Breast cancer, sickness absence, income and marital status. A study on life situation 1 year prior diagnosis compared to 3 and 5 years after diagnosis

Return to Work in Breast Cancer Patients following an Interdisciplinary Rehabilitation Program in a Community-Based Cancer Rehabilitation Center: A Pilot Study

Despite curative treatment and discharge from acute hospital settings, breast cancer patients often have cancer- and treatment-related morbidity which impairs them from returning to work. Hence, the role of community-based return to work rehabilitation programs is important to help these patients transition back to work. This was a retrospective cohort study involving patients with breast cancer conducted at a community-based cancer rehabilitation center. Patients were involved in an interdisciplinary vocational rehabilitation program involving physiatrists, occupational therapists, physiotherapists and social workers. We recruited 63 patients for this study cohort, with 46 (73.0%) patients ≤ 60 years old. After undergoing the rehabilitation program, there were 37 (58.7%) participants who successfully returned to work. These participants returned to work at either within 6 months (27.0%), 12 months (29.7%) or 24 months (43.2%) after enrollment into the program, with a majority enrolling in white collar jobs. Multivariate regression analysis revealed that significant negative factors for return to work were advanced stage of cancer (p = 0.004), along with clinically significant fatigue, measured on the Brief Fatigue Inventory (p < 0.001). However, perceived work ability (p = 0.020) was found to be a positive factor.

Coping After Breast Cancer (CABC): Protocol for a randomized controlled trial of stress management e-health interventions

BACKGROUND

One-third or more of breast cancer survivors report stress and other psychological and physical complaints that can negatively impact quality of life. Psychosocial stress-management interventions, shown to mitigate the negative impact of these complaints, can now be delivered as accessible and convenient (for the patient and provider) e-health interventions. In the present randomized controlled trial (RCT), Coping After Breast Cancer (CABC), two modified versions of the stress management e-health intervention program StressProffen were created: one with predominantly cognitive-behavioral stress-management content (Stressproffen-CBI) and one with predominantly mindfulness-based stress-management content (StressProffen-MBI).

OBJECTIVE

To investigate the effects in breast cancer survivors of using StressProffen-CBI and StressProffen-MBI compared to a control group (treatment as usual).

METHODS

Women diagnosed with breast cancer (stage I-III, unequivocally HER2+ or ER- tumors) or DCIS aged 21-69 years who completed the Cancer Registry of Norway- initiated health survey on quality of life, are invited to the CABC trial about seven months after diagnosis. Women who give consent to participate are randomized (1:1:1) to: Stressproffen-CBI, Stressproffen-MBI, or control group. Both Stressproffen interventions consist of 10 modules of stress management content delivered through text, sound, video, and images. The primary outcome is between-groups changes in perceived stress at six months, assessed with Cohen's Perceived Stress Scale. Secondary outcomes comprise changes in quality of life, anxiety, depression, fatigue, sleep, neuropathy, coping, mindfulness and work-related outcomes approximately 1, 2 and 3 years after diagnosis. Long-term effects of the interventions on work participation, comorbidities, relapse or new cancers and mortality will be obtained from national health registries.

RESULTS

We plan to recruit 430 participants in total (100 in each group). Recruitment is scheduled from January 2021 through May 2023.

CONCLUSIONS

The CABC trial is possibly the largest ongoing psychosocial e-health RCT in breast cancer patients at current. If one or both interventions prove to be effective in reducing stress and improving psychosocial and physical complains, the StressProffen e-health interventions could be beneficial, inexpensive, and easily implementable tools for breast cancer survivors when coping with late effects after cancer and cancer treatments.

CLINICALTRIAL

Clinicaltrials.gov identifier NCT04480203. First posted: July 7th 2020. https://clinicaltrials.gov/ct2/show/NCT04480203.

A systemmatic literature review on indirect costs of women with breast cancer

INTRODUCTION

The rising incidence of breast cancer places a financial burden on national health services and economies. The objective of this review is to present a detailed analysis of the research and literature on indirect costs of breast cancer.

METHODS

English literature databases from 2000 to 2020 were searched to find studies related to the objective of the present review. Study selection and data extraction was undertaken independently by two authors. Also, quality assessment was done using a checklist designed by Stunhldreher et al. RESULTS: The current study chose 33 studies that were eligible from a total of 2825 records obtained. The cost of lost productivity due to premature death based on human capital approach ranged from $22,386 to $52 billion. The cost burden from productivity lost due to premature death based on friction cost approach ranged from $1488.61 to $4,518,628.5. The cost burden from productivity lost due to morbidity with the human capital approach was reported as $126,857,360.69 to $596,659,071.28. The cost of lost productivity arising from informal caregivers with the human capital approach was $297,548.46 to $308 billion.

CONCLUSION

Evaluation of the existing evidence revealed the indirect costs of breast cancer in women to be significantly high. This study did a thorough review on the indirect costs associated with breast cancer in women which could serve as a guide to help pick the appropriate method for calculating the indirect costs of breast cancer based on existing methods, approach and data. There is a need for calculations to be standardised since the heterogeneity of results in different domains from various studies makes it impossible for comparisons to be made among different countries.

Impact of cancer on income, wealth and economic outcomes of adult cancer survivors: a scoping review

OBJECTIVE

To summarise peer-reviewed evidence on the effect of a cancer diagnosis on the different sources of income of individuals diagnosed with cancer during adulthood (age ≥18 years).

DESIGN

A scoping review following the Joanna Briggs Institute's methodological framework for conducting scoping reviews and reporting results following the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews checklist.

DATA SOURCES

Ovid MEDLINE, PsycINFO, CINAHL, EMBASE, Econ-Lit and Evidence-based Medicine Reviews, and reference lists of evidence syntheses. Published literature of any study type in English was searched from January 2000 to December 2020.

ELIGIBILITY AND CRITERIA

Study participants were individuals diagnosed with cancer during adulthood (age ≥18 years). Studies from any country and/or healthcare system were included. Primary outcomes were employment income (eg, individual or household); investment income (eg, stocks/bonds, properties, savings); government transfer payments (eg, disability income/pension); debt and bankruptcy.

DATA EXTRACTION AND SYNTHESIS

Findings are summarised descriptively and in tabular form.

RESULTS

From 6297 citations retrieved, 63 studies (67 articles) met our inclusion criteria. Most (51%) were published in 2016-2020; 65% were published in the USA or Scandinavia. Survivors incurred debt (24 studies), depleted savings (13 studies) and liquidated stocks/bonds (7 studies) in response to a cancer diagnosis. 41 studies reported changes to employment income; of these, 12 case-control studies reported varying results: 5 reported survivors earned less than controls, 4 reported no significant differences, 2 reported mixed results and 1 reported income increased. Initial declines in income tended to lessen over time.

CONCLUSIONS

Cancer's impact on survivors' income is complex and time-varying. Longitudinal studies are needed to document the trend of initial declines in income, with declines lessening over time, and its variations. Study designs using standardised income measures and capturing treatment type and follow-up time will improve our understanding of cancer's impact on survivors' income.

A Systematic Review: The Effect of Cancer on the Divorce Rate

Introduction

Research on the impact of cancer on close relationships brings up conflicting results. This systematic review collects empirical evidence on the research questions whether a cancer diagnosis in general or the type of cancer affects the divorce rate.

Materials and Methods

This systematic review was conducted according to the guidelines of the Cochrane Collaboration and the PRISMA statement. The following electronic databases were searched: Web of Science, Ovid SP MEDLINE, PsycINFO, PsyINDEX, CINAHL, ERIC. Risk of bias assessment was performed with the preliminary risk of bias for exposures tool template (ROBINS-E tool). The grading of methodological quality was assessed with the Newcastle-Ottawa Scale.

Results

Of 13,929 identified records, 15 were included in the qualitative synthesis. In 263,616 cancer patients and 3.4 million healthy individuals, we found that cancer is associated with a slightly decreased divorce rate, except for cervical cancer, which seems to be associated with an increased divorce rate.

Discussion

According to this systematic review, cancer is associated with a tendency to a slightly decreased divorce rate. However, most of the included studies have methodologic weaknesses and an increased risk of bias. Further studies are needed.

Employment After Breast Cancer Diagnosis and Treatment Among Women in the Sister and the Two Sister Studies

Purpose Women undergoing diagnosis and treatment for breast cancer may face challenges in employment. We investigated the impact of demographic, clinical, workplace, and psychosocial characteristics on loss of employment after a breast cancer diagnosis and treatment. We further describe changes in work status and work environment for cancer survivors who sustain employment. Methods We analyzed responses from a survey of breast cancer survivors from the Sister Study and the Two Sister Study cohorts who reported being employed at the time of their breast cancer diagnosis and who reported employment status (lost vs. sustained employment) at the time of survey administration. Multivariate logistic regression was used to identify the effects of lymphedema, neuropathy, problems with memory or attention, social support, health insurance, and sick leave on lost employment, adjusting for demographic characteristics, cancer stage, treatment, and general health. Results Of the 1675 respondents who reported being employed at the time of diagnosis, 83.5% reported being 'currently' employed at the time of the survey. Older age, peripheral neuropathy, lack of sick leave, late stage at diagnosis, a recurrence or a new cancer, problems with memory or attention, and poor general health were significantly associated with lost employment. Conclusions The long-term effects of breast cancer treatment and workplace provisions for leave and accommodation may have a substantial effect on women's ability to sustain employment. The findings from this study highlight challenges reported by cancer survivors that may inform clinical and occupational interventions to support survivors' return to work.

