
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