# Employment Status Among Brazilian Women With Estrogen Receptor‐Positive Nonmetastatic Breast Cancer

## TL;DR

This study examines employment outcomes for Brazilian women with breast cancer, finding that nearly one-third stop working and do not return, influenced by factors like public healthcare and lower education.

## Contribution

The study provides novel insights into employment patterns and barriers for breast cancer survivors in Brazil, highlighting disparities linked to healthcare access and sociodemographic factors.

## Key findings

- Nearly one-third of breast cancer survivors in Brazil did not return to work within two years postdiagnosis.
- Public healthcare treatment, lower education, younger age, and longer treatment duration were associated with higher job loss risk.
- Workplace adaptations and targeted support are needed to improve return-to-work rates among cancer survivors.

## Abstract

Employment is a critical determinant of quality of life, social reintegration, and financial stability for breast cancer survivors. International studies have shown that return‐to‐work (RTW) rates vary widely, ranging from 27% to over 80% within the first 3 years postdiagnosis, and are strongly influenced by sociodemographic and systemic factors. In Brazil, however, there is a scarcity of data on employment outcomes after breast cancer, despite pronounced disparities in healthcare access between public and private systems. Understanding these dynamics is crucial to identify vulnerable groups and to inform strategies that promote equitable reintegration into the workforce.

We conducted a multicenter cross‐sectional study including 454 women with nonmetastatic ER+ breast cancer who were employed at diagnosis and receiving endocrine therapy. Employment status, sociodemographic and clinical variables, and quality‐of‐life scores were collected through patient‐reported questionnaires and medical records. Univariate and multivariate generalized logit models were applied.

Among 774 participants, 454 (67.1%) were employed at diagnosis. Of these, 87 (19.2%) continued working during treatment, 233 (51.54%) stopped and returned, and 134 (29.29%) stopped and did not return. Compared with privately treated patients who remained employed, those treated in public hospitals had significantly higher odds of stopping work and returning (OR = 5.93) and of stopping work and not returning (OR = 2.39). Younger age (≤ 60 years) was associated with permanent work interruption (OR = 2.39). Lower education was associated with temporary interruption (OR = 3.12). Treatment duration ≥ 2 years was associated with not returning to work (OR = 2.18).

Treatment in public hospitals, lower education, younger age, and prolonged treatment were associated with a higher risk of job loss. Addressing barriers and fostering workplace adaptations is vital for improving return‐to‐work rates among cancer survivors, as nearly one‐third do not return to work within 2 years postdiagnosis.

A significant proportion of breast cancer survivors (nearly 1/3) stopped and did not return to work within two years postdiagnosis, with treatment in public hospitals, lower education, younger age, and prolonged treatment associated with a higher risk of job loss. Addressing barriers and promoting workplace adaptations is vital to improve return‐to‐work rates among cancer survivors.