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Multicenter Study
. 2025 Nov;14(21):e71306.
doi: 10.1002/cam4.71306.

Employment Status Among Brazilian Women With Estrogen Receptor-Positive Nonmetastatic Breast Cancer

Daniele Assad-Suzuki  1   2 , Luciana Castro Garcia Landeiro  2   3 , Danielle Laperche-Santos  2   4 , Heloisa Resende  2   5 , Fernanda Cesar Moura  1   6 , Sulene Cunha Sousa Oliveira  7 , Andrea Kazumi Shimada  2   8 , Renata Arakelian  2   9 , Anna Luiza Zapalowski Galvão  10 , Bruno Santos Wance de Souza  9 , Amanda Guimarães Castro Custódio  1 , Monalisa Ceciliana Freitas Moreira de Andrade  7 , Yuri Cardoso Rodrigues Beckedorff Bittencourt  8 , Maria Cristina Figueroa Magalhães  2   11 , Cristiano de Pádua Souza  11   12 , Carlos Eduardo Paiva  2   12 , Poliana Albuquerque Signorini  2   13 , Ariane Vieira Carvalho  14 , Daniela Jessica Pereira  15 , Laura Cereser Albaneze  16 , Angélica Nogueira-Rodrigues  2   15   17 , Daniela Dornelles Rosa  2   16   18 , Romualdo Barroso-Sousa  2   19
Affiliations
Multicenter Study

Employment Status Among Brazilian Women With Estrogen Receptor-Positive Nonmetastatic Breast Cancer

Daniele Assad-Suzuki et al. Cancer Med. 2025 Nov.

Abstract

Background: Employment is a critical determinant of quality of life, social reintegration, and financial stability for breast cancer survivors. International studies have shown that return-to-work (RTW) rates vary widely, ranging from 27% to over 80% within the first 3 years postdiagnosis, and are strongly influenced by sociodemographic and systemic factors. In Brazil, however, there is a scarcity of data on employment outcomes after breast cancer, despite pronounced disparities in healthcare access between public and private systems. Understanding these dynamics is crucial to identify vulnerable groups and to inform strategies that promote equitable reintegration into the workforce.

Methods: We conducted a multicenter cross-sectional study including 454 women with nonmetastatic ER+ breast cancer who were employed at diagnosis and receiving endocrine therapy. Employment status, sociodemographic and clinical variables, and quality-of-life scores were collected through patient-reported questionnaires and medical records. Univariate and multivariate generalized logit models were applied.

Results: Among 774 participants, 454 (67.1%) were employed at diagnosis. Of these, 87 (19.2%) continued working during treatment, 233 (51.54%) stopped and returned, and 134 (29.29%) stopped and did not return. Compared with privately treated patients who remained employed, those treated in public hospitals had significantly higher odds of stopping work and returning (OR = 5.93) and of stopping work and not returning (OR = 2.39). Younger age (≤ 60 years) was associated with permanent work interruption (OR = 2.39). Lower education was associated with temporary interruption (OR = 3.12). Treatment duration ≥ 2 years was associated with not returning to work (OR = 2.18).

Conclusions: Treatment in public hospitals, lower education, younger age, and prolonged treatment were associated with a higher risk of job loss. Addressing barriers and fostering workplace adaptations is vital for improving return-to-work rates among cancer survivors, as nearly one-third do not return to work within 2 years postdiagnosis.

Keywords: breast cancer; employment; endocrine therapy; quality of life; return to work.

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Conflict of interest statement

