Diminished Employment Participation After Breast Cancer Linked to Race and Insurance Status

African American patients and uninsured patients are more likely to have diminished employment participation 2 years after being cancer free than are those with no history of cancer, according to new research published in Cancer.

A research team, led by Christine Ekenga, PhD, MPH, examined data from a longitudinal prospective cohort study of 723 white and African American women of working age who had been diagnosed with incident stage 0 to stage IIA breast cancer (n = 347) and women who had no breast cancer history (n = 376) to examine changes in quality of life over time in women diagnosed with early-stage breast cancer and their age-matched controls. This population of cancer survivors, said the authors, is one in that has an excellent prognosis for disease-free survival.

The researchers evaluated employment trajectories at 2 years of follow-up. At each interview, study participants were asked whether they were currently employed full-time, employed part-time, unemployed/unable to work, a homemaker, or retired.

The researchers found that:

• There was a socioeconomic difference between the groups, with a greater percentage of non-patients (66.5%) than patients (55%) having an income of $50,000 or more per year.
• 70.6% of patients versus 79% of non-patients were employed.
• Sustained employment participation (employed at each time point assessed) after 2 years was 56% in the patient group and 63% in the control group.
• Among patients who were employed at enrollment in the study, 20% experienced diminished employment (employed at 1 time point) during follow-up.
• There was a statistically significant correlation between both African American race (odds ratio [OR], 4.01; 95% CI, 1.57-10.28) and public insurance, lack of insurance, or unknown insurance status (OR, 4.76; 95% CI, 1.34-12.38) and diminished employment participation.

Furthermore, there was a greater likelihood of emerging employment (unemployed, unable to work, or a homemaker, at the first time point, then later employed) among non-patients in the control group, but there was no such association with emerging employment among patients. Fatigue was a significant predictor of diminished employment participation in both the patient group and the control group.

The researchers noted that, while their study assessed participants’ inability to work, it did not assess the reasons why patients were unable to work, and whether employment after treatment for cancer was influenced by factors such job autonomy, schedule flexibility, physically demanding tasks, or organizational policies. Such issues are modifiable, wrote the authors, and could influence employment outcomes among these patients. Future studies should consider these factors, especially among the most vulnerable of subgroups.

“In addition to the added benefit of employer-sponsored health insurance, paid employment has the potential to mitigate the financial stresses associated with cancer,” Ekenga said in a statement. “For women with breast cancer, employment could play a significant role in post-diagnostic health. Health benefits associated with employment include an increased sense of purpose, higher self-esteem and a stronger sense of social support from others, all of which have been associated with improved quality of life.”

Reference

Ekenga CC, Pérez M, Jargenthaler JA, Jeffe DB. Early-stage breast cancer and employment participation after 2 years of follow-up: a comparison with age-matched controls. Published February 13, 2018. Cancer. doi: 10.1002/cncr.31270.