— Important study not only for physicians, but also for society overall
by Bahar Ladarian, MD
A recent study addressed the need for attention to breast cancer survivors after surgery, chemotherapy, and/or radiation to shed light on the adverse effects of treatment on employment. The hope was that knowing the results could better prepare patients and healthcare providers as well as employers and policymakers.
Many women who develop breast cancer go on to longer-term survival thanks to modern medicine and technology. As oncologists, however, we do not pay much attention to their day-to-day struggles after the cancer ordeal is over for them; we are not equipped to attend to their multiplicity of symptoms, whether psychological or physical. Our goal as oncologists is to make sure our patients are free of cancer. However, not surprisingly, cancer and cancer therapy do take a toll on a patient's personal life, from causing years of fatigue to depression and anxiety and other physical and psychological signs and symptoms.
Given that more than 85% of patients with breast cancer live at least 5 years after diagnosis in western countries and that more than 70% of these women are in the labor force, it's a major public health issue if they do not return to their jobs for years after being deemed free of cancer.
The study by Agnes Dumas, et al. used data from a prospective clinical cohort of patients diagnosed with stages I-III primary breast cancer from 26 French cancer centers with no prior history of cancer other than basal cell skin cancer or in situ cervical carcinoma within the past 5 years. The patients' tumor classification and treatment were extracted from medical records and data on the comorbidities as well as treatment-related toxicities were collected face-to-face by trained oncology nurses. Patient-reported outcomes were collected using questionnaires that assess physical and psychological outcomes post-treatment as well as socioeconomic status of the patients. It was found that 21% of breast cancer patients had not returned to work by the end of 2 years after diagnosis/treatment.
The odds of not returning to the workforce were significantly higher among those who were treated with the combination of chemotherapy and trastuzumab. In addition, those who suffered from grade 3 or higher toxicities, arm morbidity, anxiety, and/or depression had a higher likelihood of not returning to work as fast as other patients.
This is an important study not just for physicians but also for society as a whole, which identifies the vulnerable members in hopes of changing policies to better support them through different strategies.
Bahar Laderian, MD, is a clinical fellow at Columbia University Medical Center/ New York Presbyterian in New York City.