title: Breast cancer and early retirement: Associations with disease characteristics, treatment, comorbidity, social position and participation in a six-day rehabilitation course in a register-based study in Denmark.
abstract: BACKGROUND
  The purpose of this register-based study was to identify factors related to disease, treatment, sociodemographics and comorbidity associated with taking early retirement among women treated for breast cancer, and to evaluate the risk for taking early retirement among breast cancer survivors who attended a six-day rehabilitation course.
  
  
  METHODS
  The study population consisted of 856 women who attended the rehabilitation course and a comparison group of 1 805 women who did not attend the course identified through the Danish Breast Cancer Cooperative Group. We obtained information on receipt of unemployment benefits, sickness benefits and early retirement pension for each of the years 1996-2007. Multivariate cox-regression models were used to analyze disease-specific, treatment-related, comorbidity and sociodemographics factors associated with early retirement after breast cancer and to evaluate the effect of attending a rehabilitation course on taking early retirement.
  
  
  RESULTS
  The rate of retirement was higher for women with somatic comorbidity (hazard ratio [HR], 1.91; 95% CI, 1.3; 2.9 for score 1, and HR 1.42; 95% CI, 0.7; 2.7 for score ≥2), previous depression (HR, 2.29; 95% CI, 1.7; 3.2) or having received sickness benefits in the year before their breast cancer diagnosis (HR, 3.75; 95% CI, 1.8; 7.8). Living with a partner was associated with a reduced hazard ratio for taking early retirement (HR, 0.70; 95% CI, 0.5-0.9). Having received chemotherapy, alone or in combination with anti-hormone treatment, reduced the hazard ratio (HR, 0.49; 95% CI, 0.3; 0.8 and HR, 0.5; 95% CI, 0.3; 0.8, respectively). The rate of retirement was higher for women the year after attending the rehabilitation course but returned to unity by three years.
  
  
  CONCLUSIONS
  The results of this study contribute to the identification of at-risk women and point to the need for tailored rehabilitation to avoid unnecessary marginalization of breast cancer survivors due to permanent labor market withdrawal.
authors.affiliation: Institute for Cancer Epidemiology, Copenhagen, Denmark. damkjaer@cancer.dk
authors.forename: Lars Henrik
authors.initials: LH
authors.lastname: Damkjaer
authors.forename: Isabelle
authors.initials: I
authors.lastname: Deltour
authors.forename: Nis Palm
authors.initials: NP
authors.lastname: Suppli
authors.forename: Jane
authors.initials: J
authors.lastname: Christensen
authors.forename: Niels T
authors.initials: NT
authors.lastname: Kroman
authors.forename: Christoffer
authors.initials: C
authors.lastname: Johansen
authors.forename: Susanne Oksbjerg
authors.initials: SO
authors.lastname: Dalton
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001943:Breast Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000534:rehabilitation* / Q000628:therapy; D015897:Comorbidity; D003479:Curriculum; D003718:Denmark / Q000453:epidemiology; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D010353:Patient Education as Topic; D010358:Patient Participation; D012042:Registries; D012179:Retirement / Q000706:statistics & numerical data; D012923:Social Class; D013997:Time Factors