Employment loss and financial hardship among women with breast cancer receiving chemotherapy.

Abstract

505 Background: A breast cancer diagnosis and subsequent treatment an have both physical and emotional toxicities. Many who are employed have to reduce hours or take leave, often resulting in loss of income. The effect of this loss of income is potentially compounded by the cost of medical care and can result in significant financial hardship. However, the association between employment income loss and financial hardship is not well studied. Methods: This is an analysis of the Genetics, Molecular Mechanisms, and Symptom Science (GEMMS) longitudinal study of people with newly diagnosed breast cancer undergoing curative intent chemotherapy and surgery. The study collects clinical data, patient-reported outcomes, cognitive assessments, and biospecimens for correlative studies. Participants completed assessments at baseline (prior to chemotherapy initiation), mid-way, and chemotherapy completion, as well as 3 and 6 month post chemotherapy and annually thereafter for up to 5 years. This analysis was restricted to data collected within 1 year of completing chemotherapy. Multivariable logistic regression models were constructed to determine which features were associated with employment loss and financial hardship. Financial hardship was assessed using a single question, “In the past week, has your physical condition or medical treatment caused you financial difficulties?”. Results: 149 participants are included in GEMMS, of which 111 (75%) were employed at diagnosis. Within the 1 year following completion of chemotherapy, 48% of working women reported at least one 4 week period of where they did not work. This was most common 3 months following completion, where 30% reported being out of work for the prior 4 weeks. None of the variables tested (age, race, marital status, education level, stage of cancer, etc.) predicted employment loss. Overall, 61% of women reported financial hardship within the year following commencement of treatment. Neither being employed at diagnosis nor suffering employment loss were associated with experiencing financial hardship. Of the other variables tested, only marital status was associated with financial hardship. Married women were 70% ( p = 0.02) less likely to report financial hardship than unmarried women. Conclusions: Nearly half of women receiving curative intent chemotherapy for breast cancer report job loss of 4 weeks or more and nearly two-thirds report financial hardship during the year following commencement of chemotherapy. These negative consequences of breast cancer and its treatment seem to effect women of different backgrounds similarly.