Factors influencing changes in employment among women with newly diagnosed breast cancer.
BACKGROUND
Although studies have demonstrated that women are less likely to work after they are diagnosed with breast cancer, the influence of cancer treatments on employment is less clear. The authors of this report assessed whether chemotherapy or radiation therapy was associated with a disruption in employment during the year after a breast cancer diagnosis.


METHODS
Using a database of health insurance claims that covered 5.6 million US residents, 3,233 women aged <or=63 years were identified who were working full time or part time when they were diagnosed with breast cancer between 1998 and 2002. All changes in employment during the year after a breast cancer diagnosis were identified. Using a Cox proportional hazards model that incorporated time-varying treatment variables, the authors evaluated the impact of chemotherapy and radiation therapy on the likelihood of experiencing an employment disruption.


RESULTS
Although most women (93%) continued to work, chemotherapy recipients were more likely than nonrecipients to go on long-term disability, stop working, or retire (hazards ratio, 1.8; P < .01). Women aged >or=54 years were more likely to experience a change in employment than women aged <or=44 years (P < .01). Radiation therapy did not influence employment (P = .22).


CONCLUSIONS
In this population of employed, insured women, chemotherapy had a negative impact on employment. This finding may aid treatment decision making and could foster the development of interventions that support a patient's ability to continue working after treatment. It also reinforces the need to assess the impact of treatments, especially new treatments, on patient-centered outcomes such as employment.
Hassett
Michael J
MJ
Center for Outcomes and Policy Research, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, USA. mhassett@partners.org
O'Malley
A James
AJ
Keating
Nancy L
NL
D000328:Adult; D000367:Age Factors; D000970:Antineoplastic Agents / Q000009:adverse effects; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*; D004651:Employment; D005260:Female; D006801:Humans; D008875:Middle Aged; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D000970:Antineoplastic Agents