Job loss, return to work, and multidimensional well-being after breast cancer treatment in working-age Black and White women

Prognostic factors for return to work in breast cancer survivors

BACKGROUND

Breast cancer is the most common type of cancer in women around the world. Large numbers of people diagnosed with breast cancer are working at the time of diagnosis. Accumulating evidence suggests that breast cancer survivors participate less often in paid work compared to others. Return to work among breast cancer survivors is multifactorial. It is currently unknown which factors are associated with return to work in breast cancer survivors. Therefore, it is important to systematically review and synthesize the literature on the association between sociodemographic, breast cancer-related, other health-related, personal, and work-related factors and return to work in this group of people.

OBJECTIVES

The objective is to systematically review and synthesize the literature on the association between sociodemographic, breast cancer-related, other health-related, personal, and work-related factors and return to work in the 24 months following breast cancer diagnosis among breast cancer survivors having paid work at the time of diagnosis.

SEARCH METHODS

The search strategy included electronic searches in OVID/MEDLINE, Embase.com, EBSCOhost/CINAHL with Full Text, EBSCOhost/PsycINFO, Clarivate Analytics/Web of Science Core Collection and Wiley/Cochrane Library from inception up to 20 January 2023, as well as handsearching references of relevant reviews, included studies, and Google Scholar.

SELECTION CRITERIA

The following inclusion criteria were applied: - The type of study is a prospective cohort study, retrospective cohort study with time lag between assessment of prognostic factor and outcome, or prognosis study based on a randomized controlled trial. - The study sample included people diagnosed with breast cancer, having paid work at the time of their breast cancer diagnosis. - At least one variable as specified in our variable framework was studied. - Return to work (yes/no), or time to return to work was assessed somewhere between one and 24 months of follow-up. - The article type is an original research article (commentaries, reviews, and editorials were excluded). - Full text of the article is available. - The article was published in a peer-reviewed journal.

DATA COLLECTION AND ANALYSIS

Study characteristics and estimates of unadjusted and adjusted associations between one of the variables from the pre-defined variable framework and return to work were extracted. Risk of bias was assessed using the Quality in Prognosis Studies (QUIPS) tool. When at least four adjusted or four unadjusted measures of association (e.g. Odds Ratio (OR)) were available and more or less comparable in terms of how the measures of association were included in the analysis of the original study, a meta-analysis was conducted.

MAIN RESULTS

The systematic searches yielded 14,799 records with 2 identified via other sources. The systematic searches yielded 8486 references after duplicates were removed. We assessed 280 full-text articles for eligibility and excluded 249, including one article that was classified as 'awaiting classification' as it required professional translation. This left 31 articles based on 19 cohorts that fulfilled our inclusion criteria. Seven of the 19 studies could be included in one or more meta-analyses with a total of 2473 participants. All but one study were conducted in either Europe or the USA. The return to work rate ranged from 56% to 88%. From our prespecified variable framework, altogether 35 variables were studied in one or more included studies as prognostic factors. From these, we could combine five factors in the meta-analyses. - We found low-quality evidence that higher age is associated with lower odds of return to work in an adjusted analysis (pooled adjusted OR 0.96, 95% confidence interval (CI) 0.94 to 0.98; 4 studies, 1333 participants). - We found low-quality evidence that lower level of education is associated with lower odds of return to work in an unadjusted analysis (pooled unadjusted OR 0.40, 95% CI 0.29 to 0.55; 4 studies, 1680 participants), but not in an adjusted analysis (pooled adjusted OR 0.60, 95% CI 0.33 to 1.08; 4 studies, 1147 participants). - We found low-quality evidence that not having a partner is not associated with return to work in an unadjusted analysis (pooled unadjusted measures of association: 0.91 95% CI 0.67 to 1.23; 4 studies, 1680 participants). - We found low-quality evidence that receiving chemotherapy was associated with lower odds of return to work in an unadjusted analysis (pooled unadjusted measures of association: 0.48, 95% CI 0.31 to 0.73; 5 studies, 1766 participants). - We found low-quality evidence that receiving radiotherapy is not associated with return to work, respectively (pooled unadjusted measures of association: 1.03, 95% CI 0.64 to 1.17; 4 studies, 1680 participants). Due to the low number of included studies that measured the outcome, time to return to work, it was not possible to pool data of these studies.

