Employment Changes Following Breast Cancer Diagnosis: The Effects of Race and Place

Abstract

The financial implications of breast cancer diagnosis may be greater among rural and black women. Women with incident breast cancer were recruited as part of the Carolina Breast Cancer Study. We compared unadjusted and adjusted prevalence of cancer-related job or income loss, and a composite measure of either outcome, by rural residence and stratified by race. We included 2435 women: 11.7% were rural; 48.5% were black; and 38.0% reported employment changes after diagnosis. Rural women more often reported employment effects, including reduced household income (43.6% vs 35.4%, two-sided χ2 test P = .04). Rural white, rural black, and urban black women each more often reported income reduction (statistically significant vs. urban white women), although these groups did not meaningfully differ from each other. In multivariable regression, rural differences were mediated by socioeconomic factors, but racial differences remained. Programs and policies to reduce financial toxicity in vulnerable patients should address indirect costs of cancer, including lost wages and employment.

Figure 1.

Employment effects following breast cancer diagnosis by urban or rural status. The statistical significance of the differences between urban and rural were assessed using a two-sided X² test; results are weighted to account for designed oversampling. Bars represent 95% confidence intervals.

Figure 2.

Adjusted difference in cancer-related employment effects relative to white women. Unfilled bars indicate unadjusted risk difference; filled bars represent differences after adjusting for [Panel A] clinical characteristics (age, stage at diagnosis, comorbidity burden, and receipt of chemotherapy, radiation, adjuvant endocrine therapy, Herceptin, and surgery) or [Panel B] clinical and socioeconomic characteristics (household income, educational attainment, employment sector, insurance source, and marital status). Statistical significance of the difference from urban white women was assessed using a two-sided Wald test. * P < .05; † P < .01; ‡ P < .001.