Income loss after a cancer diagnosis in Germany: An analysis based on the socio-economic panel survey

BACKGROUND AND AIMS

Cancer treatments often require intensive use of healthcare services and limit patients' ability to work, potentially causing them to become financially vulnerable. The present study is the first attempt to measure, on the German national level, the magnitude of absolute income loss after a cancer diagnosis.

METHODS

This study analyzes data from the Socio-Economic Panel (SOEP) survey, one of the largest and most comprehensive household surveys in Germany, consisting of approximately 20,000 individuals, who are traced annually. The empirical strategy consists of ordinary least squares (OLS) and multinomial logistic estimators to measure changes in job income, work status, working hours, and pension as a result of reporting a cancer diagnosis for the period between 2009 and 2015. Sample consistency checks were conducted to limit measurement error biases.

RESULTS

Our results show that job incomes dropped between 26% and 28% within the year a cancer diagnosis was reported. The effect persisted for two years after the diagnosis and was no longer observable after four years. The finding was linked to an increased likelihood of unemployment and a reduction of working hours by 24%. Pension levels, on the other hand, were not affected by a cancer diagnosis.

CONCLUSIONS

These findings suggest that many cancer patients are exposed to financial hardship in Germany, particularly when the cancer diagnosis occurs during their working age and before requirements to obtain a pension are met. Further research seems warranted to identify particularly vulnerable patient groups.

Sickness absence and disability pension among women with breast cancer: a population-based cohort study from Sweden

BACKGROUND

Women's return to work after diagnosis of breast cancer (BC) is becoming more prevalent. However, register-based national investigation on sickness absence (SA) and disability pension (DP) in BC women is lacking. The aim of the study was to explore SA and DP before and after a first BC diagnosis and the possibility to predict new cancer-related SA by using disease-related and sociodemographic factors.

METHODS

A longitudinal register study of the 3536 women in Sweden aged 19-64 with a first BC diagnosis in 2010 was conducted by linkage of five nationwide registers. Particularly, detailed information on SA and DP was obtained from the National Social Insurance Agency. Descriptive statistics on SA and DP 2 years before through 3 years after the BC diagnosis were performed. The risk of having a new SA spell due to BC or BC-related diagnoses was modeled using logistic regression.

RESULTS

The proportion of women with SA increased during the year following the BC diagnosis date and declined over the next 2 years to proportions before diagnosis. At the time of BC diagnosis, half of the women began a new SA spell > 14 days with cancer, cancer-related, or mental diagnosis. Disease-related and sociodemographic factors including occupational sector, living area, age, cancer stage, educational level, and number of previous SA days showed statistical significance (p < 0.05) in predicting a new SA around BC diagnosis. By using these factors, it was possible to correctly predict 67% of the new SA spell.

CONCLUSIONS

SA among women with BC was elevated mainly in the first year after diagnosis. New SA following BC diagnosis can accurately be predicted.

Sickness absence and disability pension among swedish women prior to breast cancer relapse with a special focus on the roles of treatment and comorbidity

OBJECTIVE

We aimed to determine the longitudinal prevalence and the predictors of sickness absence (SA) and disability pension (DP) in breast cancer (BC) women who eventually developed relapse.

METHODS

A total of 1293 BC women, who were ages 20-63 years, diagnosed between 1996 and 2011 and by 2016 had all developed relapse, were identified in Swedish registers and were followed from two years before to five years after their primary diagnosis, while they were relapse-free. Annual prevalence of SA and DP was calculated. Logistic regression was used to estimate adjusted odds ratios (AOR) for long-term SA (>30 days) at one (y1) and three (y3) years post-diagnosis.

RESULTS

Prevalence of long-term SA was 68.1% in y1 and 16.3% in y5. Prevalence of DP progressively increased from 16.3% in y1 to 29.0% in y5. Predictors of long-term SA included age <50 years (y1:AOR = 1.79 [1.39-2.29]), TNM stage III (y1:AOR = 1.54 [1.03-2.31]; y3:AOR = 2.21 [1.32-3.72]), metastasis (y1:AOR = 1.64 [1.26-2.12]; y3:AOR = 1.51 [1.05-2.18]), comorbidity (y1:AOR = 2.41 [1.55-3.76]; y3 AOR = 4.62 [2.49-8.57]) and any combination of radiotherapy, chemotherapy and hormonal therapy (y1:AOR = 2.05-5.71).

CONCLUSION

Among BC women who later developed relapse, those who had higher stages of BC, had comorbidity and received neoadjuvant and/or adjuvant therapy were at significantly higher risk of needing long-term SA after their diagnosis.

Life Expectancy after Curative-intent Treatment of Breast Cancer: Impact on Long-term Follow-up Care

Long-term survival rates after treatment for breast cancer are directly influenced by early deaths resulting from disease. For longer-term breast cancer survivors, survival rates appear deceptively low. We hypothesize that the actual survival curve for long-term survivors approaches the overall survival of the general population. The Surveillance, Epidemiology, and End Results database (1988 to 2002) was used to identify patients with nonmetastatic breast cancer who underwent definitive surgical treatment. The survival of the general population was constructed by using national life tables with an age-matched population. Comparisons of survivals were made for 3-, 5-, and 7-year breast cancer survivor cohorts. Of 237,180 patients, 92.4 per cent survived three years, 82.1 per cent five years, and 58.1 per cent seven years. Stage I patients have equivalent or better survivals compared with the age-matched general population in all three cohorts. Stage II patients reached equivalent conditional survival between eight and nine years after diagnosis regardless of cohort. Stage III patients required achieving nine to 10 years after diagnosis to achieve equivalent survival probability, except in 7-year survivors, in whom 10 to 11 years was required. In all stages, once equivalence was reached, survival exceeded the general population over the remaining years. Initial cancer stage influences overall survival for many years after diagnosis. Patients with Stage I cancer return to the general population risk as early as three years after diagnosis, whereas higher stages can require up to nine years to achieve parity with a more generalized population. These findings should be factored into general health screening issues for long-term breast cancer survivors.

Impact of chemotherapy, radiotherapy, and endocrine therapy on sick leave in women with early-stage breast cancer during a 5-year period: a population-based cohort study

Purpose

To examine the influence of type of oncological treatment on sick leave in women of working age with early-stage breast cancer.

Methods

We identified 8870 women aged 30–64 diagnosed with stage I–II breast cancer between 2005 and 2012 in the Breast Cancer Data Base Sweden. Associations between type of oncological treatment (radiotherapy, endocrine therapy, and chemotherapy) and sick leave were estimated by hazard ratios, probabilities, and length of sick leave using multi-state survival analysis.

Results

During the first 5 years after diagnosis, women aged 50–54 years at diagnosis receiving chemotherapy spent on average 182 (95% CI 151–218) additional days on sick leave compared with women not receiving chemotherapy, but with otherwise similar characteristics. Correspondingly, women initiating endocrine therapy spent 30 (95% CI 18–44) additional days on sick leave and women receiving post-mastectomy radiotherapy 53 (95% CI 37–69) additional days. At year five, the rate of sick leave was increased in women who had received chemotherapy (HR 1.19, 95% CI 1.11–1.28) or endocrine therapy (HR 1.15, 95% CI 1.05–1.26). Chemotherapy and endocrine therapy were associated with increased rates of sick leave due to depression or anxiety.

Conclusion

Our findings of increased long-term risks of sick leave after oncological treatment for breast cancer warrant attention from caregivers taking part in cancer rehabilitation. In light of the ongoing debate about overtreatment of early-stage breast cancer, our findings point to the importance of properly selecting patients for chemotherapy not only for the medical toxicity but also the possible impact on their livelihood.

Electronic supplementary material

The online version of this article (10.1007/s10549-020-05720-4) contains supplementary material, which is available to authorized users.

Trajectories of sickness absence and disability pension in the 2 years before and 3 years after breast cancer diagnosis: A Swedish longitudinal population-based cohort study

BACKGROUND

After breast cancer (BC) diagnosis, work incapacity often occurs among working-age women. We investigated the trajectories of previous and subsequent sickness absence and/or disability pension (SA/DP) days, and risk factors for consistently high levels of future SA/DP among these women.

METHODS

This longitudinal cohort study included all 3536 women in Sweden aged 19-64 years who received a first BC diagnosis in 2010. Their annual SA/DP net days from 2 years before to 3 years after diagnosis were calculated. SA/DP patterns were depicted by a group-based trajectory model. Logistic regressions were used to calculate odds ratios (ORs) with 95% CIs of >90 or >180 SA/DP days/year.