D.A.‐S. received speaker bureau fees from AstraZeneca, Daichi Sankyo, Lilly, Novartis, Merck, and Roche. She has also served as a consultant/advisor to AstraZeneca, Novartis, and Daichi Sankyo. She received support from AstraZeneca, Roche, and Daichi Sankyo for attending the medical conferences. The authors received institutional research funding from Daichi Sankyo and Lilly and Company. L.C.G.L. has served as a consultant/advisor to Daichi Sankyo and AstraZeneca. She received support from Libbs Farmacêutica, Pfizer, and Merck for attending the medical conferences. D.L.‐S. reported receiving speaker bureau fees from AstraZeneca, Daichi Sankyo, Lilly, Merck, and Roche. She has also served as a consultant/advisor for AstraZeneca and Roche and has received support for attending medical conferences from AstraZeneca, Roche, Lilly, Daichi Sankyo, Amgen, Novartis, and Merck. F.C.M. reported receiving speaker bureau fees from AstraZeneca, Daiichi Sankyo, Novartis, Merck, and Roche. B.S.W.S. is the CEO of Oncoliv startup. S.C.S.O. reported receiving speaker bureau fees from AstraZeneca, Daiichi Sankyo, GSK, Novartis, Astellas, and Janssen. She has also served as a consultant/advisor to AstraZeneca and Daiichi Sankyo. She received support from AstraZeneca for attending the medical conferences. A.K.S. has reported receiving speaker bureau fees from AstraZeneca, Daichi Sankyo, Lilly, Novartis, Pfizer, MSD, Janssen, Adium, Pint Pharma, Gilead, and Roche. She has also served as a consultant/advisor to AstraZeneca, Daichi Sankyo, and Pfizer. She received support from Pfizer, Roche, and Daichi Sankyo for attending medical conferences. R.A. reported receiving speaker bureau fees from AstraZeneca, Daiichi Sankyo, Lilly, Novartis, Merck, and Gilead. She has also served as a consultant/advisor for AstraZeneca and Daiichi Sankyo and has received support for attending medical conferences from Novartis and AstraZeneca. Y.C.R.B.B. reported receiving speaker bureau fees from AstraZeneca, Daiichi Sankyo, Novartis, Pfizer, Merck, Adium, and Pint Pharma. M.C.F.M. reported receiving bureau fees from Novartis, Lilly, Bristol‐Myers Squibb, Knight, Merck, Daiichi Sankyo, AstraZeneca, Pint Pharma, GSK, Roche, Gilead, and Adium. She has also served as a consultant/advisor to Novartis, AstraZeneca, Adium, MSD, and Lilly. She has participated as an investigator/subinvestigator in studies sponsored by the pharmaceutical industry. She received support for attending medical conferences from AstraZeneca, Daiichi Sankyo, and Novartis. She is the Vice President of INTES (Instituto de Inovação e Ensino em Saúde) [Institute for Education and Innovation in Health]. P.A.S. received speaker fees from AstraZeneca, Lilly, Pfizer, Novartis, Johnson and Johnson, Takeda, and Adium. A.N.‐R. Received personal honoraria for advisory boards and lectures from AbbVie, AstraZeneca, Daiichi Sankyo, Eisai, Gilead, GSK, Immunogen, Merck, Novartis, Pfizer, Roche; President elect for the Brazilian Society of Medical Oncology (uncompensated); Chair LACOG (uncompensated); Director of Strategic Planning Brazilian Group of Gynecologic Cancer (uncompensated); and Director International Affairs Brazilian Group of Studies in Breast Cancer (uncompensated). D.D.R. reported served as a consultant for Roche, Novartis, AstraZeneca, Lilly, GSK, Sanofi, Libbs, Eisai, Pfizer, Dr. Reddy's, United Medical, and Daiichi Sankyo. She received research funding from Amgen, Roche, GSK, and L'Oréal. She provided expert testimony for Roche, Novartis, Pfizer, AstraZeneca, Lilly, Teva, and Gilead. R.B.‐S. reported receiving speaker bureau fees from Agilant, AstraZeneca, Daichi Sankyo, Lilly, Pfizer, Novartis, Merck, and Roche. He also served as a consultant/advisor for AstraZeneca, Lilly, Libbs, Roche, and Merck and received support for attending medical conferences from AstraZeneca, Roche, Lilly, Daichi Sankyo, and Merck. The authors received institutional research funding from AstraZeneca and Daichi Sankyo. He holds stock in RD Medicine—Educação Médica LTDA. H.R., A.L.Z.G., A.G.C.C., M.C.F.M.A., C.P.S., C.E.P., A.V.C., D.J.P., L.C.A. declares no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Recruitment of patients among the oncology institutions. Public institutions–Noninsured health care: Hospital do Câncer de Barretos, São Paulo (SP). Mackenzie, Paraná (PR). Hospital de Base, DF (Distrito Federal), Liga de Câncer Natal, RN (Rio Grande do Norte), Santa Casa de Misericódia, MG (Minas Gerais). Jardim Amália‐ RJ (Rio de Janeiro), Hospital da Mulher‐SP (São Paulo), CINPAM‐Manaus‐AM (Amazonas). Private institution‐insured health care: Hemolabor‐GO(Goiás), Hospital Sírio Libanês‐ Bsb (Brasília). NOB (Núcleo de Oncologia da Bahia)‐ Salvador, Oncocentro‐ MG (Minas Gerais), Hospital Sírio Libanês‐SP (São Paulo), Hospital Moinhos de Vento‐RS (Rio Grande do Sul).
FIGURE 2
FIGURE 2
Employment status distribution among the complete cohort at diagnosis and in the employed cohort.
See this image and copyright information in PMC

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