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

Abstract

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. 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). At 25months 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 2years 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. 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. Our findings indicate that work continuation and returning to work may be a useful measure for a range of wellbeingconcerns, particularly among Black breast cancer survivors who experience greater job loss.