PD06-09: Early Predictors of Prolonged Unemployment after a Diagnosis of Breast Cancer.

Abstract

Abstract Introduction: Low-income women may be more vulnerable to job loss and prolonged work absence after a diagnosis of breast cancer than their higher-income counterparts. This can have important adverse financial consequences on breast cancer survivors. The identification of early risk factors for long-term unemployment could inform interventions to help patients avoid this outcome. Methods: A consecutive sample of 921 low-income, underinsured or uninsured, English and/or Spanish-speaking women treated for breast cancer through the California Breast and Cervical Cancer Treatment Program was recruited and surveyed 6 months after a diagnosis of breast cancer. Participants completed follow-up telephone surveys at 18, 36, and 60 months post-diagnosis; 539 remained in the cohort at 60 months. This analysis includes only the 315 (58%) women who were employed before diagnosis. Our primary study outcome was prolonged unemployment, defined as being unemployed at every survey. Baseline characteristics (measured in the 6-month survey) were compared between women with prolonged unemployment and those who were working 60 months after diagnosis. Results: The median age of the study sample was 50, and 98% had a baseline annual household income < $40,000. Eighty-five of 315 (27%) women who were employed before diagnosis had prolonged unemployment after diagnosis. In contrast, 168 (53%) were working at 60 months. Baseline predictors of prolonged unemployment after diagnosis include lower household income (p=0.003), inadequacy of financial resources to cover needs (40% vs. 23%, for inadequate vs. adequate, p=0.006), lower education (43%, 30%, and 23% among those who did not complete high school, had a high school diploma, and had a college diploma, respectively, p=0.04), higher comorbidity burden (p=0.006), higher cancer stage at diagnosis (p=0.001), and receipt of chemotherapy (p=0.008). Variables found not to be associated with prolonged unemployment include age, ethnicity, acculturation, marital status, children in the home, social support, job type, type of breast surgery, type of axillary surgery, endocrine therapy, and radiation therapy. In a multivariable analysis that included ethnicity, education, income, chemotherapy, and comorbidity, the latter three variables remained statistically significant predictors of prolonged unemployment, but education and ethnicity were not significantly associated with the outcome. Discussion: More than a quarter of women treated for breast cancer never returned to work during the five years after their diagnosis. In this low-income sample, those with the lowest income appeared to be especially vulnerable to prolonged unemployment, even when controlling for education. It is possible that the income provided by a low-paying job provides a marginal benefit, if any, over disability income, and additional research is needed to better understand this relationship and its financial and psychosocial consequences. Clinical variables also were important predictors of prolonged unemployment. Women with a higher comorbidity burden and those treated with chemotherapy appear to be most vulnerable to prolonged unemployment. This may have clinical implications for informed decision-making between oncologists and their patients. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr PD06-09.