RESULTS

Three trajectories of SA/DP days/year were identified: increasing only in year₊₁ (61% of all), increasing then decreasing in year₊₃ (30%), and constantly very high (9%). The risk factors associated with annual SA/DP days >90 (long) and >180 days (extreme long) were similar. Factors associated with having >90 SA/DP days for years 1-3 were: stage II (OR, 4.59; 95% CI, 2.98-7.07), stage III+IV (OR, 26.57; 95% CI, 13.52-52.22), prediagnosis SA 1-30 days (OR, 2.73; 95% CI, 1.30-5.70), prediagnosis SA >90 days (OR, 24.52; 95% CI, 12.25-49.08), and prediagnosis DP (OR, 659.97; 95% CI, 292.52->999.99). Conversely, adjusting for prediagnosis SA/DP and stage, sociodemographic factors were not associated with high levels of SA/DP.

CONCLUSION

After BC diagnosis, SA/DP increased significantly but then decreased. The absolute majority had no SA/DP during year 3. Advanced cancer stage and previous high SA/DP rendered the greatest risk for future high SA/DP. More knowledge is needed for applying the information in rehabilitation and return-to-work planning.

Does marital status correlate with the female breast cancer risk? A systematic review and meta-analysis of observational studies

Objective

To investigate that whether an association between marital status and the female breast cancer risk exists.

Methods

The MEDLINE, EMBASE and PsycINFO databases were searched from their inception to July 2019. The Newcastle-Ottawa Scale was used to rate the methodological quality of included studies. Study data were pooled using random-effects meta-analyses to compare the breast cancer risk between unmarried, widowed, divorced or lifelong single women and married women. This study is registered with PROSPERO (number CRD42018112368).

Results

Forty-nine publications were included in the meta-analysis. Compared with married women, unmarried and lifelong single women had an elevated risk of breast cancer, and the pooled ORs of case-control studies were 1.20 (95% CI: 1.07 to 1.35) and 1.24 (95% CI: 1.05 to 1.45), respectively. In the subgroup analyses under these two comparisons, hospital-based estimates and multivariate-adjusted estimates demonstrated a strong association, while population-based estimates and age-adjusted estimates produced nonsignificant results. The pooled OR of cohort studies examining the effect of being a lifelong single woman was 1.10 (95% CI: 1.04 to 1.16). Heterogeneity was moderate to substantial across case-control studies (I²: 46% to 82%), which may be partially explained by differences in geographic regions, publication years and control types. Possible publication bias was indicated by the funnel plot and Egger’s test (P = 0.03).

Conclusions

Marital status may correlate with the risk of developing female breast cancer. However, suboptimal selection of controls, insufficient exploration of confounding effects, inadequate ascertainment of marital status, and possible publication bias may have limited the quality of the available evidence. Overall, conclusions that marital status is an independent risk factor for breast cancer could not be drawn, and further prospective rigorous cohort studies are warranted.

Breast Reconstruction May Improve Work Ability and Productivity After Breast Cancer Surgery

OBJECTIVE

The aim of this study was to evaluate work ability and productivity in women who had undergone different types of surgical treatment for breast cancer, as well as breast reconstruction after mastectomy.

METHODS

This cross-sectional study assessed 152 women between 30 and 60 years of age, who worked outside the home in formal or informal jobs, or as self-employed. Thirty-eight of them had no history of breast cancer (control group), and 114 had undergone surgical treatment for breast cancer at least 1 year before their enrollment in the study, and were allocated as follows: mastectomy group (n = 38), breast-conserving surgery group (n = 38), or breast reconstruction breast reconstruction group (n = 38). The validated Brazilian versions of the Work Productivity and Activity Impairment-General Health questionnaire and Work Limitations Questionnaire were self-administered.

RESULTS

The groups were homogeneous regarding age, education level, and other sociodemographic characteristics. Patients in the mastectomy and breast-conserving surgery groups showed reduced work performance and productivity compared with women in the breast reconstruction and control groups (P = 0.0004 and P = 0.0006, respectively). In addition, women in the mastectomy group had more difficulty in performing activities of daily living compared with those in other groups (P = 0.0121).

CONCLUSIONS

Women who had undergone mastectomy or breast-conserving surgery had decreased work ability and productivity compared with women without a history of breast cancer and to those who had undergone breast reconstruction.

Process evaluation of a tailored work-related support intervention for patients diagnosed with gastrointestinal cancer

Purpose

To perform a process evaluation of a tailored work-related support intervention for patients diagnosed with gastrointestinal cancer.

Methods

The intervention comprised three tailored psychosocial work-related support meetings. To outline the process evaluation of this intervention, we used six key components: recruitment, context, reach, dose delivered, dose received and fidelity. Data were collected using questionnaires, checklists and research logbooks and were analysed both quantitatively and qualitatively.

Results

In total, 16 hospitals, 33 nurses and 7 oncological occupational physicians (OOPs) participated. Analysis of the six key components revealed that the inclusion rate of eligible patients was 47%. Thirty-eight intervention patients were included: 35 actually had a first meeting, 32 had a second and 17 had a third. For 31 patients (89%), the first meeting was face to face, as per protocol. However, in only 32% of the cases referred to support type A (oncological nurse) and 13% of the cases referred to support type B (OOP), the first meeting was before the start of the treatment, as per protocol. The average duration of the support type A meetings was around the pre-established 30 min; for the OOPs, the average was 50 min. Protocol was easy to follow according to the healthcare professionals. Overall, the patients considered the intervention useful.

Conclusions

This study has shown that the strategy of tailored work-related support is appreciated by both patients and healthcare professionals and applicable in clinical practice.

Implications for Cancer survivors

The intervention was appreciated by patients; however, whether the timing of the work-related support was adequate (i.e. before treatment was started) requires further research.

Trial registration

NTR5022.

Electronic supplementary material

The online version of this article (10.1007/s11764-019-00797-3) contains supplementary material, which is available to authorized users.

Does timing of alloplastic breast reconstruction in older women impact immediate postoperative complications? An analysis of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database

BACKGROUND

Alloplastic breast reconstruction is safe in well-selected older women. The impact of timing of surgery on complication rates is unknown. This study aimed to determine the immediate (30-day) postoperative complication rates of older women who underwent immediate (IBR) and delayed breast reconstruction (DBR) with alloplastic techniques.

METHODS

The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database was used to identify women ≥70 years old with in situ or invasive breast cancer who underwent either IBR or DBR (2005-2016). Outcomes included 30-day postoperative morbidity and mortality.

RESULTS

A total of 2,085 older women underwent alloplastic breast reconstruction of which 90% and 10% were IBR and DBR, respectively. Both groups had similar median age, body mass index, and frequency of smoking, diabetes mellitus, and steroid use. Tumors were mainly invasive in the IBR group (83.5%) and in situ in the DBR group (83.3%). IBR had significantly longer operative times (median 154 min vs 98 min, p < 0.0001), but equal length of stay (median 3 days vs 3 days, p = 0.1). The 30-day overall morbidity (medical or surgical complication) rate was significantly higher in the IBR group (7.5% vs 1.0%, p < 0.0004). Women with IBR were significantly more likely to develop infectious complications (6% vs 1%, p = 0.002). Cardiac/transfusion, pulmonary, thromboembolic, renal, and neurological morbidity rates were equal between groups. Thirty-day mortality rates were similar across both groups (IBR: 0.05% vs DBR: 0%, p = 0.74).

CONCLUSIONS

While overall thirty-day postoperative complication rates in older women who undergo breast reconstruction were low, there were higher rates of infectious complications in the IBR cohort. The risks and benefits of alloplastic breast reconstruction should be discussed with older women undergoing mastectomy for breast cancer treatment.

Changes in employment status up to 5 years after breast cancer diagnosis: A prospective cohort study

AIM

To assess how sociodemographic, clinical and treatment characteristics impact employment status five-years following a breast cancer diagnosis, and to compare the incidence rate of changes with the general population.

METHODS

A total of 462 women with incident breast cancer were evaluated before treatment and three- and five-years later. Adjusted odds ratios (ORs) with 95% confidence intervals (95%CIs) were computed through multinomial logistic regression. Data for comparisons were retrieved from the SHARE Project. Incidence rate ratios (IRRs) with 95%CIs were calculated using Poisson regression.

RESULTS

Among the 242 employed women prior to diagnosis, 162 remained employed, 26 became unemployed, 27 entered early retirement, 14 entered normal retirement and 13 were on sick leave at five-years. Unemployment increased with age (≥55 vs < 55 years: OR = 4.49, 95%CI:1.56-12.92; OR = 3.40, 95%CI:1.05-10.97 at three- and five-years, respectively) and decreased with education (>4 vs ≤ 4 years: OR = 0.36, 95%CI:0.13-0.97; OR = 0.27, 95%CI:0.10-0.71 at three- and five-years, respectively). Axillary surgery (unemployment at five-years: OR = 5.13, 95%CI:1.30-20.27), hormonal therapy (unemployment at three-years: OR = 0.28, 95%CI:0.10-0.83) and targeted therapy (sick leave at three-years: OR = 3.79, 95%CI:1.14-12.63) also influenced employment status. Five-years post diagnosis, women with breast cancer had a lower incidence of unemployment (IRR = 0.51, 95%CI:0.30-0.89) than the general population, while, among older women, there was a higher tendency to enter early retirement (IRR = 1.72, 95%CI:0.82-3.61).

