Breast cancer-related mortality in Central and Eastern Europe: years of life lost and productivity costs

BACKGROUND

Breast cancer (BC) poses a public health challenge as the most commonly diagnosed cancer among women globally. While BC mortality has declined across Europe in the past three decades, an opposite trend has been reported in some transitional European countries. This analysis estimates the mortality burden and the cost of lost productivity due to BC deaths in nine Central and Eastern Europe (CEE) countries: Bulgaria, Croatia, Czech Republic, Hungary, Poland, Romania, Serbia, Slovakia, and Slovenia, that have defied the favorable cancer mortality trends. These estimates may provide relevant evidence to aid decision-makers in the prioritization of BC-targeted policies.

METHODS

The human capital approach (HCA) was used to estimate years of life lost (YLL) and productivity losses due to premature death from BC (ICD-10 code: C50 Malignant neoplasm of breast). YLL and present value of future lost productivity (PVFLP) were calculated using age and gender-specific mortality, wages, and employment rates. Data were sourced from the World Health Organization (WHO), Eurostat, and the World Bank.

RESULTS

In 2019, there were 19,726 BC deaths in the nine CEE countries. This study estimated BC deaths resulted in 267,184 YLL. Annual PVFLP was estimated to be €85 M in Poland, €46 M in Romania, €39 M in Hungary, €21 M in Slovakia, €18 M in Serbia, €16 M in Czech Republic, €15 M in Bulgaria, €13 M in Croatia, and €7 M in Slovenia.

CONCLUSION

Premature death from BC leads to substantial YLL and productivity losses. Lost productivity costs due to premature BC-related mortality exceeded €259 million in 2019 alone. The data modeled provide important evidence toward resource allocation priorities for BC prevention, screening, and treatment that could potentially decrease productivity losses. Careful consideration should be given to BC-specific policies, such as surveillance programs and the availability of new treatments in CEE countries to decrease the medical and financial burden of the disease.

An integrative review: Women's psychosocial vulnerability in relation to paid work after a breast cancer diagnosis

AIM

The aim of this integrative review was to explore psychosocial vulnerabilities in women after a breast cancer diagnosis that are related to their paid work.

DESIGN

The review methodology was guided by Whittemore and Knafl. The Mehnert Cancer Survivorship and Work Model provided a lens through which to view vulnerability in working women with a focus on facilitating interventions to improve both recovery and work outcomes.

DATA SOURCES

PUBMED, CINAHL, Web of Science, and PsycNET databases were searched for English language papers published between January 2014-June 2020.

REVIEW METHODS

Titles and abstracts were screened. Inclusion/exclusion criteria were then applied to full text screen of the remaining articles following PRISMA guidelines. Thirteen studies meeting the inclusion criteria were critically appraised using the Critical Appraisal Skills Programme (CASP) checklist. A constant comparison approach was used to systematically distil findings into categories and assess their fit within the Mehnert Model subdomains.

RESULTS

Vulnerabilities coalesced predominantly within the following subdomains: (a) changes in identity and role functioning; (b) social reintegration; (c) coping strategies; and (d) social supports. Patterns and themes within these subdomains were related both positively and negatively to form the contours of a survivor's satisfaction/dissatisfaction with quality of life related to work and breast cancer recovery.

CONCLUSION

Overall, findings highlight the importance of employment and work environments in bolstering women's psychosocial health after a breast cancer diagnosis.

IMPACT

Findings from this review support adapting psychosocial distress screening to include vulnerabilities relating to work life. Nurses are ideally positioned to facilitate this screening and engage clinicians in a dialogue surrounding patient's support needs due to nursing's central role on the interdisciplinary team. Nurses may also foster collective accountability for implementing ongoing multidisciplinary survivorship care plans that include a return to work component.

Productivity costs associated with metastatic breast cancer in younger, midlife, and older women

BACKGROUND

The objective of the current study was to estimate productivity costs due to metastatic breast cancer (mBC) via productive time lost among survivors and potential life-years lost from premature mortality among 3 age groups: younger (aged 18-44 years), midlife (aged 45-64 years), and older (aged ≥65 years) women.

METHODS

The authors estimated the number of work and home productivity days missed due to mBC by age group using data from the 2000 to 2016 National Health Interview Survey. Years of potential life lost (YPLL) due to mBC were calculated for each age group using 2015 National Vital Statistics System data. The authors valued both sources of lost productivity time using the Current Population Survey and prior studies.

