Breast Cancer Chemotherapy Linked to Unemployment Risk

Adjuvant chemotherapy may reduce the likelihood of returning to work after breast cancer treatment

medwireNews: Clinicians should consider the long-term impact of treatment decisions on employment status when caring for early-stage breast cancer patients, US researchers suggest.

The investigators, led by Reshma Jagsi, from the University of Michigan in Ann Arbor, found that receipt of adjuvant chemotherapy was associated with a 1.4-fold increased risk of loss of paid work 4 years after treatment.

“Many clinicians believe that although patients may miss work during treatment, they will ‘bounce back’ in the longer term,” the team writes in Cancer.

“The results of the current study suggest otherwise and highlight a possible adverse consequence of adjuvant chemotherapy.”

Using data from the Los Angeles and Detroit Surveillance, Epidemiology, and End Results registries, the researchers followed up 1026 patients who were aged less than 65 years at the time of non-metastatic breast cancer diagnosis.

At baseline, 76% of patients reported being in paid work but 30% of these patients were no longer employed at follow-up 4 years later, Reshma Jagsi et al say.

Multivariate analysis showed that adjuvant chemotherapy was a significant and independent predictor of unemployment (odds ratio [OR]=1.42), alongside older age (OR=1.42 for ≥56 vs <46 years), having two or more comorbidities versus none (OR=2.16) and lack of employment support (OR=1.33).

Of concern, 55% of the 127 patients who had not worked since their breast cancer diagnosis stated that it was important for them to be working, and 39% were actively seeking employment. Unemployment was associated with poor insurance and financial status.And there was no significant difference in these responses for patients who did and did not receive adjuvant chemotherapy, the team notes.

“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,” the authors say, citing the potential for neuropathy, neurocognitive deficits and the downstream effects of missed work due to the acute toxicity of side effects.


R Jagsi, S Hawley, P Abrahamse, Y Li, et al. Impact of Adjuvant Chemotherapy on Long-Term Employment of Survivors of Early-Stage Breast Cancer. Cancer 2014; Advance online publication April 28. doi: 10.1002/cncr.28607

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