Race, insurance status linked to job loss after breast cancer

Job loss following early-stage breast cancer diagnosis is associated with race and insurance status, but not with any clinical or treatment-related factors, finds a new study from the Brown School at Washington University in St. Louis.

Not only were an African-American patient or an uninsured patient four times more likely to leave the workforce despite fighting a cancer with high survival rates, but they also were more likely to return in a lesser job within the first two years cancer-free.

The study, “Early-Stage Breast Cancer and Employment Participation After 2 Years of Follow-Up: A Comparison With Age-Matched Controls,” was published Feb. 13 in the journal Cancer.

“We examined post-treatment employment patterns in early-stage breast cancer patients,” said lead author Christine Ekenga, assistant professor at the Brown School.


“During the two-year follow-up, African-American patients were four times more likely to leave the workforce than white patients, and uninsured/publicly insured patients were 4.7 times more likely to leave the workforce than privately insured patients.”

As part of a larger cohort study of 1,096 patients with early-stage breast cancer and same-aged women without breast cancer, data from 723 working-age women 40-64 years old (347 patients and 376 controls) were analyzed to evaluate four employment trajectories: sustained unemployment, diminished employment, emerging employment and sustained employment.

The study focused on patients with early-stage breast cancer, a population that has an excellent prognosis for disease-free survival.

Fatigued patients, African-American patients and publicly insured/uninsured patients with cancer were more likely to experience diminished employment after two years of follow-up.

The study collected information regarding a participant’s inability to work but participants were not asked why they were unable to work. A follow up study aims to address this question.

Although cancer survivors are more likely to report unemployment than individuals without a cancer history, working after diagnosis may represent a return to normalcy for some patients with breast cancer, Ekenga wrote in the paper.

“In addition to the added benefit of employer-sponsored health insurance, paid employment has the potential to mitigate the financial stresses associated with cancer,” she wrote.

“Moreover, for women with breast cancer, employment could play a significant role in post-diagnostic health. Health benefits associated with employment include an increased sense of purpose, higher self-esteem and a stronger sense of social support from others, all of which have been associated with improved quality of life.”

The study was funded by the National Cancer Institute and the Breast Cancer Stamp Fund (R01 CA102777), the National Institute for Occupational Safety and Health (U19 OH008868), the National Cancer Institute Postdoctoral Training in Cancer Prevention and Control (T32 CA190194), and the Cancer Center Support Grant (P30 CA91842).
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