Jagsi Reshma, Abrahamse Paul H, Lee Kamaria L, Wallner Lauren P, Janz Nancy K, Hamilton Ann S, Ward Kevin C, Morrow Monica, Kurian Allison W, Friese Christopher R, Hawley Sarah T, Katz Steven J
Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
Cancer. 2017 Dec 15;123(24):4791-4799. doi: 10.1002/cncr.30959. Epub 2017 Oct 9.
Many patients with breast cancer work for pay at the time of their diagnosis, and the treatment plan may threaten their livelihood. Understanding work experiences in a contemporary population-based sample is necessary to inform initiatives to reduce the burden of cancer care.
Women who were 20 to 79 years old and had been diagnosed with stage 0 to II breast cancer, as reported to the Georgia and Los Angeles Surveillance, Epidemiology, and End Results registries in 2014-2015, were surveyed. Of the 3672 eligible women, 2502 responded (68%); 1006 who reported working before their diagnosis were analyzed. Multivariate models evaluated correlates of missing work for >1 month and stopping work altogether versus missing work for ≤1 month.
In this diverse sample, most patients (62%) underwent lumpectomy; 16% underwent unilateral mastectomy (8% with reconstruction); and 23% underwent bilateral mastectomy (19% with reconstruction). One-third (33%) received chemotherapy. Most (84%) worked full-time before their diagnosis; however, only 50% had paid sick leave, 39% had disability benefits, and 38% had flexible work schedules. Surgical treatment was strongly correlated with missing >1 month of work (odds ratio [OR] for bilateral mastectomy with reconstruction vs lumpectomy, 7.8) and with stopping work altogether (OR for bilateral mastectomy with reconstruction vs lumpectomy, 3.1). Chemotherapy receipt (OR for missing >1 month, 1.3; OR for stopping work altogether, 3.9) and race (OR for missing >1 month for blacks vs whites, 2.0; OR for stopping work altogether for blacks vs whites, 1.7) also correlated. Those with paid sick leave were less likely to stop working (OR, 0.5), as were those with flexible schedules (OR, 0.3).
Working patients who received more aggressive treatments were more likely to experience substantial employment disruptions. Cancer 2017;123:4791-9. © 2017 American Cancer Society.
许多乳腺癌患者在确诊时仍在工作挣钱，而治疗方案可能会威胁到她们的生计。了解当代基于人群样本中的工作经历对于制定减轻癌症护理负担的举措很有必要。
对2014 - 2015年向佐治亚州和洛杉矶监测、流行病学及最终结果登记处报告的年龄在20至79岁且被诊断为0至II期乳腺癌的女性进行了调查。在3672名符合条件的女性中，2502人做出了回应（68%）；对其中1006名报告在确诊前有工作的女性进行了分析。多变量模型评估了误工超过1个月和完全停止工作与误工时间≤1个月的相关因素。
在这个多样化的样本中，大多数患者（62%）接受了乳房肿瘤切除术；16%接受了单侧乳房切除术（8%进行了重建）；23%接受了双侧乳房切除术（19%进行了重建）。三分之一（33%）接受了化疗。大多数（84%）在确诊前全职工作；然而，只有50%有带薪病假，39%有残疾福利，38%有灵活的工作时间表。手术治疗与误工超过1个月（双侧乳房切除并重建与乳房肿瘤切除术的比值比[OR]为7.8）以及完全停止工作（双侧乳房切除并重建与乳房肿瘤切除术的OR为3.1）密切相关。接受化疗（误工超过1个月的OR为1.3；完全停止工作的OR为3.9）和种族（黑人与白人相比，误工超过1个月的OR为2.0；黑人与白人相比，完全停止工作的OR为1.7）也存在相关性。有带薪病假的人停止工作的可能性较小（OR为0.5），有灵活工作时间表的人也是如此（OR为0.3）。
接受更积极治疗的在职患者更有可能经历实质性的就业中断。《癌症》2017年；123：4791 - 4799。©2017美国癌症协会。
