Sustainable return to work among breast cancer survivors

Abstract

Purpose: This study assessed sustainable return to work (SRTW) of breast cancer survivors (BCS).

Methods: We used data from the prospective French cohort, CANTO. We included 1811 stage I-III BCS who were <57 years old and employed at the moment of diagnosis and working 2 years after diagnosis. Using logistic regression, we investigated the role of clinical, health and socio-economic factors, and the work environment on SRTW 3 years after diagnosis. We compared having any sick leave with having worked continuously and being unemployed to having worked continuously between 2 and 3 years after diagnosis.

Results: Overall, 77% (n = 1395) worked continuously after return to work (RTW). Out of the other 416 BCS, 66% had any sick leave period, 33% had been unemployed, 4% had an early retirement, 2% a disability and 1% another status (multiple situations possible). Being on sick leave was associated with age > 50 (OR = 0.59; 95%CI = 0.43-0.82), stage III (2.56; 1.70-3.85), tumour subtype HR+/HER2+ (0.61; 0.39-0.95), severe fatigue (1.45; 1.06-1.98), workplace accommodations (1.63; 1.14-2.33) and life priorities (0.71; 0.53-0.95). Unemployment was associated with age > 50 (0.45; 0.29-0.72), working in the public sector (0.31; 0.19-0.51), for a small company (3.00; 1.74-5.20) and having a fixed-term contract (7.50; 4.74-11.86).

Conclusions: A high number of BCS have periods of sick leave or unemployment after RTW. The determinants differ between sick leave and unemployment.

Implications for cancer survivors: BCS need to be supported even after RTW, which should be regarded as a process.

Keywords: breast cancer; cohort; employment; epidemiology; quality of life.

FIGURE 1

Timeline of data collection for the CANTO cohort. Dx, diagnosis; PRO, Patient‐reported outcome. T1, T2 and T3 correspond to approximately 1, 2 and 3 years after diagnosis. *Treatment lasted 6–9 months and T1 took place 3–6 months after treatment was completed.

FIGURE 2

Flow chart of the study population from CANTO cohort participants. *Visit not expected: <1 year has elapsed since last visit. BC, breast cancer; dx, diagnosis; T1, T2 and T3, 1, 2 and 3 years post‐diagnosis. **1671 had information on whether they had any sick leave between T2 and T3, and 1530 had information on whether they had any period of unemployment between T2 and T3.