Vanderpool Robin C, Swanberg Jennifer E, Chambers Mara D
University of Kentucky College of Public Health, Department of Health Behavior, Lexington, United States.
University of Maryland School of Social Work, Baltimore, United States.
Glob Adv Health Med. 2013 Sep;2(5):75-85. doi: 10.7453/gahmj.2013.046.
Breast cancer is the leading cause of cancer among women in the United States, costing the healthcare system, employers, and society billions of dollars each year. Despite improvements in screening and treatment, significant breast cancer treatment and survivorship disparities exist among various groups of women. One variable that has not been explored extensively as a possible contributor to breast cancer treatment disparities is employment. This is concerning, given the changing economic and employment trends in the United States favoring low-wage employment. Currently, one-quarter to one-third of all US workers are considered to be working poor, and women are disproportionally represented in this group. Characteristics of low-wage work-limited paid time off, minimal health benefits, schedule inflexibility, and economic insecurity-may become even more significant in the event of a breast cancer diagnosis. To date, there has been limited research into how job conditions inherent to low-wage work may influence working poor survivors' receipt of guideline-recommended breast cancer treatment. Therefore, the purpose of this narrative review was to critically examine the current literature to further our understanding of how employment context may impact treatment decisions and adherence-and therefore receipt of guideline-recommended care-among newly diagnosed, working poor breast cancer survivors. After undertaking a comprehensive review, we failed to identify any published literature that explicitly addressed low-wage employment and receipt of guideline-recommended breast cancer treatment. Four articles reported circumstances where women delayed, missed, or quit treatments due to work interference, or alternatively, developed strategies that allowed them to continue to work and obtain their breast cancer treatment concurrent with medical and economic challenges. An additional five articles, while focused on other cancer and employment outcomes, described the need for increased patient-provider communication about the influence of work on treatment decisions and the development of alternative treatment plans. Due to the paucity of research in this area, future policy, practice, and research efforts should focus on the employment context of working poor breast cancer survivors as a potential contributor to cancer disparities. Engagement of women, employers, oncology providers, healthcare systems, and interdisciplinary researchers is warranted to improve cancer outcomes among this disparate population of working women.
乳腺癌是美国女性癌症的主要病因，每年给医疗保健系统、雇主和社会造成数十亿美元的损失。尽管在筛查和治疗方面有所改进，但不同群体的女性在乳腺癌治疗和生存方面仍存在显著差异。就业这一变量尚未作为导致乳腺癌治疗差异的可能因素得到广泛研究。鉴于美国经济和就业趋势朝着低薪就业发展，这令人担忧。目前，美国所有工人中有四分之一到三分之一被认为是在职贫困人口，而女性在这一群体中的占比过高。低薪工作的特点——带薪休假有限、健康福利极少、工作时间不灵活以及经济不安全——在被诊断出患有乳腺癌的情况下可能会变得更加突出。迄今为止，关于低薪工作所固有的工作条件如何影响在职贫困幸存者接受指南推荐的乳腺癌治疗的研究有限。因此，本叙述性综述的目的是批判性地审视当前文献，以加深我们对就业背景如何影响治疗决策和依从性——进而影响新诊断的在职贫困乳腺癌幸存者接受指南推荐治疗的理解。在进行全面综述后，我们未能找到任何明确涉及低薪就业与接受指南推荐的乳腺癌治疗的已发表文献。有四篇文章报道了女性因工作干扰而推迟、错过或放弃治疗的情况，或者相反，制定了使她们能够继续工作并在应对医疗和经济挑战的同时接受乳腺癌治疗的策略。另外五篇文章虽然关注其他癌症与就业结果，但描述了加强医患沟通以探讨工作对治疗决策的影响以及制定替代治疗方案的必要性。由于该领域研究匮乏，未来的政策、实践和研究工作应将重点放在在职贫困乳腺癌幸存者的就业背景上，因为这可能是导致癌症差异的一个因素。有必要让女性、雇主、肿瘤学提供者、医疗保健系统和跨学科研究人员参与进来，以改善这一不同工作女性群体的癌症治疗效果。