CONCLUSIONS

Although not all women may want to pursue or continue a professional life following their breast cancer experience; those who do may benefit from social and employer support when returning to work.

Work cessation after cancer diagnosis: a population-based study

BACKGROUND

Long-term work maintenance among cancer survivors is important for patients, their families and society.

AIMS

To assess the risk of work cessation among workers at baseline in cancer survivors at 2 and 4 years after diagnosis compared with a matched cancer-free control group.

METHODS

Baseline measurements for this historical prospective study were drawn from the Israeli Central Bureau of Statistics 1995 National Census, followed up until 2011. Patients who died before the end of 2011 were excluded from the study. Adjusted odds ratios (ORs) for the study outcome were assessed by binary logistic regression analyses, controlled for age, sex, ethnicity, years of education and socioeconomic position.

RESULTS

Cancer was associated with not working at 2 years after diagnosis (adjusted OR = 1.71, 95% confidence interval [CI] 1.59-1.84, P < 0.001), while only mild attenuation was seen at 4 years after diagnosis (adjusted OR = 1.57, 95% CI 1.46-1.68, P < 0.001). Analysis by cancer type revealed that patients diagnosed with central nervous system (adjusted OR = 3.42, 95% CI 2.41-4.86, P < 0.001), renal (adjusted OR = 2.10, 95% CI 1.38-3.16, P < 0.001), breast (adjusted OR = 2.05, 95% CI 1.76-2.38, P < 0.001) and haematologic malignancies (adjusted OR = 2.04, 95% CI 1.59-2.61, P < 0.001) showed the greatest magnitude effect at 2 years.

CONCLUSIONS

These results emphasize the need for tailored interventions in order to enhance work maintenance, even among patients who are working at baseline and with very long-term survivors.

What causes patients with breast cancer to change employment?: evidence from the health insurance data in a medical facility

This study aims to make clear the following aspects of breast cancer patients and their occupation. 1. What percentage of patients have changed their working status around surgery? 2. When did patients change their employment? 3. What is the cause of the employment change? We investigated 269 patients who underwent curative surgery for primary breast cancer at one university hospital in Tokyo. Patients who were under the age of 58 at the time of surgery and had the experience of being a company or government employee during a year prior to the surgery were used as sample for analysis. To determine factors related to the employment change, multiple logistic regression analysis was performed. Nineteen percent patients changed the employment status before and after surgery. Of those, 19% changed the employment by the end of surgery month while 42% did by the fourth month after surgery. Treatment-related factors such as mastectomy and the combination of chemotherapy and hormone therapy affected changes in employment. We believe that the validity of our study can be confirmed by comparing with the previous study results. We show the potential large effects of cancer treatment on patients' daily lives.

Sociodemographic and disease-related determinants of return to work among women with breast cancer: a German longitudinal cohort study

Background

Return to work (RTW) is a key parameter of outcome quality that ensures social participation. Therefore, this study analyses the sociodemographic and disease-related determinants of RTW among newly diagnosed breast cancer patients.

Methods

In a prospective, multicentre cohort study, breast cancer patients were surveyed three times: directly after surgery, after 10 weeks, and after 40 weeks. Logistic regression analysis was applied to estimate the association of RTW at 40 weeks following discharge with sociodemographic and disease-related characteristics (n = 577).

Results

The sociodemographic variables “entrance certificate at a university of applied science” compared to “university entrance certificate” (OR = 3.1, 95%-CI = 1.2–8.1), age group “55–59 years” compared to “18–44 years” (OR = 3.2, 95%-CI = 1.2–8.4) and “having children” (OR = 2.8, 95%-CI = 1.2–6.2) as well as the disease-related variables “rehabilitation” (OR = 0.5, 95%-CI = 0.3–0.9), self-rated health “good” and “excellent” compared to “bad” (OR = 2.7, 95%-CI = 1.4–5.5; OR = 11.6, 95%-CI = 4.2–31.8) and the UICC-classification “stage II” and “stage III/IV” in comparison to “stage 0/I” (OR = 0.5, 95%-CI = 0.3–0.8; OR = 0.2, 95%-CI = 0.1–0.5) significantly affect RTW among breast cancer patients (Nagelkerke’s Pseudo-R² = 0.275).

Conclusions

The findings show that significant differences in RTW exist between patient groups and suggest that RTW issues must be addressed more effectively before, during and after treatment. For future research on RTW in Germany, longitudinal studies with a follow-up of several years are necessary. Information and support deficits should be tackled by social services or breast care nurses.

Trial registration

Database Health Services Research, VfD_PIAT_12_001630, registered 01.03.2012

Electronic supplementary material

The online version of this article (10.1186/s12913-018-3768-4) contains supplementary material, which is available to authorized users.

Women's experiences of encounters with healthcare professionals' regarding work after breast-cancer surgery and associations with sickness absence: a 2-year follow-up cohort study

Introduction

Breast cancer (BC) is the most common cancer among women, and half of those diagnosed are of working age. Positive encounters regarding work from healthcare professionals have been shown to promote return to work among sickness absentees in general. However, the knowledge about encounters possible associations with sickness absence (SA) in women with BC is scarce.

Aim

To explore if women had experienced encounters regarding work from healthcare professionals during the first year after BC surgery and if this was associated with SA during the second year after surgery, controlled for treatment and sociodemographic effects.

Methods

A prospective cohort study of 690 Swedish women with primary BC, aged 24–63 years included after surgery. Descriptive statistics and adjusted logistic regression (age, birth country, education, self-rated health, treatment) with 95% confidence intervals (CI) were used.

Results

Eighty percent of the women had experienced encounters regarding work. Women who got advice and support regarding work (adjusted odds ratio (OR) 0.5; 0.3–0.9) or were encouraged to work (adjusted OR 0.6; 0.3–0.9) had less SA. A larger proportion of those encouraged to work had less advanced cancer, surgery, hormone, or radiotherapy. Consistently, women encouraged to be on SA had more SA, but this was partly explained by disease or treatment factors (crude OR 1.6; 1.1–2.4, adjusted OR 1.2 (0.8–1.9) since a larger proportion of those with more advanced cancer, surgery, or chemotherapy had more SA.

Conclusion

Most women experienced encounters regarding work, and the nature of these encounters were associated with SA 2 years after BC surgery.

Determinants of return at work of breast cancer patients: results from the OPTISOINS01 French prospective study

INTRODUCTION

Return to work (RTW) after breast cancer (BC) is still a new field of research. The factors determining shorter sick leave duration of patients with BC have not been clearly identified. The aim of this study was to describe work during BC treatment and to identify factors associated with sick leave duration.

MATERIALS AND METHODS

An observational, prospective, multicentre study was conducted among women with operable BC. A logbook was given to all working patients to record sociodemographic and work-related data over a 1-year period.

RESULTS

Work-related data after BC were available for 178 patients (60%). The median age at diagnosis was 50 years (27-77), 87.9% of patients had an invasive form of BC and 25.3% a lymph node involvement. 25.9% had a radical surgery and 24.2% had an axillary dissection. Radiotherapy was performed in 90.9% of patients and chemotherapy in 48.1%. Sick leave was prescribed for 165 patients (92.7%) for a median of 155 days. On univariate analysis, invasive BC (p=0.025), lymph node involvement (p=0.005), radical surgery (p=0.025), axillary dissection (p=0.004), chemotherapy (p<0.001), personal income <€1900/month (p=0.03) and not having received the patient information booklet on RTW (p=0.047) were found to be associated with a longer duration of sick leave. On multivariate analysis, chemotherapy was found to be associated with longer sick leave (OR: 3.5; 95% CI 1.6 to 7.9; p=0.002). The cost of sick leave to French National Health Insurance was fourfold higher in the case of chemotherapy (p<0.001).

CONCLUSION

Advanced disease and chemotherapy are major factors that influence sick leave duration during the management of BC.

TRIAL REGISTRATION NUMBER

NCT02813317.

Predictors of Unemployment After Breast Cancer Surgery: A Systematic Review and Meta-Analysis of Observational Studies

Purpose Breast cancer surgery is associated with unemployment. Identifying high-risk patients could help inform strategies to promote return to work. We systematically reviewed observational studies to explore factors associated with unemployment after breast cancer surgery. Methods We searched MEDLINE, EMBASE, CINAHL, and PsycINFO to identify studies that explored risk factors for unemployment after breast cancer surgery. When possible, we pooled estimates of association for all independent variables reported by more than one study. Results Twenty-six studies (46,927 patients) reported the association of 127 variables with unemployment after breast cancer surgery. Access to universal health care was associated with higher rates of unemployment (26.6% v 15.4%; test of interaction P = .05). High-quality evidence showed that unemployment after breast cancer surgery was associated with high psychological job demands (odds ratio [OR], 4.26; 95% CI, 2.27 to 7.97), childlessness (OR, 1.30; 95% CI, 1.11 to 1.53), lower education level (OR, 1.15; 95% CI, 1.05 to 1.25), lower income level (OR, 1.46; 95% CI, 1.24 to 1.73), cancer stage II, III or IV (OR, 1.43; 95% CI, 1.13 to 1.82), and mastectomy versus breast-conserving surgery (OR, 1.18; 95% CI, 1.07 to 1.30). Moderate-quality evidence suggested an association with high physical job demands (OR, 2.11; 95%CI, 1.52 to 2.93), African-American ethnicity (OR, 1.89; 95% CI, 1.21 to 2.96), and receipt of chemotherapy (OR, 1.95; 95% CI, 1.36 to 2.79). High-quality evidence demonstrated no significant association with part-time hours, blue-collar work, tumor size, positive lymph nodes, or receipt of radiotherapy or endocrine therapy; moderate-quality evidence suggested no association with age, marital status, or axillary lymph node dissection. Conclusion Addressing high physical and psychological job demands may be important in reducing unemployment after breast cancer surgery.

