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Long Term Unemployment after Breast Cancer

Posted 4/29/2014

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  This is big news today. A study just published in Cancer suggests that  30% of women who have received chemotherapy for early stage breast cancer are unemployed four years later. This is an astounding statistic--almost 1/3 of all women so treated. It is such a large number that it, frankly, leaves me somewhat puzzled and searching for explanations. The suggestion of the study authors, from the University of Michigan Medical School, is that long-term consequences of chemotherapy are often under-estimated and under-appreciated by oncologists.

  Here are the numbers:

Among 3,133 surveyed patients with breast cancer, 2,290 (73%) completed a baseline survey soon after diagnosis; of these, 1,536 (67%) completed the 4 year followup questionnaire.
According to study results, the researchers observed that among 1,026 patients who experienced breast cancer
recurrence and had responded to both surveys, 76% had worked for pay prior diagnosis. However, of these patients, 30% were no longer employed at the time of the followup survey. Additionally, patients who received chemotherapy as part of their initial treatment were less likely to be working at the time of the
followup survey (38% vs. 27%; P=.003).

And here is a really distressing quote: “Many doctors believe that even though patients may miss work during treatment, they will ‘bounce back’ in the longer term. The results of this study suggest otherwise. Loss of employment is a possible longterm negative consequence of chemotherapy that
may not have been fully appreciated to date,” Reshma Jagsi, MD, DPhil, associate professor of radiation oncology at the University Michigan Medical School, said in a press release. “We also need to ensure that patients who are deciding on whether to receive chemotherapy understand the potential longterm
consequences of receiving treatment, including possible implications for their employment and financial outcomes.”

  Does this mean that oncologists who tell their already scared-half-to-death new breast cancer patients that they lose their jobs and become unemployable if they have needed chemotherapy? There is already a lot of discussion about doctors addressing the costs of care itself, specifically the costs of drugs, and I am horrified by the suggestion that, perhaps, they also need to be employment counselors. Here is one thing I do know: None of us are at our best or thinking our most clearly at the time of diagnosis and treatment planning. To add this fear to the already long list of worries seems a grave mistake.

  Now it begins to get fuzzy. In my experience, women make all kinds of decisions about work and cancer treatment. There surely is not a single right answer, and the many variables include the content of the job, available benefits, family finances, the experienced side effects of treatment, and the support (or not) from the manager and the company. Some women don't get paid if they don't show up, and others need to work for their mental health and others enjoy their work and want to carry on per usual. Some other women have jobs that are not compatible with chemotherapy (e.g. heavy construction or jobs with a great deal of travel) and decide they must take a leave. I can't remember more than one or two women who have opted to quit a job because of chemo, but some lose their jobs because they are hourly workers or use up all their sick leave or just can't get there.

  So then what happens when they try to find a new job? And this seems to be the crux of the study: that finding employment is very tough. There are a number of unmentioned variables, the most obvious being the recession and generally poor job market, and the reality that many women with breast cancer are older and are likely encountering age discrimination in the workplace. I suspect those reasons are more relevant than the less common long term bothersome physical changes like neuropathy or chemobrain. With physical changes, there is huge variability, but just about everyone gets better over time. Thankfully.

  I would love to hear your thoughts about this.

Here is a link to the Eureka Alert story:

http://www.eurekalert.org/pub_releases/2014-04/w-rca042414.php

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  • Claire Blum said:
    4/29/2014 2:23 PM

    Wow -- then we need to think about the financial piece and provide temporary loans -- like student loans-- to the cancer-made poor. The financial piece also extends to caregivers who take time off to help support sick partners. Insurers need to think about the implications of providing decent benefits to their customers post-cancer, when expenses mount up from their conventional medical expenses, The Blums

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