Resignation in Working Women With Breast and Gynecologic Cancers.

IMPORTANCE

Diagnosis of breast and gynecologic cancers may hamper employment; little is known about who is at greater risk of resignation.

OBJECTIVE

To examine whether a breast or gynecologic cancer diagnosis is associated with resignation in working women and to identify high-risk subpopulations.

DESIGN, SETTING, AND PARTICIPANTS: This matched cohort study included women aged 15 to 58 years insured by the Japan Health Insurance Association. From April 2017 to March 2023, women newly diagnosed with breast, cervical, uterine, or ovarian cancer were identified and matched in a 1:10 ratio to working women without these cancers.

EXPOSURE

Cancer diagnosis was based on International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10).

MAIN OUTCOMES AND MEASURES

The primary outcome was all-cause resignation, and the secondary outcome was a composite of resignation and death, both assessed during a 2-year follow-up. Stratified Cox proportional-hazards models were applied, with multiple imputation and covariate adjustments. Subgroup analyses by prespecified covariates assessed effect size moderation and interactions between exposure and these covariates.

RESULTS

The study included 99 964 women with cancer, including 59 452 women with breast cancer (median [IQR] age, 48 [44-53] years), 14 713 women with cervical cancer (median [IQR] age, 46 [39-51] years), 16 933 women with uterine cancer (median [IQR] age, 49 [44-53 years]), and 8866 women with ovarian cancer (median age [IQR] age, 47 [40-52] years), as well as 999 640 matched controls (594 520 for the breast cancer cohort, 147 130 for the cervical cancer cohort, 169 330 for the uterine cancer cohort, and 88 660 for the ovarian cancer cohort). Most women with cancer were working in the medical, health care, or welfare sector (32 123 women [32.1%]). During follow-up, resignation rates were significantly higher for women with cancer vs controls (breast cancer: 10 820 women [18.2%] vs 97 892 women [16.5%]; hazard ratio [HR], 1.18; 95% CI, 1.16-1.20; cervical cancer: 3296 women [22.4%] vs 27 476 women [18.7%]; HR, 1.31; 95% CI, 1.26-1.36; uterine cancer: 3161 women [18.7%] vs 27 786 women [16.4%]; HR, 1.24; 95% CI, 1.19-1.29; ovarian cancer: 2004 women [22.6%] vs 15 847 women [17.9%]; HR, 1.44; 95% CI, 1.37-1.51). Regarding the composite outcome of resignation and death, there was an increased risk for all cohorts, ranging from an HR of 1.25 (95% CI, 1.22-1.27) for breast cancer to 1.81 (95% CI, 1.73-1.89) for ovarian cancer. Among all 4 cancer cohorts, resignation risk was higher among women with older age, lower income, and a history of depression.

CONCLUSIONS AND RELEVANCE

In this cohort study using a nationwide health claims database in Japan, breast and gynecologic cancers were associated with a higher resignation risk, especially among those with older age, lower income, and depression history. These findings suggest that developing targeted support interventions may benefit women at high resignation risk after a cancer diagnosis.