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. 2024 Aug 1;7(8):e2427576.
doi: 10.1001/jamanetworkopen.2024.27576.

Cognition and Return to Work Status 2 Years After Breast Cancer Diagnosis

Marie Lange  1   2 , Justine Lequesne  1   2 , Agnes Dumas  3 , Bénédicte Clin  1   4 , Ines Vaz-Luis  5 , Barbara Pistilli  6 , Olivier Rigal  7   8 , Christelle Lévy  9 , Florence Lerebours  10 , Anne-Laure Martin  11 , Sibille Everhard  11 , Gwenn Menvielle  5 , Florence Joly  1   2   12
Affiliations

Cognition and Return to Work Status 2 Years After Breast Cancer Diagnosis

Marie Lange et al. JAMA Netw Open. .

Abstract

Importance: Return to work after breast cancer (BC) treatment depends on several factors, including treatment-related adverse effects. While cancer-related cognitive impairment is frequently reported by patients with BC, to date, no longitudinal studies have assessed its association with return to work.

Objective: To examine whether cognition, assessed using objective and subjective scores, was associated with return to work 2 years after BC diagnosis.

Design, setting, and participants: In a case series of the French Cancer Toxicities (CANTO) cohort, a study of patients with stage I to III BC investigated cognition from April 2014 to December 2018 (2 years' follow-up). Participants included women aged 58 years or younger at BC diagnosis who were employed or looking for a job.

Main outcomes and measures: The outcome was return to work assessed 2 years after BC diagnosis. Objective cognitive functioning (tests), cognitive symptoms, anxiety, depression, and fatigue were prospectively assessed at diagnosis (baseline), 1 year after treatment completion, and 2 years after diagnosis. Multivariable logistic regression models were used to explain return to work status at year 2 according to each cognitive measure separately, adjusted for age, occupational class, stage at diagnosis, and chemotherapy.

Results: The final sample included 178 women with BC (median age: 48.7 [range, 28-58] years), including 37 (20.8%) who did not return to work at year 2. Patients who returned to work had a higher (ie, professional) occupational class and were less likely to have had a mastectomy (24.1% vs 54.1%; P < .001). Return to work at year 2 was associated with lower overall cognitive impairment (1-point unit of increased odds ratio [1-pt OR], 0.32; 95% CI, 0.13-0.79; P = .01), higher working memory (1-pt OR, 2.06; 95% CI, 1.23-3.59; P = .008), higher processing speed (1-pt OR, 1.97; 95% CI, 1.20-3.36; P = .01) and higher attention performance (1-pt OR, 1.63; 95% CI, 1.04-2.64; P = .04), higher perceived cognitive abilities (1-pt OR, 1.12; 95% CI, 1.03-1.21; P = .007), and lower depression (1-pt OR, 0.83; 95% CI, 0.74-0.93; P = .001) at year 2 assessment. Return to work at year 2 was associated with several measures assessed at baseline and year 1: higher processing speed (1-pt OR, 2.38; 95% CI, 1.37-4.31; P = .003 and 1.95; 95% CI, 1.14-3.50; P = .02), higher executive performance (1-pt OR, 2.61; 95% CI, 1.28-5.75; P = .01, and 2.88; 95% CI, 1.36-6.28; P = .006), and lower physical fatigue (10-pt OR, 0.81; 95% CI, 0.69-0.95; P = .009 and 0.84; 95% CI, 0.71-0.98; P = .02).

Conclusions and relevance: In this case series study of patients with BC, return to work 2 years after diagnosis was associated with higher cognitive speed performance before and after BC treatment. Cognitive difficulties should be assessed before return to work to propose suitable management.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Vaz-Luis reported receiving nonfinancial support to the institution from Pfizer, AstraZeneca, Novartis, and Amgen, and grants from Resilience outside the submitted work. Dr Pistilli reported receiving grants to the institution from AstraZeneca, Gilead, Seagen, Novartis, Lilly, MSD, and Daiichi-Sankyo; and personal fees from Daiichi-Sankyo, AstraZeneca, Pfizer, and MSD outside the submitted work. Dr Lerebours reported receiving personal fees from Astra Zeneca, Gilead, Novartis, Lilly, and Seagen; and nonfinancial support from Daiichi-Sankyo, MSD, and Pfizer outside the submitted work. Dr Joly reported receiving grants from Ruban rose outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Patient Flowchart
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References

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