Cognitive outcomes linked to return to work after breast cancer diagnosis
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Cognition appeared associated with likelihood that individuals would return to work 2 years after breast cancer diagnosis, according to results of a case series study.
Prior research showed at least half of patients with breast cancer report cognitive challenges — such as such as difficulties with attention, memory or processing speed — after adjuvant chemotherapy, according to study background. Up to one-quarter are found to have objective cognitive decline.
One study showed 76% of patients with cognitive symptoms reported difficulties returning to work, with related challenges including difficulties with memory or concentration, reduced efficiency, and problems executing or planning their work.
However, no longitudinal studies had been conducted to evaluate the association between cancer-related cognitive impairment and return to work.
Marie Lange, PhD, of the clinical research department at Centre François Baclesse in France, and colleagues conducted their study to evaluate the association between cognition — evaluated using subjective and objective measures — and return to work 2 years after breast cancer diagnosis.
They used the cohort from CANTO — a prospective study conducted in France that assessed treatment-related chronic toxicity among women with stage I to stage III breast cancer — to conduct their case series.
The study cohort included women diagnosed with breast cancer at age 58 years or younger who either were employed or looking for a job.
Return to work 2 years after breast cancer diagnosis served as the main outcome.
All women underwent objective cognitive functioning tests, as well as prospective assessments for cognitive symptoms, anxiety, fatigue and depression, at diagnosis, 1 year after treatment completion and 2 years after diagnosis.
Lange and colleagues used multivariable logistic regression models adjusted for age, stage and diagnosis and other factors to assess return to work status at year 2 according to each cognitive measure.
The analysis included 178 women (median age, 48.7 years; range, 28-58). Thirty-seven (20.8%) had not returned to work at year 2.
Those who returned to work appeared half as likely as those who did not return to have had a mastectomy (24.1% vs. 54.1%; P < .001).
Results showed associations between return to work at 2 years and several outcomes of 2-year assessments. These outcome measures included lower overall cognitive impairment (1-point unit of increased OR [1-pt OR] = 0.32; 95% CI, 0.13-0.79), higher working memory (1-pt OR = 2.06; 95% CI, 1.23-3.59), higher processing speed (1-pt OR = 1.97; 95% CI, 1.2-3.36), higher attention performance (1-pt OR = 1.63; 95% CI, 1.04-2.64), higher perceived cognitive abilities (1-pt OR = 1.12; 95% CI, 1.03-1.21) and lower depression (1-pt OR = 0.83; 95% CI, 0.74-0.93).
Researchers also identified associations between return to work at 2 years and outcomes of assessments performed at baseline and 1 year after treatment completion. These outcomes included higher processing speed (baseline, 1-pt OR = 2.38; 95% CI, 1.37-4.31; 1-year, 1-point OR = 1.95; 95% CI, 1.14-3.5), higher executive performance (baseline, 1-pt OR = 2.61; 95% CI, 1.28-5.75; 1-year, 1-pt OR = 2.88; 95% CI, 1.36-6.28) and lower physical fatigue (baseline, 10-pt OR = 0.81; 95% CI, 0.69-0.95; 1 year, 10-point OR = 0.84; 95% CI, 0.71-0.98).
“Cognitive difficulties should be assessed before return to work to propose suitable management,” Lange and colleagues wrote.
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