Returning to Work and Quality of Life after Breast Cancer

Institution: Women's Cancer Resource Center
Investigator(s): Rani Eversley, Ph.D. - Diane Estrin, BA -
Award Cycle: 1999 (Cycle V) Grant #: 5AB-1100 Award: $86,147
Award Type: CRC Pilot Award
Research Priorities
Community Impact of Breast Cancer>Sociocultural, Behavioral, and Psychological Issues: the human side

Initial Award Abstract (1999)
Ethnic differences in the rates at which women have returned to work after undergoing breast cancer surgery have been observed in previous studies. African-American women return to work at a slower and decreased rate as compared with Caucasians. These differences have been attributed to ethnic differences in women’s occupations, with African-American women being employed in more physically demanding work. Little is known, though, about the relationship between the responsiveness of the workplace to women’s needs after undergoing surgery and women’s ability to return to work. Secondly, little is known about the relationship between return to work and quality of life among women who have undergone breast cancer surgery, or how this differs among ethnic groups.

We will conduct a survey of 180 women to examine racial and other demographic differences in return to work and quality of life after breast cancer surgery. Equal numbers of African-American, Latina, and Caucasian women will be assessed. Women will be recruited from the Women’s Cancer Resource Center's telephone hotline and other support services, as well as from other community locations.

Data will be entered and analyzed at the researcher partners’ office at UCSF with consultation from UCSF statistical staff. Results from this research will be used to plan intervention research for this population as well as counseling, case management and advocacy

Final Report (2001)
This pilot project has three specific aims: 1) to develop measures to assess perceived support in the workplace (employer support, co-worker support) for women who are attempting to return to work following breast cancer surgery; 2) to test measures to assess perceived support in the workplace (employer support, co-worker support) for women who are attempting to return to work following breast cancer surgery; and 3) to examine the relationship between perceived support in the workplace and the length of time to return to work among women following breast cancer surgery.

Twenty-seven women participated in four focus groups to identify sources of support for returning to work after breast cancer surgery. Pilot survey data was collected from 116 women who had undergone breast cancer surgery.

The mean age of the women who participated in the pilot survey was 47(29-68). Thirty percent were Caucasian, 30% African-American, 25% Latina, and 15% women of other ethnic backgrounds. Thirty-seven percent of the women surveyed were currently working full time, 32% part-time, 18% unemployed, 11% percent were of unknown work status. Forty percent reported that they changed jobs after undergoing breast cancer surgery, 17% were terminated or laid off after breast cancer surgery, and 29% felt that they were harassed at their jobs after due breast cancer. Sixty-nine percent reported a change in their pay after breast cancer surgery. For the majority of women this appears to be a loss in pay; the mean monthly income prior to breast cancer surgery was $1812, the mean monthly income after undergoing surgery was $1167. The mean number of weeks off work reported by the study population was 26(0-144). Race/ethnicity was associated with amount of time off from work and with being off from work one year after surgery. Caucasian women reported a mean number off 23(14-33) weeks off from work, African-American women reported a mean of 37(24-50) weeks off from work, and Latina women reported a mean of 11(5-18) weeks off from work (p<0.01). African-American women (29%) were almost twice as likely to not be working after one year compared to Caucasians (16%) (p<0.01). Four percent of Latinas were out of work after one year. In a multivariate (least squares regression) model to examine the independent associates of the amount of time out of work, children living at the home (p<0.05), enrollment in public benefits programs (p<0.01) and mastectomy (p<0.01) were independently predictive of the number of weeks taken off. Ethnicity, stage of disease, and the new support measures were not independently associated with number of weeks off work.

Our data supports the published literature in finding a high prevalence of problems with returning to work. The data also supports the published literature in finding ethnic differences in returning to work. In our data the ethnic associations appear to be modified by the presence of dependent children, surgical procedure, and receiving public disability. The other new findings from this data include the relative short period of return to work among Latinas and the dramatically lower rate of receiving disability among Latinas, despite relatively high levels of disease progression. This finding warrants additional investigation and may be associated with immigration status.