Study: How does a breast cancer diagnosis affect employment of young women?

IN-DEPTH REVIEW OF RESEARCH

Study background:

Work during treatment and recovery or a return to work has many benefits for breast cancer survivors, including lower distress and better quality of life, self-esteem and physical and mental function.

Some studies have shown that breast cancer treatment can have impacts on work and job performance. Some women experience work-related stress and changes in physical and mental function that can impact their ability to work. Unemployment after breast cancer surgery ranges from 6 to 56%, depending on the study. Most of the research about the effect of breast cancer on women's work has been done in women of varying ages.

Almost 10% of new breast cancer cases each year are among women who are age 40 or younger. It is unknown whether breast cancer treatment affects young career women differently than older populations that may include more women with a long career history or who are closer to retirement. The researchers of this study wanted to look at the impact of cancer on young women's employment and the ability and desire to work.

Researchers of this study wanted to know:

How breast cancer diagnosis and treatment affect young women's jobs.

Populations looked at in this study:

The participants were 911 women who were part of the Young Women's Breast Cancer Study.

All participants, who were enrolled between 2006 and 2016, were diagnosed with breast cancer by age 40 and did not have metastatic cancer (women who were stage 0-3 were eligible). The average age at diagnosis was 36 years; 83% were non-Hispanic white women and 14% identified with a different race/ethnicity; 903 of 911 (99%) of the women had health insurance in the 3 months prior to their diagnosis.

Study design:

Each participant was asked to complete a baseline survey about her job in the three months prior to her breast cancer diagnosis. Baseline surveys were completed within 5 months of diagnosis based on remembering what happened prior to diagnosis. At 1 year after diagnosis, each woman was then asked to take another survey about her job and job-related issues.

Study findings:  

Three months prior to their breast cancer diagnosis, most women (762 of 911 women, 84%) were employed.

• 578 (63%) were employed full time
• 148 (16%) were employed part time
• 36 (4%) were self-employed
• 30 (3%) were unemployed due to health or other reasons
• 119 (13%) were full-time homemakers

One year after their breast cancer diagnosis, most women (729 of 911 women, 80%) were employed.

• 700 of 911 women (77%) were employed 3 months prior and at 1 year after their diagnosis.
• 29 of 911 women (3%) were employed 3 months prior and at 1 year after their diagnosis.

Some women remained unemployed:

• 120 of 911 women (13%) were unemployed 3 months prior to their diagnosis and one year later.

Some women transitioned from being employed to unemployed:

• 62 of 911 women (7%) were employed at the time of their diagnosis and were unemployed 1 year after their diagnosis.
• Over half of the women (32 of 62 women, 52%) who were no longer employed 1 year after their diagnosis stated that they were unemployed because of health reasons.

Among the 729 women who had been employed before diagnosis, factors associated with becoming unemployed were:

• later stage cancer (stage 3 compared with stage 1)
• less initial financial means (defined as those who had difficulty paying bills while they were employed or who had to cut back to pay bills compared with women who had discretionary income).
• race or ethnicity, being married, having children (radiation treatment and age at diagnosis were not associated with the risk of becoming unemployed).

At first glance, education level (women without a college degree compared to those with a college degree) was associated with becoming unemployed after breast cancer diagnosis, but this did not hold up when other factors were considered.

Most women (93%) who were still employed at one year after diagnosis reported that their cancer treatment did not interfere with their job very much or at all.

• Of those employed, only 51 of 723 women (7%) reported that cancer treatment limited their ability to do their job.
• Most employed women predicted that they were likely to be working in 1 year (2 years after diagnosis).
• 464 of 723 women (64%) reported that their employers were willing to make accommodations for their cancer treatment; 211 of 723 women (29%) said that accommodations were not needed.
• 192 of 723 women (27%) reported job dissatisfaction 1 year after their breast cancer diagnosis. Women who reported financial stress before breast cancer diagnosis were the most likely to report job dissatisfaction after diagnosis and that their employer was unwilling to make accommodations related to their treatment.

Limitations:

This study had multiple limitations.

• First, the study included relatively few participants (911). While this is sufficient to support the primary findings, the number of women who were unemployed after diagnosis was small (62), and few conclusions can be made about the reasons for their unemployment.
• The diversity of the participants was also limited. The overwhelming majority of participants (99%) who had health insurance were white, well-educated and most did not report financial difficulties at baseline. These characteristics are not representative of the U.S. population in general. It is expected that financial impacts of breast cancer and employment may differ greatly among those with jobs who do not have health insurance, but this remains unknown.
• Reports of employment and job satisfaction were self-reported. The baseline survey required participants to remember their job status, financial stress and job satisfaction in the 3 months prior to diagnosis, which may have been as long as 8 months earlier. In any retrospective study, some people may not accurately remember their past, particularly given that they have had the stress of a breast cancer diagnosis in the intervening time.
• These findings are not generalizable to other countries where health insurance and work conditions and laws differ from those in the U.S.
• This is an observational study that correlates an event (breast cancer diagnosis) with particular factors (employment or job satisfaction). These correlations may or may not be due to the reasons that researcher claim.
• The design of this study did not include a control group of women who were matched by circumstances but who had not had a breast cancer diagnosis. Whether the rates of unemployment or job satisfaction would be greater, lesser or the same among a control group is unknown. This information would have provided a greater understanding of the impact of breast cancer on the participants.
• Other factors that were not considered may impact the results. Diabetes, heart conditions and other health factors that may have affected employment were not evaluated. Work-related problems other than job satisfaction, including productivity, ability and stress, were not explored.

Conclusions:

Most young women in this study did not have problems with their job following a breast cancer diagnosis. Most women were employed and reported job satisfaction. The women who had job difficulties or became unemployed were women who initially had the most financial stress and least job satisfaction.

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Posted 1/10/20