Impact of adjuvant chemotherapy on long-term employment of survivors of early-stage breast cancer.
BACKGROUND
Many women with early-stage breast cancer are working at the time of diagnosis and survive without disease recurrence. The short-term impact of chemotherapy receipt on employment has been demonstrated, but the long-term impact merits further research.


METHODS
The authors conducted a longitudinal multicenter cohort study of women diagnosed with nonmetastatic breast cancer between 2005 and 2007, as reported to the population-based Los Angeles and Detroit Surveillance, Epidemiology, and End Results program registries. Of 3133 individuals who were sent surveys, 2290 (73%) completed a baseline survey soon after diagnosis and of these, 1536 (67%) completed a 4-year follow-up questionnaire.


RESULTS
Of the 1026 patients aged < 65 years at the time of diagnosis whose breast cancer did not recur and who responded to both surveys, 746 (76%) worked for pay before diagnosis. Of these, 236 (30%) were no longer working at the time of the follow-up survey. Women who received chemotherapy as part of their initial treatment were less likely to be working at the time of the follow-up survey (38% vs 27%; P = .003). Chemotherapy receipt at the time of diagnosis (odds ratio, 1.4; P = .04) was found to be independently associated with unemployment during survivorship in a multivariable model. Many women who were not employed during the survivorship period wanted to work: 50% reported that it was important for them to work and 31% were actively seeking work.


CONCLUSIONS
Unemployment among survivors of breast cancer 4 years after diagnosis is often undesired and appears to be related to the receipt of chemotherapy during initial treatment. These findings should be considered when patients decide whether to receive adjuvant chemotherapy, particularly when the expected benefit is low.
Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
Reshma
R
Jagsi
Sarah T
ST
Hawley
Paul
P
Abrahamse
Yun
Y
Li
Nancy K
NK
Janz
Jennifer J
JJ
Griggs
Cathy
C
Bradley
John J
JJ
Graff
Ann
A
Hamilton
Steven J
SJ
Katz
D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D003625:Data Collection; D004651:Employment; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D012042:Registries; D018426:SEER Program; D011795:Surveys and Questionnaires; D017741:Survivors
Epidemiology; Surveillance; and End Results (SEER); breast cancer; chemotherapy; employment; survey; survivorship; work