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J Clin Oncol. 2019 Dec 13:JCO1901726. doi: 10.1200/JCO.19.01726. [Epub ahead of print]

Impact of Breast Cancer Treatment on Employment: Results of a Multicenter Prospective Cohort Study (CANTO).

Author information

1
Université de Paris, ECEVE UMR 1123, INSERM (National Institute for Health and Medical Research), Paris, France.
2
Clinical Research Department, Gustave Roussy, Villejuif, France.
3
Breast Cancer Unit, Department of Medical Oncology, Gustave Roussy, Villejuif, France.
4
INSERM Unit U 981, Villejuif, France.
5
Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France.
6
Department of Supportive Care, Gustave Roussy, Université Paris-Saclay, Villejuif, France.
7
Laboratoire de Psychopathologie et Processus de Santé (EA 4057), Université de Paris, Paris, France.
8
Clinical Research Department, Centre Georges-François Leclerc, Dijon, France.
9
INSERM U1018, Center for Research in Epidemiology and Population Health, Villejuif, France.
10
Department of Medical Oncology, Institut Curie, Paris, France.
11
Institut de Cancérologie de Lorraine Alexis Vautrin, Vandoeuvre les Nancy, France.
12
Department of Medical Oncology, Institut Curie, Saint-Cloud, France.
13
Centre Léon Berard, Lyon, France.
14
Centre Oscar Lambret, Lille, France.
15
Centre François Baclesse, Caen, France.
16
UNICANCER, Paris, France.

Abstract

PURPOSE:

Adverse effects of breast cancer treatment can negatively affect survivors' work ability. Previous reports lacked detailed clinical data or health-related patient-reported outcomes (PROs) and did not prospectively assess the combined impact of treatment and related sequelae on employment.

METHODS:

We used a French prospective clinical cohort of patients with stage I-III breast cancer including 1,874 women who were working and ≥ 5 years younger than legal retirement age (≤ 57 years) at breast cancer diagnosis. Our outcome was nonreturn to work (non-RTW) 2 years after diagnosis. Independent variables included treatment characteristics as well as toxicities (Common Toxicity Criteria Adverse Events [CTCAE] v4) and PROs (European Organization for Research and Treatment of Cancer [EORTC] Quality of life Questionnaires, Breast cancer module [QLQ-BR23] and Fatigue module [QLQ-FA12], Hospital Anxiety and Depression Scale) collected 1 year after diagnosis. Logistic regression models assessed correlates of non-RTW, adjusting for age, stage, comorbidities, and socioeconomic covariates.

RESULTS:

Two years after diagnosis, 21% of patients had not returned to work. Odds of non-RTW were significantly increased among patients treated with combinations of chemotherapy and trastuzumab (odds ratio [OR] v chemotherapy-hormonotherapy: for chemotherapy-trastuzumab, 2.01; 95% CI, 1.18 to 3.44; for chemotherapy-trastuzumab-hormonotherapy, 1.62; 95% CI, 1.10 to 2.41). Other significant associations with non-RTW included grade ≥ 3 CTCAE toxicities (OR v no, 1.59; 95% CI, 1.15 to 2.18), arm morbidity (OR v no, 1.59; 95% CI, 1.19 to 2.13), anxiety (OR v no, 1.47; 95% CI, 1.02 to 2.11), and depression (OR v no, 2.29; 95% CI, 1.34 to 3.91).

CONCLUSION:

Receipt of systemic therapy combinations including trastuzumab was associated with increased odds of non-RTW. Likelihood of unemployment was also higher among patients who reported severe physical and psychological symptoms. This comprehensive study identifies potentially vulnerable patients and warrants supportive interventional strategies to facilitate their RTW.

PMID:
31834818
DOI:
10.1200/JCO.19.01726

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