Job loss, return to work, and multidimensional well-being after breast cancer treatment in working-age Black and White women

Abstract

Purpose: Breast cancer survivorship has improved in recent decades, but few studies have assessed the patterns of employment status following diagnosis and the impact of job loss on long-term well-being in ethnically diverse breast cancer survivors. We hypothesized that post-treatment employment status is an important determinant of survivor well-being and varies by race and age.

Methods: In the Carolina Breast Cancer Study, 1646 employed women with primary breast cancer were longitudinally evaluated for post-diagnosis job loss and overall well-being. Work status was classified as "sustained work," "returned to work," "job loss," or "persistent non-employment." Well-being was assessed by the Functional Assessment of Cancer Therapy (FACT-G) instrument. Analysis of covariance was used to evaluate the association between work status and well-being (physical, functional, social, and emotional).

Results: At 25 months post-diagnosis, 882 (53.6%) reported "sustained work," 330 (20.1%) "returned to work," 162 (9.8%) "job loss," and 272 (16.5%) "persistent non-employment." Nearly half of the study sample (46.4%) experienced interruptions in work during 2 years post-diagnosis. Relative to baseline (5-month FACT-G), women who sustained work or returned to work had higher increases in all well-being domains than women with job loss and persistent non-employment. Job loss was more common among Black than White women (adjusted odds ratio = 3.44; 95% confidence interval 2.37-4.99) and was associated with service/laborer job types, lower education and income, later stage at diagnosis, longer treatment duration, and non-private health insurance. However, independent of clinical factors, job loss was associated with lower well-being in multiple domains.

Conclusions: Work status is commonly disrupted in breast cancer survivors, but sustained work is associated with well-being. Interventions to support women's continued employment after diagnosis are an important dimension of breast cancer survivorship.

Implications for cancer survivors: Our findings indicate that work continuation and returning to work may be a useful measure for a range of wellbeing concerns, particularly among Black breast cancer survivors who experience greater job loss.

Keywords: Breast cancer; Employment; Health-related quality of life; Job loss; Racial disparities; Return to work; Well-being.

Figure 1

Flow diagram of participants’ working status from baseline (5-months after diagnosis) and 25-months after diagnosis. Green node (n=882) indicates “sustained work”; blue node (n=330) indicates “return to work”; purple node (n=162) indicates “job loss”; and orange node (n=272) indicates “persistent non-employment”. The primary difference between the ‘job loss’ and ‘return to work’ categories is that at the 25-month interview, the ‘job loss’ category still had not reported resumption of employment.