# Return to work or leaving work? Differences of return to work between breast cancer patients and the general population and determinants of return to work

## TL;DR

Breast cancer survivors are less likely to return to work compared to the general population, and factors like job autonomy and education influence this over time.

## Contribution

The study reveals how the timing of assessments affects the relationship between work-related factors and employment outcomes in breast cancer survivors.

## Key findings

- Breast cancer survivors had lower employment rates than the general population (OR = 0.59).
- High occupational autonomy significantly increased return to work 4–6 years after surgery (OR = 4.56).
- Education level showed a significant effect on employment only at the final measurement (OR = 2.23).

## Abstract

It was examined whether employment among breast cancer survivors was lower than in the general population 4 to 6 years after surgery. We also examined whether disease severity, post-surgical treatment, social, and workplace characteristics have effects on employment as primary outcome, and whether the distance from surgery to observation may determine employment.

We performed a multicentric observational study with four survey waves. Data were collected based on mailed surveys and patient records. Patients were up to 63 years old at entry with TNM-tumour stages T0 to TIV. Comparisons with the general population were performed by drawing controls from the German Socio-Economic Panel.

N = 372 breast cancer survivors participated in all surveys (= 82.2% of the initial sample). Their rate of occupationally active women was lower than in the general population (ORpatients = 0.59; 95% CI = 0.42–0.84; p < 0.01). Among patients, tumour stage had no effects on employment 12 months after surgery; 4–6 years later, this was the case only among patients with the most unfavourable tumour stage (OR = 0.16; p = 0.01; 95% CI = 0.04–0.58). Antihormone therapy was unrelated with employment (OR = 0.80; p = 0.27; 95% CI = 0.54–1.19); inpatient rehabilitation was negatively associated at 12 months after surgery (OR = 0.47; p = 0.02; 95% CI = 0.25–0.89) and unrelated at the last survey wave (OR = 0.95; p = 0.86; 95% CI = 0.55–1.64). Compared with the lowest level of occupational autonomy, it was unrelated with employment 12 months after surgery (OR = 0.79; p = 0.75; 95% CI = 0.18–4.41), but for the highest level of autonomy, it had significant effects 4 to 6 years later (OR = 4.56; p = 0.04; 95% CI = 1.10–18.81). Effort-reward imbalance as a continuously scaled indicator of pre-surgery occupational distress was significantly associated with return to work 12 months after surgery (OR = 0.13; p < 0.01; 95% CI = 0.06–0.31), but it had no effect at the last survey wave (OR = 0.64; p = 0.31; 95% CI = 0.28–1.50). One year after surgery, education at higher levels had no significant effects on return to work (OR = 1.30; p = 0.57; 95% CI = 0.56–3.00 for the highest level compared with the lowest one), only at the last measurement marked differences by education emerged (OR = 2.23; p = 0.03; 95% CI = 1.08–4.63).

Temporal distance between surgery and survey wave determines whether potentially influencing factors have effects. Disease severity and post-surgical treatment were unrelated to employment. Whether work-related and socio-demographic factors are determining employment depends on the date of measurement.