Early-stage breast cancer and employment participation after 2 years of follow-up: A comparison with age-matched controls

BACKGROUND

Although cancer survivors are more likely to be unemployed than individuals without a cancer history, employment participation after treatment of early-stage breast cancer has not been widely studied to date. The objectives of the current study were to evaluate employment trajectories in a cohort of patients with early-stage breast cancer and age-matched controls from the time of diagnosis to the 2-year follow-up, and identify factors associated with diminished and emerging employment participation.

METHODS

As part of a larger cohort study of 1096 patients with early-stage breast cancer and same-aged women without breast cancer, data from 723 working-age (aged 40-64 years) women (347 patients and 376 controls) were analyzed to evaluate 4 employment trajectories (sustained unemployment, diminished employment, emerging employment, and sustained employment). Multivariable logistic regression models were used to identify factors associated with diminished employment versus sustained employment, and emerging employment versus sustained unemployment.

RESULTS

Lower percentages of patients (71%) compared with controls (79%) reported full-time or part-time employment at enrollment (P<.01). Fatigue was a significant predictor of diminished employment for both patients (odds ratio [OR], 5.71; 95% confidence interval [95% CI], 2.48-13.15) and controls (OR, 2.38; 95% CI, 1.21-4.68). Among patients, African American race (OR, 4.02; 95% CI, 1.57-10.28) and public/uninsured insurance status (OR, 4.76; 95% CI, 1.34-12.38) were found to be associated with diminished employment. Among controls, high social support was associated with emerging employment (OR, 3.12; 95% CI, 1.25-7.79).

CONCLUSIONS

Fatigued patients, African American patients, and publicly insured/uninsured patients with cancer were more likely to experience diminished employment after 2 years of follow-up. Further investigation with longer follow-up is warranted to identify factors associated with these disparities in employment participation after treatment of early-stage breast cancer. Cancer 2018;124:2026-35. © 2018 American Cancer Society.

Loss in working years after a breast cancer diagnosis

Background:

Breast cancer can negatively influence working life, but it is unclear how many working years women with breast cancer can expect to lose.

Methods:

Women diagnosed with breast cancer between 1997 and 2012 were identified in the Breast Cancer Data Base Sweden (N=19 661), together with breast cancer-free comparison women (N=81 303). Using flexible parametric survival modelling, the loss in working years was calculated as the difference in the remaining years in the work force between women with and without breast cancer.

Results:

Women aged 50 years at diagnosis with stage I disease lost on average 0.5 years (95% CI, 0.2–0.7) of their remaining working time; the corresponding estimates were 0.9 years (0.5–1.2) in stage II, 2.5 years (1.9–3.1) in stage III and 8.1 years (6.5–9.7) in stage IV. Women with in situ breast cancer did not lose any working years. The strongest treatment determinant was axillary lymph node dissection.

Conclusions:

We found a loss in working years not only in late but also in early-stage breast cancer. Although it is reassuring that some groups had no or only a modest work loss, the economic consequences for society are considerable given the large number of women annually diagnosed with breast cancer.

Three-Year Prospective Cohort Study of Factors Associated with Return to Work After Breast Cancer Diagnosis

Purpose The purpose of this prospective cohort study of breast cancer survivors was to identify factors before diagnosis, during treatment, and after treatment that are associated with return to work (RTW). Methods A total of 288 women with breast cancer (stage I-III) and whose age were 18-65 years-old answered questionnaires at 4-6, 12, 24, and 36 months after diagnosis. The surveys asked about performance of regular exercise and health-related quality of life issues. "RTW at 36 months" was assigned to patients who reported any of the following: working at least twice; no job at baseline but working more than once; job at baseline, stopped working, and then started working again; and working during all 3 years. Results We classified 107 of 288 of the women (37.1%) as having returned to work. Analysis of pre-diagnostic factors indicated that more education and practice of regular endurance exercise were positively associated with RTW. Analysis of factors during treatment indicated that appetite loss and fatigue were negatively associated with RTW. Analysis of factors at post-treatment indicated that better body image, better physical function, better existential well-being, and participation in regular endurance and resistance exercise were positively associated with RTW. Childbirth at 12-24 months was negatively associated with RTW. Conclusion Women who participate in exercise before, during, and after treatment for breast cancer are more likely to RTW. A woman's need to care for children, perceived body image, and existential well-being may also affect her RTW.

The long-term financial consequences of breast cancer: a Danish registry-based cohort study

BACKGROUND

A breast cancer diagnosis affects an individual's affiliation to labour market, but the long-term consequences of breast cancer on income in a Danish setting have not been examined. The present study investigated whether breast cancer affected future income among Danish women that participated in the work force. We also examined the roles of sociodemographic factors and prior psychiatric medical treatment.

METHODS

This registry-based cohort study was based on information retrieved from linked Danish nationwide registries. We compared the incomes of 13,101 women (aged 30-59 years) diagnosed with breast cancer (exposed) to those of 60,819 women without breast cancer (unexposed). Changes in income were examined during a 10-year follow-up; for each follow-up year, we calculated the mean annual income and the relative change compared to the income earned one year prior to diagnosis. Expected changes in Danish female income, according to calendar year and age, were estimated based on information from Statistics Denmark. For exposed and unexposed groups, the observed income changes were dichotomized to those above and those below the expected change in income in the Danish female population. We examined the impact of breast cancer on income each year of follow-up with logistic regression models. Analyses were stratified according to educational level, marital status, and prior psychiatric medical treatment.

RESULTS

Breast cancer had a temporary negative effect on income. The effect was largest during the first three years after diagnosis; thereafter, the gap narrowed between exposed and unexposed cohorts. The odds ratio for an increase in income in the cancer cohort compared to the cancer-free cohort was 0.81 (95% CI 0.77-0.84) after three years. After seven years, no significant difference was observed between cohorts. Stratified analyses demonstrated that the negative effect of breast cancer on income lasted longest among women with high educational levels. Being single or having received psychiatric medical treatment increased the chance to experience an increase in income among women with breast cancer.

CONCLUSION

A breast cancer diagnosis led to negative effects on income, which ameliorated over the following seven years. Sociodemographic factors and prior psychiatric medical treatment might influence long-term consequences of breast cancer on income.

Sickness Absence and Disability Pension After Breast Cancer Diagnosis: A 5-Year Nationwide Cohort Study

Purpose To explore future diagnosis-specific sickness absence and disability pension among women with breast cancer compared with women without breast cancer. Also, to examine associations with disease-related and sociodemographic factors among those with breast cancer. Methods Longitudinal register data on 3,547 women living in Sweden (age 20 to 65 years) who were first diagnosed with breast cancer in 2005, and a matched comparison cohort (n = 14,188), were analyzed for the annual prevalence of diagnosis-specific sickness absence and disability pension over 5 years. Logistic regressions were used to explore associations of disease-related and sociodemographic factors with future sickness absence and disability pension among women with breast cancer. Results Immediately after being diagnosed with breast cancer, the proportion of women with sickness absence was high but decreased continuously from the 1st through 5th year after diagnosis (71%, 40%, 30%, 22%, and 19%, respectively). In comparison, the range for women without breast cancer was 17% to 11%, respectively. The higher prevalence of sickness absence after breast cancer was mainly a result of breast cancer diagnosis, not a mental diagnosis, or other somatic diagnoses. Advanced cancer at diagnosis, > 90 days sickness absence before diagnosis, low education, and being born outside Sweden were associated with higher odds ratios for sickness absence and disability pension (odds ratio range, 1.40 to 6.45). Conclusion The level of sickness absence increased substantially in women with breast cancer during the first year after diagnosis and approached the level of breast cancer-free women in the following years; however, even in the first year, most women were not on sickness absence for a substantial time, and even in high-risk groups, many were not on sickness absence or disability pension in the following years. Information about relatively low future sickness absence and disability pension levels can be used by patients when planning their work, by health care professionals, and by social insurance officers. Employers and Occupational Health Services need this information to adequately handle workplace adjustments.

Glucose and lipoprotein biomarkers and breast cancer severity using data from the Swedish AMORIS cohort

Background

The lipid and glucose metabolisms are postulated as possible intermediary mechanisms in linking obesity and breast cancer (BC). Links between serum lipid and glucose biomarkers and BC risk has been observed in the Swedish Apolipoprotein MORtality RISk (AMORIS) cohort. We conducted a follow-up analysis including information on tumour characteristics.

