Originally published as JCO Early Release 10.1200/JCO.2005.09.500 on October 11 2005

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Not Working 3 Years After Breast Cancer: Predictors in a Population-Based Study

From the Unité de Recherche en Santé des Populations, Centre de Recherche du Centre Hospitalier Affilié Universitaire de Québec; Université Laval; Centre des Maladies du Sein Deschênes-Fabia, Hôpital du Saint-Sacrement Québec City, Québec, Canada; and Fred Hutchinson Cancer Research Center, Seattle, WA

Address reprint requests to Elizabeth Maunsell, PhD, Unité de Recherche en Santé des Populations, Hôpital du Saint-Sacrement, 1050 Chemin Sainte-Foy, Québec, Québec City, Canada G1S 4L8; e-mail: elizabeth.maunsell{at}uresp.ulaval.ca

PURPOSE: Little is known about factors increasing likelihood of not working among breast cancer survivors compared with women in the general population.

PATIENTS AND METHODS: A population-based retrospective cohort study was conducted in Quebec, Canada, based on the consecutive series of working women aged younger than 60 years when first treated for breast cancer (identified through the Quebec Tumor Registry), and on a group of randomly selected similar women, living in Quebec, who were working at the time of survivors' diagnoses, but who were without cancer (identified through provincial health care files). Data came from a telephone interview, 3 years after diagnosis for 646 survivors (73% of those eligible) or during a similar period for 890 comparison women (51%).

RESULTS: Slightly more survivors were not working 3 years after diagnosis compared with women never diagnosed with cancer (21% and 15%, respectively). Older age (for survivors and comparison women, relative risk [RR] = 4.62, P < .0001 and RR = 4.98, P < .0001, respectively) and union membership (RR = 1.88, P = .0003 and RR = 1.40, P = .06, respectively) increased the likelihood of not working at the end of follow-up. In addition, income less than $20,000 compared with $50,000 was associated with not working only among survivors (RR = 3.18; P = .0008). Adjuvant treatments did not predict work cessation, but any new cancer event during follow-up did (RR = 2.14; P < .0001).

CONCLUSION: Although reassuring that adjuvant treatments did not appear to play a role in survivors' not working, other aspects of the cancer experience might nonetheless have influenced the decision to reduce work effort after breast cancer.

Supported by research Grants from the Canadian Breast Cancer Research Alliance and the Fondation Québécoise du Cancer. E.M. and C.B. were National Health Research and Development Program National Health Research Scholars at the time this work was originally planned and funded, and are (E.M.) or were (C.B.) Investigators of the Canadian Institutes of Health Research. M.D. holds a PhD Fellowship Award from the Fonds de Recherche en Santé du Québec.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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