Return to work or leaving work? Differences of return to work between breast cancer patients and the general population and determinants of return to work.

PURPOSE

It was examined whether employment among breast cancer survivors was lower than in the general population 4 to 6 years after surgery. We also examined whether disease severity, post-surgical treatment, social, and workplace characteristics have effects on employment as primary outcome, and whether the distance from surgery to observation may determine employment.

METHODS

We performed a multicentric observational study with four survey waves. Data were collected based on mailed surveys and patient records. Patients were up to 63 years old at entry with TNM-tumour stages T0 to TIV. Comparisons with the general population were performed by drawing controls from the German Socio-Economic Panel.

RESULTS

N = 372 breast cancer survivors participated in all surveys (= 82.2% of the initial sample). Their rate of occupationally active women was lower than in the general population (OR = 0.59; 95% CI = 0.42-0.84; p < 0.01). Among patients, tumour stage had no effects on employment 12 months after surgery; 4-6 years later, this was the case only among patients with the most unfavourable tumour stage (OR = 0.16; p = 0.01; 95% CI = 0.04-0.58). Antihormone therapy was unrelated with employment (OR = 0.80; p = 0.27; 95% CI = 0.54-1.19); inpatient rehabilitation was negatively associated at 12 months after surgery (OR = 0.47; p = 0.02; 95% CI = 0.25-0.89) and unrelated at the last survey wave (OR = 0.95; p = 0.86; 95% CI = 0.55-1.64). Compared with the lowest level of occupational autonomy, it was unrelated with employment 12 months after surgery (OR = 0.79; p = 0.75; 95% CI = 0.18-4.41), but for the highest level of autonomy, it had significant effects 4 to 6 years later (OR = 4.56; p = 0.04; 95% CI = 1.10-18.81). Effort-reward imbalance as a continuously scaled indicator of pre-surgery occupational distress was significantly associated with return to work 12 months after surgery (OR = 0.13; p < 0.01; 95% CI = 0.06-0.31), but it had no effect at the last survey wave (OR = 0.64; p = 0.31; 95% CI = 0.28-1.50). One year after surgery, education at higher levels had no significant effects on return to work (OR = 1.30; p = 0.57; 95% CI = 0.56-3.00 for the highest level compared with the lowest one), only at the last measurement marked differences by education emerged (OR = 2.23; p = 0.03; 95% CI = 1.08-4.63).

CONCLUSION

Temporal distance between surgery and survey wave determines whether potentially influencing factors have effects. Disease severity and post-surgical treatment were unrelated to employment. Whether work-related and socio-demographic factors are determining employment depends on the date of measurement.