AUTHORS' CONCLUSIONS

We found that higher age and receiving chemotherapy may be associated with lower odds of returning to work in breast cancer survivors (low-quality evidence; for chemotherapy, only pooled unadjusted results were available). Results regarding educational level are inconclusive. We furthermore found that there was no statistically significant adjusted association between having a partner and receiving radiotherapy (low-quality evidence; only unadjusted results were available). Further research is warranted to identify those breast cancer survivors who are at higher risk of not returning to work, so that they can receive timely support.

Returning to work after breast cancer: a longitudinal analysis of employment and financial hardship

PURPOSE

This study explored changes in employment and financial hardship following breast cancer diagnosis.

METHODS

We used data from a single-institution, longitudinal study of women with newly diagnosed breast cancer who received curative intent chemotherapy. The primary outcomes of interest in this analysis were breaks in active employment, defined as being out of work for the four weeks prior, and patient-reported acute financial burden during chemotherapy and up to 24 months following chemotherapy completion. Mixed-effects logistic regression models were used to identify factors associated with breaks in employment and financial burden.

RESULTS

The cohort consisted of 104 women who were employed at time of breast cancer diagnosis. The mean age was 49.6 years and 86% were non-Hispanic White, 11% African American or Black, and 4% another race or ethnicity. In multivariable models, African-American women were 168% more likely to report a break from active employment than their non-Hispanic white counterparts (adjusted odds ration [aOR] 2.68; p = 0.026). A break from active employment was not statistically associated with greater self-reported acute financial burden, but patients from the lowest socioeconomic status tertile were 173% more likely to report financial burden than those in the highest tertile (aOR 2.73; p = 0.022).

CONCLUSION

African-American breast cancer survivors were more likely to report breaks from active employment than their White peers, even after adjusting for type of work and socioeconomic status.

IMPLICATION FOR CANCER SURVIVORS

African-American and Black breast cancer survivors may face greater challenges returning to work.

Impact of a Breast Cancer Diagnosis on Finances and Marital Status in Young Women

PURPOSE

A breast cancer diagnosis can impact every aspect of a woman's life, particularly for women diagnosed before age 45 when they are in the process of establishing stability in their personal and professional lives. This study investigated the impact of a breast cancer diagnosis on employment, finances, and personal relationships among young breast cancer survivors.

METHODS

We conducted descriptive statistical analysis of survey data from 315 women diagnosed with breast cancer before age 45. Surveys were administered electronically and included 40 questions on demographics asking about employment, insurance, income, and marital status at two time points: at diagnosis and at the time the survey was completed. Descriptive and regression analyses were conducted. The McNemar-Bowker Test of Symmetry was used to calculate the significance of changes in employment, insurance, income, and marital status at the two time points.

RESULTS

We found significant changes following diagnosis in employment and insurance. Prior to diagnosis, 68.6% of respondents were employed full time, compared to 52.4% following diagnosis - falling from 212 to 162 respondents. Individuals who were unable to work increased by 14.6% after diagnosis, rising from 4 to 49 respondents. The decline in full-time employment was highest among those with a diagnosis of Stage IV cancer (33.9%), with the number of full-time worker respondents falling from 79 to 41. We found a significant change in insurance (p < .001) with a decline in individuals with private or no insurance of 4.7% and 3.4%, respectively, while those with public insurance increased by 8.1%.

CONCLUSION

Our findings suggest that young breast cancer survivors are particularly vulnerable to changes in employment, with more than a tenfold increase in the number of young women who reported being unable to work following diagnosis. Our findings also indicate a significant shift from private to public insurance, particularly for individuals living with Stage IV cancer. These results point to opportunities to address the specific needs of young women diagnosed with breast cancer and improve their overall quality of life.

