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Aggressive breast cancer surgeries increase likelihood of missed work
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Aggressive surgery treatments for breast cancer increased a patient’s likelihood of missing more than 1 month of work or stopping work altogether, according to results of a population-based survey.
Women who underwent bilateral mastectomy with reconstruction had eight times increased risk for missing over 1 month of work than patients who underwent lumpectomy, the research showed.
“The impact of treatment on employment and finances is a consideration that women may wish to take into account when weighing the pros and cons of various surgical options they are considering,” Reshma Jagsi, MD, DPhil, associate professor and deputy chair of radiation oncology at University of Michigan Medical School, said in a press release. “This study helped to quantify the impact of this decision on the employment and financial experiences of those women soon after diagnosis.”
Research has yielded mixed results regarding the effect of breast cancer diagnosis and treatment on employment. Awareness of the burden of cancer treatment also has increased.
Jagsi and colleagues used the SEER registries of Georgia and Los Angeles Counties to identify diagnosed with stage 0 to stage II breast cancer between 2014 and 2015. The researchers surveyed 3,672 women about employment status currently and before diagnosis.
The analytic sample included 1,006 women (48% white; 55% aged 51-65 years).
Researchers used multivariate models to determine correlation of missed work for more than 1 month or stopping work altogether vs. missing work for less than 1 month. Patient-reported missed work related to breast cancer or its treatment served as the primary dependent variable of interest.
Sixty-two percent of women underwent lumpectomy, 16% unilateral mastectomy (8% with reconstruction) and 23% bilateral mastectomy (19% with reconstruction). In addition, 33% received chemotherapy.
A majority of patients (84%) reported working full-time before diagnosis. Of these, only 50% held jobs that offered paid sick leave, 39% had disability benefits and 38% had a flexible work schedule. At the time of the survey, 65% of women reported full-time employment and 15% reported part-time employment after diagnosis.
Surgical treatments strongly correlated with missing more than 1 month of work (OR for bilateral mastectomy with reconstruction vs. lumpectomy = 7.8; 95% CI, 4.5-13.4) and stopping work altogether (OR = 3.1; 95% CI, 1.6-5.9).
Chemotherapy receipt also increased likelihood of missing more than 1 month of work (OR = 1.3; 95% CI, 0.8-2) and stopping altogether (OR = 3.9; 95% CI, 2.6-5.8).
Further, race correlated with missed work (P = .01), with black patients being more likely than white patients to miss more than 1 month of work (OR = 2; 95% CI, 1.3-3.2) or stop altogether (OR = 1.7; 95% CI, 1.1-2.8).
Patients with paid sick leave (OR = 0.5; 95% CI, 0.3-0.7) and a flexible work schedule (OR = 0.3; 95% CI, 0.2-0.5) appeared less likely to stop working. Patients with a flexible work schedule also appeared less likely to miss more than 1 month of work (OR = 0.7; 95% CI, 0.5-1).
Conversely, patients with disability benefits appeared more likely to stop working (OR = 1.6; 95% CI, 1-2.4) or miss more than 1 month of work (OR = 2.7; 95% CI, 1.8-3.9).
Among women who missed more than 1 month of work, 29% reported a loss of more than $5,000 in income.
“Our results show that treatment has a profound effect on returning to work in the modern era despite improvements in symptom control and changes in social policy,” the researchers wrote.
Practical actions by clinicians — such as reducing the overuse of aggressive treatments — should also be taken into consideration, they noted.
“In particular, when patients are being counseled about surgical treatment options, the potential impact on employment outcomes and the financial impact quantified in this study merit discussion to ensure that patients make choices fully informed about potential consequences,” the researchers wrote.
Disclosures: Jagsi reports grants from the Doris Duke Foundation, the Greenwall Foundation and NIH unrelated to the study. Please see the full study for a list of all other authors’ relevant financial disclosures.
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