Multidimensional Factors Underlying Ability to Work After Primary Treatment for Nonmetastatic Breast Cancer

In In The News by Barbara Jacoby

By: Susan Moench, PhD, PA-C


Results of a large prospective, longitudinal study showed that receipt of combination systemic therapy including chemotherapy plus trastuzumab was associated with an increased odds of not returning to work 2 years after diagnosis of nonmetastatic breast cancer. The findings from this study were published in the Journal of Clinical Oncology.

Although results of previously conducted studies have shown return-to-work (RTW) after treatment of nonmetastatic breast cancer to be “a complex process that is strongly influenced by medical factors such as treatment and its related adverse effects,” most of those studies were limited by their size and/or design, and were characterized by an absence of data based on validated patient-reported outcome (PRO) measures. Furthermore, the majority of the studies evaluating physical domains did not also include assessments of psychological domains.

In addition, many of those earlier studies did not evaluate patients receiving contemporary multimodality therapy, including newer chemotherapy and endocrine therapy agents, and HER2-directed therapy (eg, trastuzumab), leading the study researchers to comment that “a clear and comprehensive assessment of the burden of contemporary breast cancer treatment and its related toxicities on employment is lacking.”

The analysis was conducted in France and included 1874 women with stage I to III breast cancer enrolled in the prospective CANTO study ( Identifier: NCT01993498). At breast cancer diagnosis, all patients were employed and aged 57 years or younger, which was 5 years prior to the earliest age of retirement in France.

Data related to medical history, including comorbidities, were collected at baseline (ie, diagnosis of breast cancer), along with patient socioeconomic characteristics, and physical and psychological symptoms as assessed by validated PRO measures. At the end of primary treatment, information related to tumor classification and treatments received were recorded, and patients subsequently attended 2 post-treatment visits. Physical toxicities according to the Common Terminology Criteria for Adverse Events (CTCAE) and physical and psychological symptoms according to PROs were assessed at first post-treatment visit, which occurred 3 to 6 months following the end of primary treatment. Finally, RTW history was assessed at the second post-treatment visit, which occurred 1 and 2 years following the first post-treatment visit and breast cancer diagnosis, respectively.

Baseline patient characteristics included a mean age at breast cancer diagnosis of 47 years. Three-quarters of patients worked full time, with 39.4% and 24.6% reporting employment as a clerk or a manager, respectively. Of note, approximately one-third of women reported 1 or more comorbidities at baseline.

At the first post-treatment visit, at least 1 severe physical CTCAE toxicity was present in 15.5%, and physical, cognitive, and emotional fatigue was reported by 22.8%, 15.7%, and 17.8% of patients, respectively. In addition, 20.4% of study respondents reported being anxious.

Approximately one-fifth of patients had not returned to work by the second post-treatment visit, with nearly three-fourths of these patients on sick leave at that time. In addition, 23.6% of patients who worked full time at cancer diagnosis reported part-time employment on follow-up.

On multivariable analyses, factors association with non-RTW were a baseline Charlson Comorbidity Index of 1 or higher (odds ratio [OR], 1.52; 95% CI, 1.08-2.14) treatment with chemotherapy plus trastuzumab compared with chemotherapy plus hormone therapy (OR, 2.01; 95% CI, 1.18-3.44), treatment with chemotherapy plus trastuzumab plus hormone therapy compared with chemotherapy plus hormone therapy (OR, 1.62; 95% CI, 1.10-2.41), at least 1 severe CTCAE toxicity (OR vs no, 1.59; 95% CI,  1.16 -2.18), severe arm morbidity (OR vs no, 1.59; 95% CI, 1.19-2.13), anxiety (OR vs no, 1.47; 95% CI, 1.02-2.11), and depression (OR vs no, 2.29; 95% CI, 1.34-3.91).

In their concluding remarks, the study authors commented that “this comprehensive study identified potentially vulnerable patients and thus warrants additional research focusing on these patients who lag behind and on supportive interventional strategies to facilitate their RTW.”


Dumas A, Vaz Luis I, Bovagnet T, et al. Impact of breast cancer treatment on employment: Results of a multicenter prospective cohort study (CANTO)[WU1]  [published online December 13, 2019]. J Clin Oncol. doi:10.1200/JCO.19.01726