"Crying in the Wilderness"-The Use of Web-Based Support in Telomere Biology Disorders: Thematic Analysis

BACKGROUND

Web-based information and social support are commonly used in rare disease communities where geographic dispersion and limited provider expertise complicate in-person support. We examined web-based resource use among caregivers of individuals with telomere biology disorders (TBDs), which are rare genetic conditions with long diagnostic odysseys and uncertain prognoses including multiorgan system cancer risk.

OBJECTIVE

This study explored internet-based information-seeking and social support practices and perspectives of patients with TBDs and their caregivers.

METHODS

Our qualitative descriptive study used semistructured interviews of patients with TBDs and caregivers. Data were transcribed verbatim and thematically analyzed by an interdisciplinary team.

RESULTS

A total of 32 adults completed interviews. Participant ages ranged from 27 to 74 years. The majority (n=28, 88%) were female, occupied multiple TBD roles (eg, patient and parent), and had undergone genetic testing. Most engaged in web-based information-seeking (n=29, 91%) and TBD-specific social media (n=26, 81%). Participants found web-based resources useful for information-seeking but reported privacy concerns and frustration with forming supportive relationships. Most participants described ambivalence toward web-based resource use, citing tensions between hunger for information versus distrust, empowerment versus overwhelm, disclosure versus privacy, and accessibility versus connection. Fluctuations in web-based support use arose from perceived harms, information saturation, or decreased relevance over the course of TBD illness experience.

CONCLUSIONS

Individuals with TBDs and their caregivers reported frequent use of web-based informational and emotional support. However, ambivalence about the benefits and liabilities of web-based resources and persistent medical uncertainty may impact the adoption of and adherence to web-based support among patients with TBD and caregivers. Our findings suggest web-based psychosocial support should target long-term and multifaceted informational and emotional needs, be user-initiated, be offered alongside in-person formats, provide expert-informed information, and be attentive to personal privacy and evolving support needs of the TBD community. This study suggests web-based resources will be most effective in the TBD context when they achieve the following features: (1) offer a variety of ways to engage (eg, active and passive), (2) provide privacy protections in moderated "safe spaces" designed for personal disclosure, (3) offer separate venues for informational versus emotional support, (4) combine web-based relationship formation with opportunities for in-person gathering, (5) provide information that is reliable, easy to access, and informed by medical professionals, (6) remain mindful of user distress, and (7) are responsive to variations in levels and types of engagement. Additionally, advocacy organizations may wish to avoid traditional social media platforms when designing safe spaces for web-based emotional support, instead pivoting to internet-based tools that minimize privacy threats and limit the perpetual public availability of shared information.

Factors affecting return to work in breast cancer survivors in Korea: a cross-sectional study

PURPOSE

Return to work (RTW) has been understudied in Asian women with cancer, despite the increasing number of breast cancer survivors (BCS). This study examined RTW among Korean BCS, exploring its associations with cancer-related fatigue, quality of sleep, mental adjustment, and psychosocial factors.

METHODS

This cross-sectional study recruited BCS from a hospital, a breast cancer support group, and an online community in Korea between July and August 2019. We collected data on levels of fatigue, fatigability, quality of sleep, mental adjustment, and quality of working life. The analysis included data from 135 respondents who were employed prior to their cancer diagnosis. Descriptive statistics and multiple logistic regression analyses were conducted.

RESULTS

Although all participants were employed prior to diagnosis, only 57% remained employed afterward. Participants who returned to work reported significant levels of subjective fatigue (102.48±39.84), physical fatigability (28.14±11.34), borderline poor sleep quality (8.57±4.11), anxious preoccupation (23.33±4.54), and low satisfaction with quality of working life (39.68±21.51). Marital status (odds ratio [OR], 3.34; p=.027), time since breast cancer diagnosis (OR, 2.85; p=.028), anxious preoccupation (OR, 0.89; p=.021), and quality of working life (OR, 1.04; p=.010) were found to be predictors of RTW, explaining 34% of the variance.

