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A longitudinal analysis of phenotypic and symptom characteristics associated with inter-individual variability in employment interference in patients with breast cancer

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Abstract

Purpose

A breast cancer diagnosis has a substantial economic impact. Study aims were to evaluate for inter-individual differences in cancer’s level of interference with employment and identify phenotypic and symptom characteristics associated with higher levels of interference.

Methods

Patients (n = 387) were enrolled prior to breast cancer surgery and followed for 12 months. Interference with employment was measured using a 0 (no problem) to 10 (severe problem) numeric rating scale. Hierarchical linear modeling (HLM) was used to evaluate for inter-individual differences in trajectories of employment interference and characteristics associated with employment interference at enrollment and over 12 months.

Results

Patients’ mean age was 55.0 (±11.7) years and the majority underwent breast conservation surgery (80.6%). Mean employment interference score was 3.2 (±3.7). Unconditional model for employment interference demonstrated a decreasing linear trend (−.076/month). Younger age, lower income, higher pain intensity, and having an axillary lymph node dissection were associated with higher pre-surgical interference scores. Having a sentinel lymph node biopsy was associated with ongoing employment interference scores. Higher sleep disturbance scores were associated with both initial and ongoing employment interference scores. Receipt of chemotherapy, use of complementary or alternative therapies, and re-excision or mastectomy following surgery were significant time varying covariates.

Conclusion

This study is the first to use HLM to describe inter-individual differences in the trajectories of cancer’s interference with employment and associated factors prior to and for 12 months following breast cancer surgery. Patients with the identified risk factors warrant ongoing assessments of employment interference and appropriate referrals.

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Funding

The Oncology Nursing Foundation provided funding for this project. The original study was funded by grants from the National Cancer Institute (NCI, CA107091 and CA118658). Dr. Miaskowski is an American Cancer Society Clinical Research Professor and has a K05 award from the NCI (CA168960). This project was supported by NIH/NCRR UCSF-CTSI Grant Number UL1 RR024131. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health or the Oncology Nursing Foundation.

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Authors and Affiliations

  1. School of Nursing, Queensland University of Technology, Q4059, Kelvin Grove, Australia

    Raymond Javan Chan

  2. Institute of Health and Biomedical Innovation, Queensland University of Technology, QLD, Kelvin Grove, 4059, Australia

    Raymond Javan Chan

  3. Princess Alexandra Hospital, Metro South Hospital and Health Services, QLD, Woolloongabba, Queensland, 4102, Australia

    Raymond Javan Chan

  4. Department of Physiological, Nursing School of Nursing, University of California, 2 Koret Way – N631Y, San Francisco, CA, 94143-0610, USA

    Bruce Cooper, Steven M. Paul, Kord M. Kober & Christine Miaskowski

  5. Flinders Centre for Innovation in Cancer, Flinders Medical Centre, Flinders University, Bedford Park, SA, 5042, Australia

    Bogda Koczwara

  6. Department of Pharmacy, Faculty of Science, National University of Singapore, Block S4A, Level 3, 18 Science Drive 4, Singapore, 117543, Republic of Singapore

    Alexandre Chan & Chia Jie Tan

  7. Department of Pharmacy, National Cancer Centre, 11 Hospital Drive, Singapore, 169610, Republic of Singapore

    Alexandre Chan & Chia Jie Tan

  8. School of Medicine, Stanford University, Stanford, CA, USA

    Laura B. Dunn

  9. School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA

    Yvette P. Conley

  10. School of Medicine, University of California, San Francisco, San Francisco, CA, USA

    Jon D. Levine

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  1. Raymond Javan Chan
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Correspondence to Christine Miaskowski.

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Chan, R.J., Cooper, B., Koczwara, B. et al. A longitudinal analysis of phenotypic and symptom characteristics associated with inter-individual variability in employment interference in patients with breast cancer. Support Care Cancer 28, 4677–4686 (2020). https://doi.org/10.1007/s00520-020-05312-4

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