Work Reintegration After Chemotherapy in Patients With Early-Stage Breast Cancer: The RESTART Cross-Sectional Survey

TL;DR

This study explores how breast cancer survivors in Portugal return to work after chemotherapy, identifying factors that hinder or help their reintegration.

Contribution

The study provides new insights into the factors affecting return-to-work outcomes in breast cancer survivors, emphasizing the need for integrated vocational support.

Findings

Most participants took sick leave, with many remaining on leave after chemotherapy.

Fatigue, cognitive impairment, and workplace adaptation were common barriers to returning to work.

Lower educational level and higher physical job demands were associated with prolonged leave.

Abstract

Background: Return to work (RTW) is a key milestone for breast cancer survivors, reflecting financial stability, personal recovery, and social reintegration. However, this transition is often hindered by persistent physical, cognitive, and emotional sequelae of treatment. In this single-center exploratory study within the RESTART project, we aimed to evaluate return-to-work outcomes and identify clinical, psychosocial, and occupational factors associated with sick leave and prolonged work absence in women treated with chemotherapy for early-stage breast cancer.

Methods: We conducted a cross-sectional study in Portugal that included professionally active women (≤60 years) at least 12 months after completing chemotherapy. Data were collected from medical records and patient questionnaires addressing sociodemographic, clinical, and employment-related factors. Quality of life was assessed using the EORTC QLQ-BR23. Multivariable logistic regression was used to identify factors associated with sick leave and prolonged leave (>12 months).

Results: Seventy-one women were included (median age 52 years, interquartile range (IQR) 49-57). Most participants (59, 83.1%) took sick leave, usually starting at diagnosis, and 42 (71.2%) remained on leave after chemotherapy. At evaluation, 48 (81.4%) had returned to work, with a median time of 18 months from diagnosis (IQR 11-30) and 13 months from the end of chemotherapy (IQR 7-27). However, 7 (14.6%) transitioned to part-time work, 13 (27.1%) changed roles, and 11 (22.9%) reported income loss. The most common reasons for continued leave were fatigue (33, 82.5%), cognitive impairment (26, 72.2%), mood changes (20, 55.6%), and insufficient workplace adaptation (17, 53.1%). Physical exercise (34, 64.2%), psychological support (25, 47.2%), and physical therapy (25, 47.2%) were frequently reported as facilitators of return. In multivariable analysis, lower educational level (odds ratio (OR) 4.67, 95% confidence interval (CI) 1.07-20.5, P = 0.040) and higher physical job demands (OR 1.43, 95% CI 1.09-1.87, P = 0.009) were associated with persistent leave, while anti-human epidermal growth factor receptor 2 (anti-HER2) therapy showed a borderline association (OR 3.45, P = 0.074). Women on leave reported significantly worse quality of life, particularly in body image and breast and arm symptoms.

Conclusions: RTW after breast cancer is influenced by medical, occupational, and psychosocial factors. In this exploratory single-center sample, Portuguese survivors experienced substantial work disruption, underscoring the need for integrated survivorship care with vocational support. Interventions should focus on symptom management, employer engagement, and structured work capacity assessment. Public health strategies should acknowledge work reintegration as a core component of post-cancer recovery.

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