CONCLUSION

It is critical to address RTW-related difficulties in Korean BCS, and future RTW interventions should target cancer-related fatigue, anxious preoccupation, and quality of working life. Physical and psychosocial support is essential for BCS and their successful RTW.

Returning to Work after Breast Cancer: A One-Year Mixed-Methods Study

Breast cancer (BC) is the most common invasive neoplasm and affects many women of working age. The return to work (RTW) of female survivors (BCSs) is associated with a better quality of life and longer survival. A tailored intervention to promote RTW was launched in 2022. A year later, the women were contacted to find out if RTW had occurred regularly and what their health conditions were compared to the baseline. BCSs reported excessive fatigue, poor sleep quality, anxiety, depression and reduced work ability; these parameters had not improved significantly compared to the baseline. Thematic analysis of the interviews confirmed the presence of personal, company, and societal factors that could hinder or favor RTW. The interviews demonstrated that, even in an economically developed country that has provided numerous benefits for BCSs, protection is not always effective. Personalized intervention seems necessary to complete the process of reintegrating BCSs into their future working careers.

Predictive Models of Psychological Distress, Quality of Life, and Adherence to Medication in Breast Cancer Patients: A Scoping Review

Purpose

An interplay of clinical and psychosocial variables affects breast cancer patients' experiences and clinical trajectories. Several studies investigated the role of socio-demographic, clinical, and psychosocial factors in predicting relevant outcomes in breast cancer care, thus developing predictive models. Our aim is to summarize predictive models for specific psychological and behavioral outcomes: psychological distress, quality of life, and medication adherence. Specifically, we aim to map the determinants of the outcomes of interest, offering a thorough overview of these models.

Methods

Databases (PubMed, Scopus, Embase) have been searched to identify studies meeting the inclusion criteria: a breast cancer patients' sample, development/validation of a predictive model for selected psychological/behavioral outcomes (ie, psychological distress, quality of life, and medication adherence), and availability of English full-text.

Results

Twenty-one papers describing predictive models for psychological distress, quality of life, and adherence to medication in breast cancer were included. The models were developed using different statistical approaches. It has been shown that treatment-related factors (eg, side-effects, type of surgery or treatment received), socio-demographic (eg, younger age, lower income, and inactive occupational status), clinical (eg, advanced stage of disease, comorbidities, physical symptoms such as fatigue, insomnia, and pain) and psychological variables (eg, anxiety, depression, body image dissatisfaction) might predict poorer outcomes.

Conclusion

Predictive models of distress, quality of life, and adherence, although heterogeneous, showed good predictive values, as indicated by the reported performance measures and metrics. Many of the predictors are easily available in patients' health records, whereas others (eg, coping strategies, perceived social support, illness perceptions) might be introduced in routine assessment practices. The possibility to assess such factors is a relevant resource for clinicians and researchers involved in developing and implementing psychological interventions for breast cancer patients.

Supporting Return to Work after Breast Cancer: A Mixed Method Study

Breast cancer (BC) is the most common invasive cancer in the world. Most BC survivors (BCSs) continue working while dealing with cancer-related disabilities. BCSs' return-to-work (RTW) after cancer treatment is an important stage of their recovery and is associated with a higher survival rate. In this study, we addressed the RTW of BCSs with the intention of facilitating this process through direct action in the workplace. Thirty-two women who requested assistance from January to December 2022 were enrolled in the study. Semi-structured interviews and medical examinations were conducted by a team of three physicians. Interviews were analyzed using Thematic Analysis. Moreover, a quantitative cross-sectional study was conducted to compare the health status of BCSs with that of a control group of 160 working women, using standardized questionnaires on work ability, fatigue, sleep problems, anxiety, depression, and happiness. BCSs were also asked to rate the level of organizational justice they perceived at work prior to their illness. From the qualitative analysis emerged three facilitating/hindering themes: (1) person-related factors, (2) company-related factors, and (3) society-related factors. In the quantitative analysis, BCSs had significantly higher scores for anxiety, depression, sleep problems and fatigue, and lower levels of happiness than controls. The RTW of BCSs entails adapting working conditions and providing adequate support. The work-related analysis of each case made it possible to highlight the measures that need to be taken in the workplace to promote RTW. The treatment of cancer should be paired with advice on the best way to regain the ability to work.