Methods

One thousand eight hundred twenty-four women diagnosed with BC, with serum biomarker levels of glucose, triglycerides, cholesterol (total, HDL, and LDL), and apolipoproteins A-1 and B recorded in a routine health check at baseline were included. BC severity was split into categories (good, moderate, and poor prognosis) based on ER status, TNM stage, and age at diagnosis. Proportional odds models were used to obtain odds ratios (ORs) and 95% confidence intervals (CI), with the interval time between baseline measurement and BC diagnosis accounted for.

Results

Serum glucose and the ApoB/ApoA-1 ratio showed a non-statistically significant positive association with BC severity (proportional OR: 1.25 (95%CI: 0.92–1.70) for glucose (</≥ 5.60 mmol/L) and 1.31 (95%CI: 0.97–1.76) for ApoB/A-1 ratio (</≥ 1). The proportion of severe and moderate BC was modestly greater across all abnormal serum biomarker groups.

Conclusions

Despite the size and detail of data in AMORIS, we only found a modest positive association between serum levels of glucose, apoB/ApoA-1 and BC severity, suggesting that these factors are not the main players in linking obesity and BC aggressiveness.

Electronic supplementary material

The online version of this article (doi:10.1186/s12885-017-3232-6) contains supplementary material, which is available to authorized users.

Ganoderma spp.: A Promising Adjuvant Treatment for Breast Cancer

For the past several decades, cancer patients in the U.S. have chosen the use of natural products as an alternative or complimentary medicine approach to treat or improve their quality of life via reduction or prevention of the side effects during or after cancer treatment. The genus Ganoderma includes about 80 species of mushrooms, of which several have been used for centuries in traditional Asian medicine for their medicinal properties, including anticancer and immunoregulatory effects. Numerous bioactive compounds seem to be responsible for their healing effects. Among the approximately 400 compounds produced by Ganoderma spp., triterpenes, peptidoglycans and polysaccharides are the major physiologically-active constituents. Ganoderma anticancer effects are attributed to its efficacy in reducing cancer cell survival and growth, as well as by its chemosensitizing role. In vitro and in vivo studies have been conducted in various cancer cells and animal models; however, in this review, we focus on Ganoderma’s efficacy on breast cancers. Evidence shows that some species of Ganoderma have great potential as a natural therapeutic for breast cancer. Nevertheless, further studies are needed to investigate their potential in the clinical setting and to translate our basic scientific findings into therapeutic interventions for cancer patients.

Employment and social benefits up to 10 years after breast cancer diagnosis: a population-based study

Background:

Little is known about employment outcomes after breast cancer (BC) beyond the first years after treatment.

Methods:

Employment outcomes were compared with a general population comparison group (N=91 593) up to 10 years after BC for 26 120 patients, diagnosed before age 55 between 2000–2005, with income and social benefits data from Statistics Netherlands. Treatment effects were studied in 14 916 patients, with information on BC recurrences and new cancer events.

Results:

BC survivors experienced higher risk of losing paid employment (Hazard Ratio (HR): 1.6, 95% Confidence Interval (95% CI) 1.4–1.8) or any work-related event up to 5–7 years (HR 1.5, 95% CI 1.3–1.6) and of receiving disability benefits up to 10 years after diagnosis (HR 2.0, 95% CI 1.6–2.5), with higher risks for younger patients. Axillary lymph node dissection increased risk of disability benefits (HR 1.5, 95% CI 1.4–1.7) or losing paid employment (HR 1.3, 95% CI 1.2–1.5) during the first 5 years of follow-up. Risk of disability benefits was increased among patients receiving mastectomy and radiotherapy (HR 1.2; 95% CI 1.1–1.3) and after chemotherapy (HR 1.7; 95% CI 1.5–1.9) during the first 5 years after diagnosis.

Conclusions:

BC treatment at least partly explains the increased risk of adverse employment outcomes up to 10 years after BC.

A study to examine the influence of health professionals' advice and support on work capacity and sick leave after breast cancer surgery

PURPOSE

The aim of this study was to investigate how women, shortly after breast cancer surgery, experienced encounters with, and information from, healthcare professionals regarding work and sick leave and if these experiences were associated with self-reported work capacity and sick leave.

METHODS

This is a cross-sectional study based on questionnaire data from 605 women who had had breast cancer surgery, aged 20-63 years. Exclusion criteria were known distant metastases, pre surgical therapy, and/or previous breast cancer. Data on age, type of surgery, global health, and work environment were included as covariates in multivariable logistic regression analysis.

RESULTS

Five percent of the women had not received any advice concerning work or sick leave. Women reporting receiving useful advice or support related to paid work had lower risk of reporting reduced physical or psychological/social work capacity due to the cancer or treatment (OR 0.46 (95 % CI 0.26-0.81) respective OR 0.45 (95 % CI 0.26-0.77)). There were no associations between having received useful advice or support concerning work and being on sick leave. Women encouraged to take sick leave had an OR of 2.17 (95 % CI 1.39-3.37) of being sickness absent. They also to a higher extent had reduced physical and psychological/social work capacity. Women who reported to have been encouraged to work were sickness absent to a lower extent (OR 0.64; 95 % CI 0.41-0.98) and reported higher physical work capacity.

CONCLUSIONS

Work and sick leave is being discussed during consultations with women with breast cancer and the advice given seems to be in line with the women's subjective work capacity.

Socio-demographic, treatment-related, and health behavioral predictors of persistent pain 15 months and 7-9 years after surgery: a nationwide prospective study of women treated for primary breast cancer

The purpose of this study was to investigate and report prevalence and risk factors for persistent pain in breast cancer patients at 15 months and 7-9 years post surgery. A nationwide inception cohort study including 3343 women treated for primary breast cancer between 2001 and 2004, who returned a questionnaire 3 months post surgery. Socio-demographic and clinical information was obtained from registries. Questionnaire data on pain and health behaviors were obtained 15 months and 7-9 years post surgery. A total of 1905 women were eligible for analysis. At 15-month post surgery, 32.7 % reported pain "almost every day" or more frequently. At 7-9 years post surgery, the prevalence decreased to 20.4 %. Socio-demographic (young age, lower education, lower income, lower occupational status), treatment-related (being lymph node positive, axillary lymph node dissection (ALND), post-menopausal endocrine treatment), and health behavioral factors (smoking ≥ 10 cigarettes/day, obesity (BMI ≥ 30 and < 35), comorbidity, poor physical function) were significantly associated with pain at 15 months. Being physically active and moderate alcohol intake (<3 units/day) were negatively associated with pain. At 7-9 years post surgery, only ALND (OR:1.41, p = 0.03), post-menopausal endocrine treatment (OR:1.62, p = 0.01), poorer physical function (ORs:2.00-2.40, p = 0.003), and weight training (h/week) at 15 months (OR:1.10, p = 0.008) were significant predictors of pain when adjusting for age and pain 15 months post surgery. No socio-demographic predictors remained statistically significant. Younger age, lower socio-economic status, more invasive surgery, endocrine treatment, and adverse health behaviors emerged as risk factors for persistent pain. The influence of risk factors changed over time, suggesting a complex course of pain development and maintenance.

The global impact of non-communicable diseases on macro-economic productivity: a systematic review

Non-communicable diseases (NCDs) have large economic impact at multiple levels. To systematically review the literature investigating the economic impact of NCDs [including coronary heart disease (CHD), stroke, type 2 diabetes mellitus (DM), cancer (lung, colon, cervical and breast), chronic obstructive pulmonary disease (COPD) and chronic kidney disease (CKD)] on macro-economic productivity. Systematic search, up to November 6th 2014, of medical databases (Medline, Embase and Google Scholar) without language restrictions. To identify additional publications, we searched the reference lists of retrieved studies and contacted authors in the field. Randomized controlled trials, cohort, case-control, cross-sectional, ecological studies and modelling studies carried out in adults (>18 years old) were included. Two independent reviewers performed all abstract and full text selection. Disagreements were resolved through consensus or consulting a third reviewer. Two independent reviewers extracted data using a predesigned data collection form. Main outcome measure was the impact of the selected NCDs on productivity, measured in DALYs, productivity costs, and labor market participation, including unemployment, return to work and sick leave. From 4542 references, 126 studies met the inclusion criteria, many of which focused on the impact of more than one NCD on productivity. Breast cancer was the most common (n = 45), followed by stroke (n = 31), COPD (n = 24), colon cancer (n = 24), DM (n = 22), lung cancer (n = 16), CVD (n = 15), cervical cancer (n = 7) and CKD (n = 2). Four studies were from the WHO African Region, 52 from the European Region, 53 from the Region of the Americas and 16 from the Western Pacific Region, one from the Eastern Mediterranean Region and none from South East Asia. We found large regional differences in DALYs attributable to NCDs but especially for cervical and lung cancer. Productivity losses in the USA ranged from 88 million US dollars (USD) for COPD to 20.9 billion USD for colon cancer. CHD costs the Australian economy 13.2 billion USD per year. People with DM, COPD and survivors of breast and especially lung cancer are at a higher risk of reduced labor market participation. Overall NCDs generate a large impact on macro-economic productivity in most WHO regions irrespective of continent and income. The absolute global impact in terms of dollars and DALYs remains an elusive challenge due to the wide heterogeneity in the included studies as well as limited information from low- and middle-income countries.

