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Job loss, return to work, and multidimensional well-being after breast cancer treatment in working-age Black and White women

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Abstract

Purpose

Breast cancer survivorship has improved in recent decades, but few studies have assessed the patterns of employment status following diagnosis and the impact of job loss on long-term well-being in ethnically diverse breast cancer survivors. We hypothesized that post-treatment employment status is an important determinant of survivor well-being and varies by race and age.

Methods

In the Carolina Breast Cancer Study, 1646 employed women with primary breast cancer were longitudinally evaluated for post-diagnosis job loss and overall well-being. Work status was classified as “sustained work,” “returned to work,” “job loss,” or “persistent non-employment.” Well-being was assessed by the Functional Assessment of Cancer Therapy (FACT-G) instrument. Analysis of covariance was used to evaluate the association between work status and well-being (physical, functional, social, and emotional).

Results

At 25 months post-diagnosis, 882 (53.6%) reported “sustained work,” 330 (20.1%) “returned to work,” 162 (9.8%) “job loss,” and 272 (16.5%) “persistent non-employment.” Nearly half of the study sample (46.4%) experienced interruptions in work during 2 years post-diagnosis. Relative to baseline (5-month FACT-G), women who sustained work or returned to work had higher increases in all well-being domains than women with job loss and persistent non-employment. Job loss was more common among Black than White women (adjusted odds ratio = 3.44; 95% confidence interval 2.37–4.99) and was associated with service/laborer job types, lower education and income, later stage at diagnosis, longer treatment duration, and non-private health insurance. However, independent of clinical factors, job loss was associated with lower well-being in multiple domains.

Conclusions

Work status is commonly disrupted in breast cancer survivors, but sustained work is associated with well-being. Interventions to support women’s continued employment after diagnosis are an important dimension of breast cancer survivorship.

Implications for Cancer Survivors

Our findings indicate that work continuation and returning to work may be a useful measure for a range of wellbeing concerns, particularly among Black breast cancer survivors who experience greater job loss.

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Data availability

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

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Funding

This work was supported by grants from the UNC Lineberger Comprehensive Cancer Center funded by the University Cancer Research Fund (LCCC2017T204), the National Cancer Institute of the National Institutes of Health (P50-CA58223, U01-CA179715, T32-CA057726, P30 CA046934), and the National Institute of Environmental Health Sciences of the National Institutes of Health (P30-ES010126).

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Authors and Affiliations

  1. Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, Chapel Hill, NC, USA

    Marc A. Emerson, Melissa B. Gilkey, Shekinah N. C. Elmore & Melissa A. Troester

  2. Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA

    Bryce B. Reeve

  3. Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Melissa B. Gilkey

  4. Menzies Health Institute Queensland, Griffith University, Brisbane, Australia

    Sandi Hayes

  5. University of Colorado Comprehensive Cancer Center, Aurora, CO, USA

    Cathy J. Bradley

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  1. Marc A. Emerson
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Contributions

All authors contributed to the study. The first draft of the manuscript was written by Marc Emerson, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Marc A. Emerson.

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The study sponsors had no role in the design of the study; the collection, analysis, and interpretation of the data; the writing of the manuscript, and the decision to submit the manuscript for publication.

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This study was approved by the Institutional Review Board at the University of North Carolina at Chapel Hill,

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Emerson, M.A., Reeve, B.B., Gilkey, M.B. et al. Job loss, return to work, and multidimensional well-being after breast cancer treatment in working-age Black and White women. J Cancer Surviv 17, 805–814 (2023). https://doi.org/10.1007/s11764-022-01252-6

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