Breast cancer and occupation: Non-parametric and parametric net survival analyses among Swiss women (1990-2014)

Introduction

Occupation can contribute to differences in risk and stage at diagnosis of breast cancer. This study aimed at determining whether occupation, along with skill level and the socio-professional category, affect the breast cancer survival (BCS) up to 10 years after diagnosis.

Materials and methods

We used cancer registry records to identify women diagnosed with primary invasive breast cancer in western Switzerland over the period 1990-2014 and matched them with the Swiss National Cohort. The effect of work-related variables on BCS was assessed using non-parametric and parametric net survival methods.

Results

Study sample included 8,678 women. In the non-parametric analysis, we observed a statistically significant effect of all work-related variables on BCS. Women in elementary occupations, with low skill level, and in paid employment not classified elsewhere, had the lowest BCS, while professionals, those with the highest skill level and belonging to top management and independent profession category had the highest BCS. The parametric analysis confirmed this pattern. Considering elementary occupations as reference, all occupations but Craft and related trades had a hazard ratio (HR) below 1. Among professionals, technicians and associate professionals, and clerks, the protective effect of occupation was statistically significant and remained unchanged after adjustment for age, calendar period, registry, nationality, and histological type. After adjusting for tumor stage, the HRs increased only slightly, though turned non-significant. The same effect was observed in top management and independent professions and supervisors, low level management and skilled laborers, compared to unskilled employees.

Conclusion

These results suggest that work-related factors may affect BCS. Yet, this study was conducted using a limited set of covariates and a relatively small study sample. Therefore, further larger studies are needed for more detailed analyses of at risk occupations and working conditions and assessing the potential interaction between work-related variables and tumor stage.

Spatiotemporal Characteristics of Coupling and Coordination of Cultural Tourism and Objective Well-Being in Western China

A supply of high-quality cultural tourism products effectively promotes people's happiness. This study takes the coupling and coordination relationship between cultural tourism (CT) and objective well-being (OWB) in western China as the research object and constructs an index evaluation system for the development levels of cultural tourism and objective welfare, which are divided into three development stages of dysfunctional, transitional, and coordinated development and 10 coordination levels, including high-quality coordination. The entropy weight method, coupled coordination model, Thiel index, standard deviation, and coefficient of variation were used to calculate the comprehensive development index and coupling coordination degree of the CT and OWB systems in western China from 2007 to 2020, and then their evolution characteristics were analyzed from the perspectives of time and space. The results show the following: (1) The comprehensive development capacity of the CT and OWB systems in the western region shows a relatively consistent growth trend except for 2020, the overall development capacity of objective welfare was relatively high, and the development capacity of cultural tourism was relatively low. (2) The CT and OWB systems were in a state of transition from high coupling and low coordination to high coupling and high coordination, which were divided into three development stages: imbalanced stage (2007-2008), transitional stage (2009-2011), and coordinated development (2012-2020). The coordination degree has developed steadily from moderate misalignment to good coordination over time, and the diversified characteristics of coupling coordination levels are obvious. (3) The spatial equilibrium of the CT and OWB systems is obvious, and the spatial difference in the western region is getting smaller, but the relative gap is widening significantly. (4) The comprehensive development capacity of the cultural tourism system should be enhanced, the spiritual needs of residents based on objective well-being should be met, and the sustainable development of the CT and OWB systems.