The effect of breast cancer on personal income three years after diagnosis by cancer stage and education: a register-based cohort study among Danish females

BACKGROUND

The purpose of this study was to investigate whether there is an association between stage of incident breast cancer (BC) and personal income three years after diagnosis. The analysis further considered whether the association differed among educational groups.

METHODS

The study was based on information from Danish nationwide registers. A total of 7,372 women aged 30-60 years diagnosed with BC, 48% with metastasis, were compared to 213,276 controls. Generalised linear models were used to estimate the effect of a cancer diagnosis on personal gross income three years after diagnosis, stratified by education and stage of cancer. The models were adjusted for income two years prior to cancer diagnosis and demographic, geographic and co-morbidity covariates.

RESULTS

Adjusting for income two years prior to cancer diagnosis and other baseline covariates (see above), cancer had a minor effect on personal income three years after diagnosis. The effect of metastatic BC was a statistically significant reduction in income three years after diagnosis of -3.4% (95% CI -4.8;-2.0), -2.8% (95% CI -4.3;-1.3) and -4.1 (95% CI -5.9;-2.3) among further, vocational and low educated women, respectively. The corresponding estimates for the effect of localised BC were -2.5% (95% CI -3.8; -1.2), -1.6% (95% CI -3.0; -0.2) and -1.7% (95% CI -3.7; 0.3); the latter estimate (for the low-educated) was not statistically different from zero. We found no statistically significant educational gradient in the effect of cancer stage on income.

CONCLUSIONS

In a Danish context, the very small negative effect of BC on personal income may be explained by different types of compensation in low- and high-income groups. The public income transfers are equal for all income groups and cover a relatively high compensation among low-income groups. However, high-income groups additionally receive pay-outs from private pension and insurance schemes, which typically provide higher coverage for high-income workers.

The global impact of non-communicable diseases on households and impoverishment: a systematic review

The global economic impact of non-communicable diseases (NCDs) on household expenditures and poverty indicators remains less well understood. To conduct a systematic review and meta-analysis of the literature evaluating the global economic impact of six NCDs [including coronary heart disease, stroke, type 2 diabetes mellitus (DM), cancer (lung, colon, cervical and breast), chronic obstructive pulmonary disease (COPD) and chronic kidney disease (CKD)] on households and impoverishment. Medline, Embase and Google Scholar databases were searched from inception to November 6th 2014. To identify additional publications, reference lists of retrieved studies were searched. Randomized controlled trials, systematic reviews, cohorts, case-control, cross-sectional, modeling and ecological studies carried out in adults and assessing the economic consequences of NCDs on households and impoverishment. No language restrictions. All abstract and full text selection was done by two independent reviewers. Data were extracted by two independent reviewers and checked by a third independent reviewer. Studies were included evaluating the impact of at least one of the selected NCDs and on at least one of the following measures: expenditure on medication, transport, co-morbidities, out-of-pocket (OOP) payments or other indirect costs; impoverishment, poverty line and catastrophic spending; household or individual financial cost. From 3,241 references, 64 studies met the inclusion criteria, 75% of which originated from the Americas and Western Pacific WHO region. Breast cancer and DM were the most studied NCDs (42 in total); CKD and COPD were the least represented (five and three studies respectively). OOP payments and financial catastrophe, mostly defined as OOP exceeding a certain proportion of household income, were the most studied outcomes. OOP expenditure as a proportion of family income, ranged between 2 and 158% across the different NCDs and countries. Financial catastrophe due to the selected NCDs was seen in all countries and at all income levels, and occurred in 6-84% of the households depending on the chosen catastrophe threshold. In 16 low- and middle-income countries (LMIC), 6-11% of the total population would be impoverished at a 1.25 US dollar/day poverty line if they would have to purchase lowest price generic diabetes medication. NCDs impose a large and growing global impact on households and impoverishment, in all continents and levels of income. The true extent, however, remains difficult to determine due to the heterogeneity across existing studies in terms of populations studied, outcomes reported and measures employed. The impact that NCDs exert on households and impoverishment is likely to be underestimated since important economic domains, such as coping strategies and the inclusion of marginalized and vulnerable people who do not seek health care due to financial reasons, are overlooked in literature. Given the scarcity of information on specific regions, further research to estimate impact of NCDs on households and impoverishment in LMIC, especially the Middle Eastern, African and Latin American regions is required.

Sickness absence and disability pension following breast cancer - A population-based matched cohort study

PURPOSE

To compare sickness absence and disability pension in a population-based cohort of women with breast cancer (n = 463) from 1 year pre-diagnosis until 3 years post-diagnosis with a matched control group (n = 2310), and to investigate predictors of sickness absence during the 2nd and 3rd year post-diagnosis.

RESULTS

Following breast cancer, the proportion of disease-free women with sickness absence decreased post-diagnosis (1st-3rd year; 78%-31%-19%), but did not reach the pre-diagnostic level (14%; P < 0.05). Post-diagnosis, patients were more likely than controls to be sickness absent (1st-3rd year; P < 0.001). No between-group differences were observed for disability pension post-diagnosis (P > 0.05). Among patients, chemotherapy, baseline fatigue and pre-diagnosis sick days predicted sickness absence during the 2nd, 3rd, and 2nd and 3rd year post-diagnosis, respectively (P < 0.05).

CONCLUSIONS

Breast cancer is associated with increased sickness absence 3 years post-diagnosis. In a clinical setting, prevention and treatment of side effects are important in reducing long-term consequences.

Factors associated with work disability in employed cancer survivors at 24-month sick leave

Background

Identification of factors associated with work disability in cancer survivors on long term sick leave may support these survivors in choosing effective measures to facilitate vocational rehabilitation and return to work. Therefore, this study aims to disclose factors associated with work disability in cancer survivors at 24 months of sick leave.

Methods

A cross sectional study was conducted. The study population consisted of employed sick-listed cancer survivors, aged between 18 and 64 years. They received a questionnaire at 24-month sick leave, the maximum period of sick leave allowed by Dutch social security legislation. Data were linked with the outcome of work disability assessment, as performed by the Dutch social security agency. A hierarchical multivariate logistic regression analysis was performed to identify factors associated with work disability.

Results

Data of 351 valid cases were analysed. The multivariate analysis showed that, for cancer survivors at 24-month sick leave, Dutch nationality, higher education, receiving hormone therapy, metastatic disease, physical limitations and low self-reported work ability were associated with an increased risk for work disability.

Conclusions

This study identified factors associated with work disability of employed cancer survivors at 24 months of sick leave. The results of the current study may serve as a starting point to investigate the course of work disability beyond the maximum period of 24 months of sick leave. In order to enhance work participation of cancer survivors beyond this term, prospective data on work disability in the Netherlands are required.

Unemployment among breast cancer survivors

AIM

Though about 20% of working age breast cancer survivors do not return to work after treatment, few studies have addressed risk factors for unemployment. The majority of studies on occupational consequences of breast cancer focus on non-employment, which is a mixture of sickness absence, unemployment, retirement pensions and other reasons for not working. Unemployment in combination with breast cancer may represent a particular challenge for these women. The aim of the present study is therefore to analyze the risk for unemployment in the years following diagnosis and treatment for breast cancer.

METHOD

This study included 14,750 women diagnosed with breast cancer in Denmark 2001-2009 identified through a population-based clinical database and linked with information from Danish administrative population based registers for information on labour market affiliation, socio-demography and co-morbid conditions. Multivariable analyses were performed by Cox's proportional hazard models.

RESULTS

Two years after treatment, 81% of patients were still part of the work force, 10% of which were unemployed. Increasing duration of unemployment before breast cancer was associated with an adjusted HR = 4.37 (95% CI: 3.90-4.90) for unemployment after breast cancer. Other risk factors for unemployment included low socioeconomic status and demography, while adjuvant therapy did not increase the risk of unemployment.

CONCLUSIONS

Duration of unemployment before breast cancer was the most important determinant of unemployment after breast cancer treatment. This allows identification of a particularly vulnerable group of patients in need of rehabilitation.

The role of marital status in the association between benzodiazepines, psychotropics and injurious road traffic crashes: a register-based nationwide study of senior drivers in Sweden

BACKGROUND

Among senior drivers, benzodiazepines (BZDs) have a documented effect on the risk of road traffic crashes (RTCs). It remains unclear however if BZDs play the same role when considering marital status. Therefore, we aimed to investigate the role of marital status in the association between BZD use and injurious RTCs among senior drivers.

METHODS

Matched case-control study based on five national Swedish registers (n = 154 225). Cases comprised the first non-alcohol-related injurious RTC sustained by drivers aged 50-80 years from July 2005 to December 2009 and controls included registered residents with a valid license who did not crash during that period. Four controls were matched to each case by sex, age and place of residence. Conditional logistic regression analysis for injurious RTC was performed with adjustment for occupation and number of medications. The main exposure was dispensation of BZDs, alone or in combination with other psychotropic medications, 1-30 days prior to the crash date stratified by marital status.

