Impact of adjuvant chemotherapy on long‐term employment of survivors of early‐stage breast cancer

Abstract

Background Many women with early-stage breast cancer are working at the time of diagnosis and survive without recurrence. The short-term impact of chemotherapy receipt on employment has been demonstrated, but the long-term impact merits further research. Methods We conducted a longitudinal multicenter cohort study of women diagnosed with non-metastatic breast cancer in 2005–2007, as reported to the population-based Los Angeles and Detroit SEER registries. Of 3133 individuals sent surveys, 2290 (73%) completed a baseline survey soon after diagnosis and 1536 (68%) completed a four-year follow-up questionnaire. Results Of the 1026 patients aged <65 at diagnosis whose breast cancer did not recur and who responded to both surveys, 746 (76%) worked for pay before diagnosis. Of these, 236 (30%) were no longer working at follow-up. Women who received chemotherapy as part of initial treatment were less likely to work at follow-up (38% vs. 27%, p=0.003). Chemotherapy receipt at the time of diagnosis (OR 1.4, p=0.04) was independently associated with unemployment during survivorship in a multivariable model. Many women who were not employed in the survivorship period wanted to work: 50% reported that it was important for them to work and 31% were actively seeking work. Conclusions Unemployment among breast cancer survivors four years after diagnosis is often undesired and appears related to the receipt of chemotherapy during initial treatment. These findings should be considered when patients decide whether to receive adjuvant chemotherapy, particularly when expected benefit is low.

Pneumocystis jiroveci pneumonia (PCP) in patients receiving neoadjuvant and adjuvant anthracycline-based chemotherapy for breast cancer: incidence and risk factors

“…In conclusion, patients undergoing neoadjuvant or adjuvant dose-dense AC treatment for localized breast cancer (about 140,000 women annually in the US) [1,2] are a previously undescribed group at risk for opportunistic PCP. We have identified a potential steroid dose/time threshold of PCP risk in this population, as infections are observed in patients receiving a standard cumulative steroid dose over 8 weeks (in dose-dense administration) and…”

“…Nearly 233,000 patients were newly diagnosed with breast cancer in the United States in 2014 [1], 60 % of whom received chemotherapy for localized disease [2]. Pneumocystis jiroveci typically causes pneumonia (PCP) and is an opportunistic infection associated with immune impairment such as occurs with advanced Human Immunodeficiency Virus (HIV) infection.…”

Treatment decisions and employment of breast cancer patients: Results of a population‐based survey

“…3–7 The divergence of prior study results may be explained in part by differences in study settings and population characteristics, the wide variation in relevant policies and culture in different nations, and changes in treatments offered over time.…”

“…5,6 Furthermore, loss of paid work during treatment can result in permanent and undesirable long-term unemployment. 7 Thus, it is critical that treatments be no more burdensome than necessary and delivered in ways that minimize disruption for patients.…”

Euflammation Attenuates Central and Peripheral Inflammation and Cognitive Consequences of an Immune Challenge after Tumor Development

“…These cognitive impairments can persist as much as 20 years after cancer treatment [10] and significantly reduce quality of life [11] and employability [12]. While cancer treatments and stress contribute to mental health issues associated with cancer, pretreatment clinical findings and tumor models indicate that tumor biology also plays a significant role [13,14].…”