# Return to Work After Breast Cancer Diagnosis and Treatment in Uruguay: Challenges and Determining Factors

## TL;DR

This study explores how breast cancer survivors in Uruguay return to work and manage household tasks, finding that physical and treatment-related factors significantly impact their quality of life.

## Contribution

The study identifies specific factors influencing return to work and domestic task performance in breast cancer survivors in Uruguay, linking these to quality of life outcomes.

## Key findings

- 60.8% of employed women with breast cancer returned to work within 24 months of diagnosis.
- Non-return to work was associated with older age, manual labor, and treatment-related complications like lymphedema and arm pain.
- Women who did not return to work or required more effort for household tasks had significantly lower quality of life scores.

## Abstract

Introduction: In Uruguay, breast cancer (BC) is the most common malignancy in women and the leading cause of cancer-related mortality in the female population. It represents a significant public health problem. Improved survival, driven by early diagnosis and therapeutic advances, has brought new challenges related to quality of life, including return to work and domestic activities, which are key to full recovery and social reintegration.

Objective: To determine the rate of return to work in women with BC at least 24 months after diagnosis and to analyze associated factors. To evaluate the impact of diagnosis and treatment on household task performance and to compare quality of life according to work status and domestic performance, using the PROMIS Global Health v1.2 instrument.

Methods: A descriptive longitudinal study was conducted in patients ≥18 years, with stage I-III BC, treated at the Hospital Departamental de Soriano and Sanatorio Mautone. Sociodemographic, clinical, occupational, and domestic data were collected through a structured questionnaire. Quality of life was assessed with PROMIS Global Health v1.2. Chi-square, Fisher’s exact, Mann-Whitney, and Kruskal-Wallis tests were used, with a significance level of 5%.

Results: A total of 128 women were included (median age at diagnosis: 58 years). Among the 74 employed at diagnosis, 60.8% returned to work. Non-return was associated with older age (65 vs. 55 years), lower education, manual labor, mastectomy, axillary dissection, chemotherapy, postoperative complications, arm pain, shoulder limitation, lymphedema, and functional impairment (p<0.05). Among those who returned, 51.1% reported difficulties, mainly physical and due to a lack of adapted tasks; this rose to 79.3% among those who did not return. Regarding domestic activities, 32.5% required greater effort, 32.5% reduced activities, and only 33.3% maintained the same level and effort. Patients who did not return to work or required more effort for household tasks had lower scores in physical health, mental health, global health, and usual activities in PROMIS compared to those maintaining work or domestic tasks without changes (p<0.01).

Conclusions: Return to work and domestic activities in BC survivors are influenced by physical, occupational, and treatment-related factors, and their absence is associated with lower quality of life. Integrating physical rehabilitation, management of sequelae, and vocational guidance into oncology follow-up, especially in resource-limited settings, is essential to promote functional recovery and overall well-being.