RESULTS

BZD use, alone or in combination with other psychotropic medications, increased the risk of being involved in an RTC (BZD only: adjusted OR: 1.26, 95% CI: 1.17-1.36; BZDs and other psychotropics: adjusted OR: 1.25, 95% CI: 1.12-1.41). Compared to married drivers, those divorced (1.48, 1.43-1.53) and widowed (1.54; 1.45-1.63) had higher adjusted ORs. Marital status modified the association between BZDs and RTCs, particularly among younger male drivers.

CONCLUSIONS

Both BZDs and marital status independently affect the risk for senior drivers to be involved in an RTC. However, marital status plays a role in the association between BZD use and RTCs and this may have implications for targeting risk populations for RTCs among senior drivers.

A controlled study of income development for breast cancer survivors in Norway

AIMS

This study seeks to assess the impact of breast cancer on survivors' annual income at 1 to 13 years of follow-up.

METHODS

A Norwegian registry-based dataset with a 13-year follow-up period was used. The dataset contained case-control pairs, where each pair consisted of one breast cancer case and a cancer-free control, matched for age, marital status, and municipality of residence. A mixed linear model was used to analyse the average income development for cases and controls adjusting for available demographic variables not used in the matching procedure, such as education level, immigration history, and number of children. Individual income was only considered relevant for cancer survivors, thus case-control pairs were censored upon death. Income development by stage of tumour at time of diagnosis was also assessed.

RESULTS

The income of breast cancer survivors had reduced immediately following diagnosis. At 1 year after diagnosis, income development between cases and controls became significantly different (p = 0.006). Differences increased slightly but remained significant throughout the follow-up period. At 13 years after diagnosis, the estimated cumulative income loss for survivors was 39.403 € (p < 0.001). The income development of stage I breast cancer patients was similar to their controls. For higher stage breast cancer patients, the income differences were more pronounced but not always statistically significant.

CONCLUSIONS

Breast cancer has a significant negative effect on the individual incomes of survivors, even at 13 years after diagnosis. Effects increased for individuals with more advanced cancer stages.

IMPLICATIONS FOR CANCER SURVIVORS

In Norway, breast cancer survivors experience lower income than their cancer-free controls. This may indicate a need for financial compensations in order to maintain the standard of living for this group of patients.

Early retirement and non-employment after breast cancer

OBJECTIVE

This study examined whether workplace support, sociodemographic factors and co-morbidity are associated with early retirement or non-employment due to other reasons among breast cancer survivors. We also compared quality of life and chronic symptoms (pain, fatigue, anxiety and depression) among employed, retired and other non-employed breast cancer survivors.

METHODS

We identified breast cancer survivors diagnosed between 1997 and 2002 from either a hospital or a cancer registry in Denmark, Finland, Iceland and Norway (NOCWO study). All patients had been treated with curative intent. Information on employment, co-morbidity and support was collected via a questionnaire. The sample included 1111 working-aged cancer-free survivors who had been employed at the time of diagnosis. We used multinomial logistic regression models to analyse the association of various determinants with early retirement and other non-employment (due to unemployment, subsidized employment or being a homemaker).

RESULTS

Low education, low physical quality of life, co-morbidity and pain were associated with both early retirement and other non-employment after cancer. Other non-employed survivors also rated their mental quality of life as lower and experienced anxiety and fatigue more often than all the other survivors. Moreover, they reported a lower level of supervisor support after their diagnosis than the employed survivors. Retired survivors more often reported weak support from colleagues.

CONCLUSIONS

Differences in ill health and functional status between various groups of non-employed cancer survivors need to be considered when planning policy measures for improving the labour market participation of this population and preventing their early withdrawal from working life.

Prognostic factors of work disability in sick-listed cancer survivors

PURPOSE

Sick-listed cancer survivors may face lasting side-effects, even after a successful completion of treatment. As a consequence, they are at risk of work disability, which may lead to job loss. Knowledge of prognostic factors of work disability may support cancer survivors in their trajectory of vocational rehabilitation. The purpose of this study was to identify prognostic factors of work disability in sick-listed cancer survivors.

METHODS

From the first day of sick leave, a cohort of 131 cancer survivors was followed for 24 months. Included participants were aged between 20 and 63 years. Data were collected, using questionnaires, at 10 months after reporting sick. The level of work disability, i.e., entitlement for disability compensation, was assessed by an insurance physician and a labour expert at 24 months. Univariate and multiple logistic regression analyses were performed.

RESULTS

In the univariate analysis, 14 variables were found to be associated with the level of work disability at 24 months. These factors were related to socio-demographics, health characteristics, work-related characteristics, and return to work (RTW) expectations. Multiple logistic regression showed that at 10-month sick leave, perception of health care providers on cancer survivors' work ability and experienced influence on RTW, both reported by workers, were significantly associated with the level of work disability at 24 months.

CONCLUSION

It seems in the interest of cancer survivors to take an active role in planning their RTW trajectory and to discuss RTW with their health care providers.

IMPLICATIONS FOR CANCER SURVIVORS

The potential role healthcare providers may play in counselling cancer survivors on RTW must not be underestimated. Cancer survivors may benefit in having control on their RTW trajectory.

Case management vocational rehabilitation for women with breast cancer after surgery: a feasibility study incorporating a pilot randomised controlled trial

Background

There is a paucity of methodologically robust vocational rehabilitation (VR) intervention trials. This study assessed the feasibility and acceptability of a VR trial of women with breast cancer to inform the development of a larger interventional study.

Methods

Women were recruited in Scotland and randomised to either a case management VR service or to usual care. Data were collected on eligibility, recruitment and attrition rates to assess trial feasibility, and interviews conducted to determine trial acceptability. Sick leave days (primary outcome) were self-reported via postal questionnaire every 4 weeks during the first 6 months post-surgery and at 12 months. Secondary outcome measures were change in employment pattern, quality of life and fatigue.

Results

Of the 1,114 women assessed for eligibility, 163 (15%) were eligible. The main reason for ineligibility was age (>65 years, n = 637, 67%). Of those eligible, 111 (68%) received study information, of which 23 (21%) consented to participate in the study. Data for 18 (78%) women were analysed (intervention: n = 7; control: n = 11). Participants in the intervention group reported, on average, 53 fewer days of sick leave over the first 6 months post-surgery than those in the control group; however, this difference was not statistically significant (p = 0.122; 95% confidence interval −15.8, 122.0). No statistically significant differences were found for secondary outcomes. Interviews with trial participants indicated that trial procedures, including recruitment, randomisation and research instruments, were acceptable.

Conclusions

Conducting a pragmatic trial of effectiveness of a VR intervention among cancer survivors is both feasible and acceptable, but more research about the exact components of a VR intervention and choice of outcomes to measure effectiveness is required. VR to assist breast cancer patients in the return to work process is an important component of cancer survivorship plans.

Trial registration

ISRCTN29666484

Changes in health-related quality of life by occupational status among women diagnosed with breast cancer--a population-based cohort study

OBJECTIVE

To investigate whether longitudinal changes in health-related quality of life (HRQoL) among breast cancer patients vary by prediagnosis occupational status or postdiagnosis changes in working time.

METHODS

We identified 1573 patients in the Breast Cancer Quality Register of Central Sweden and asked them to participate in a longitudinal questionnaire study. A total of n = 841 women completed three questionnaires within a mean time of 4, 16, and 38 months postdiagnosis. Generalized estimating equation models were used to examine changes in European Organization for Research and Treatment of Cancer Quality of Life Questionnaire and the Breast Cancer-Specific Quality of Life Questionnaire subscales stratified by prediagnosis occupational status and postdiagnosis changes in working time.

RESULTS

Over time, the proportion of employed women reporting good functioning increased more, and the proportion reporting a high level of symptoms decreased more compared with women on sick leave/disability pension and retirement pensioners (p < 0.001). The latter two also showed a worsening in several subscales (p < 0.05). Among employed women, more consistent improvements in role and social functioning were observed among those with an increase/no change in working time than among those who had decreased it or stopped working (p < 0.05). A decrease in the proportion reporting pain was observed among women with an increase/no change in working time compared with women with decreased working time, among whom the proportion reporting pain increased (p = 0.008).

CONCLUSIONS

Being employed prediagnosis and resuming work to the same extent as prior to the breast cancer diagnosis are associated with consistent improvements in HRQoL. These results highlight the importance of interventions to improve HRQoL and policies to support return to work following diagnosis.

[Work disability criteria in breast cancer]

Breast cancer is one of the most frequent neoplasia in women, with an increasing prevalence in Europe and also in Spain. Although the predominance over the male sex is clear, we should not forget the cases where men are affected, even more so when in this case the risks attached to the type of job become more important. The importance of the indirect costs of this illness arises from: the high prevalence in people of working age, long periods of work disability, and permanent disability when the limitations are incompatible with the work activity once all the options of job readjustment and return to work have been exhausted. We will review the current criteria in order to establish some orientating guidelines that can be useful in the daily practice for Occupational Medicine professionals, General Practitioners and other specialists, always in collaboration with the medical teams from the National Health Service in charge of the evaluation of disabilities.