RESULTS

The per-woman value of lost productive days (work and home) due to mBC ranged from $680 for older women to $5169 for younger women. In 2015, the value of lost work and home productivity days associated with mBC nationally was $67 million for younger women, $246 million for midlife women, and $66 million for older women. YPLL were highest among midlife women (403,786 life-years), followed by older women (248,522 life-years) and younger women (95,943 life-years). Midlife women were found to have the highest market value of YPLL ($4.1 billion), followed by younger women ($1.6 billion) and older women ($527 million).

CONCLUSIONS

The results of the current study demonstrated that mBC generates a high economic burden through lost productivity, especially among midlife women.

Paid work, household work, or leisure? Time allocation pathways among women following a cancer diagnosis

BACKGROUND

There is extensive evidence on the relationship between receiving a cancer diagnosis and labour market outcomes. However, there is limited evidence on the relationship between a cancer diagnosis and non-labour market outcomes such as household work, passive leisure and physical leisure. Furthermore, most current research focuses on time allocation at a given time point, ignoring both the life course perspective and long term effects.

METHODS

Using data from the Australian Longitudinal Study on Women's Health (ALSWH), we observe time allocation for 91 women diagnosed with breast cancer and 486 women diagnosed with skin cancer, and 2711 women living without cancer. Our analysis is unique in combining sequence analysis and multivariate multinomial logit modelling. Using sequence analysis, we first analyse life-courses post a cancer diagnosis for paid work, household work, passive leisure and physical leisure from 2004 to 2016. Using multivariate multinomial logit modelling, we test whether a cancer diagnosis influences such life-courses. We consider the robustness of results to cancer severity and change in time allocation before and after a cancer diagnosis.

RESULTS

We identify three clusters for paid work and two clusters for household work, passive leisure and physical leisure. Neither a breast cancer nor skin cancer diagnosis has a significant effect on the pathways of time allocation. Such results are robust to severity of diagnosis with 'cured' and 'non-cured' breast cancer, and skin cancer treated with and without 'chemotherapy or radiotherapy'. Women post a breast cancer diagnosis are less likely to maintain their pre-cancer's time use on paid work, household work and passive leisure; however, such effects are not significant.

CONCLUSION

Being diagnosed with breast cancer or skin cancer has no significant long-term effect on the pathways of time allocation. Future work should explore the relationship between time allocation and wellbeing and the preference for time allocation.

Impact of sociodemographic characteristics on underemployment in a longitudinal, nationally representative study of cancer survivors: Evidence for the importance of gender and marital status

BACKGROUND

We examined the longitudinal association between sociodemographic factors and an expanded definition of underemployment among those with and without cancer history in the United States.

METHODS

Medical Expenditure Panel Survey data (2007-2013) were used in multivariable regression analyses to compare employment status between baseline and two-year follow-up among adults aged 25-62 years at baseline (n = 1,614 with and n = 39,324 without cancer). Underemployment was defined as becoming/staying unemployed, changing from full to part-time, or reducing part-time work significantly. Interaction effects between cancer history/time since diagnosis and predictors known to be associated with employment patterns, including age, gender/marital status, education, and health insurance status at baseline were modeled.

RESULTS

Approximately 25% of cancer survivors and 21% of individuals without cancer reported underemployment at follow-up (p = 0.002). Multivariable analyses indicated that those with a cancer history report underemployment more frequently (24.7%) than those without cancer (21.4%, p = 0.002) with underemployment rates increasing with time since cancer diagnosis. A significant interaction between gender/marital status and cancer history and underemployment was found (p = 0.0004). There were no other significant interactions. Married female survivors diagnosed >10 years ago reported underemployment most commonly (38.7%), and married men without cancer reported underemployment most infrequently (14.0%). A wider absolute difference in underemployment reports for married versus unmarried women as compared to married versus unmarried men was evident, with the widest difference apparent for unmarried versus married women diagnosed >10 years ago (18.1% vs. 38.7%).

CONCLUSION

Cancer survivors are more likely to experience underemployment than those without cancer. Longer time since cancer diagnosis and gender/marital status are critical factors in predicting those at greatest risk of underemployment. The impact of cancer on work should be systematically studied across sociodemographic groups and recognized as a component of comprehensive survivorship care.