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Chemo for Breast Cancer Tied to Long Unemployment | Breast Cancer Arabia
  • Chemo for Breast Cancer Tied to Long Unemployment

    Chemo for Breast Cancer Tied to Long Unemployment

    Almost one third of early-stage breast cancer survivors who were working when they began treatment were unemployed 4 years later, according to a new longitudinal American study.
     

    And chemotherapy was significantly associated with a heightened risk for that long-term unemployment.
     

    “Loss of employment is a possible long-term negative consequence of chemotherapy that may not have been fully appreciated to date,” said lead study author Reshma Jagsi, MD, DPhil, associate professor of radiation oncology at the University of Michigan Medical School, in a press statement.
     

    The study, published online today in Cancer, involved 1536 women with early-stage breast cancer in Detroit and Los Angeles between 2005 and 2007. They responded to an initial survey at 9 months after their diagnosis, and a follow-up survey was conducted 4 years later.
     

    Among 746 women working at the time of diagnosis (first survey), 236 (30%) were no longer working 4 years later (second survey).
     

    Women who received chemotherapy were 1.4 times more likely to be unemployed 4 years later than women who did not (odds ratio, 1.4; P = .04), report the authors from their multivariate analysis.
     

    The authors also report that many of the unemployed women wanted to work: 50% reported that employment was important and 31% were actively seeking work.
     

    However, chemotherapy was not the only patient/clinical characteristic associated with unemployment in the study.
     

    Nor was it the most potent.
     

    Women who had 2 or more comorbidities at the time of diagnosis were 2.16 times more likely to be unemployed at 4 years than women with no comorbidities (odds ratio, 2.16; P < .001).  

    Age > 56 years at diagnosis (compared with < 45 years; odds ratio, 1.4; P = .03) and not having an employer with sick leave or flexible schedule (compared with having such support; odds ratio, 1.33; P = .01) were also significantly associated with increased long-term unemployment risk.  

    A host of factors were not negative risks, including breast surgery type, geographic location, marital status, receipt of radiation, income, and stage of disease.
     

    The study results add to a limited literature on the long-term outcomes of chemotherapy for breast cancer and employment (many more have reported on 1-year outcomes).
     

    “Few studies to date have examined the long-term impact of chemotherapy on employment outcomes,” say the authors. There are 3 other long-term studies, of which 2 report a negative impact and 1 does not.
     

    The authors believe that their study underreports the negative impact of chemotherapy on paid-work outcomes.
     

    They point out that, when the first survey (38 pages long) was sent out 9 months after a diagnosis, the sickest patients may not have had the energy and focus to respond. Thus, the 1536 women who completed both surveys probably were overrepresented by healthier responders.
     

    The authors believe that clinicians should be aware of just how negatively influential chemotherapy can be.
     

    “Many clinicians believe that although patients may miss work during treatment, they will ‘bounce back’ in the longer term. The results of this study suggest otherwise,” Dr. Jagsi said.
     

    “Better strategies” are needed to identify patients who might “omit chemotherapy because the marginal benefit is small,” the authors write.
     

    Patients have a lot to deal with to get back into the job market, suggested a journalist in a recent blog post.
     

    Debra Sherman, a reporter with Reuters who recently died of lung cancer, relayed a post she saw on the career Web site LinkedIn post: “If you think it is tough finding work for the average Joe, imagine what it is like for the cancer survivor. How do you explain the gap in your resume? You lie, of course.”
     

    Cancer. Published online April 28, 2014

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