Health and employment among working-age cancer survivors.

Details

• Personal Author:
  Ekenga C
• Description:
  Background. Breast cancer is the most commonly diagnosed form of cancer (excluding skin cancer) in American women. In the United States, white women have historically had higher overall breast cancer incidence rates than African-American women; however, in 2012, the incidence gap between white and African-American women closed. With advances in detection and treatment, the population of breast cancer survivors is expected to increase by 25% to almost 4 million by the year 2024, and approximately nine out of every ten breast cancer patients are expected to live at least five years after diagnosis. Nevertheless, in contrast to recent incidence rates, racial disparities in breast cancer survival persist, with five-year survival rates of 81% for African-American women and 92% for white women, and long-term mortality rates that are 42% higher in African-American women than white women. Survivorship has become the expectation, not the exception, for women who have been diagnosed with breast cancer. In the United States, breast cancer survivors are more likely to be unemployed than the rest of the population, and among working age (<65 years) women, breast cancer has been associated with poorer employment outcomes in African-American women than in white women. In our prior studies of employment outcomes among breast cancer patients, we found that African American race and non-private insurance status were associated with diminished employment participation after early-stage breast cancer. However, few longitudinal studies have examined determinants of employment outcomes among African-American women with breast cancer. Methods. We examined factors associated with return to work over 2-year follow-up in a sample of African-American breast cancer patients participating in a randomized controlled trial of a cancer-information intervention's impact (vs. standard of care) on quality-of-life and treatment adherence outcomes. Interview and medical-record data from 227 newly diagnosed African-American breast cancer patients (stage 0-III), who enrolled a mean 6 days from surgical post-op visit or start of neoadjuvant therapy, were analyzed in association with return to work; four more interviews were conducted over two years. Potential predictors included sociodemographic variables (age, marital status, income, education, insurance status), treatment(s) received (surgery type, chemotherapy, radiation), comorbidity, and elevated depressed mood (Center for Epidemiologic Studies Depression Scale [CES-D] score > 15). Multivariable logistic regression models were used to identify factors independently associated with return to work. Results. At enrollment, 100 patients (44%) were employed part or full-time; 71 of employed patients returned to work during 2-year follow-up. Study arm and other treatment and sociodemographic variables were not significantly associated with return to work and was not included in the final model. Patients with elevated depressed mood at baseline were less likely to return to work than non-depressed patients. Conclusions. Patients with elevated depressed mood were less likely to return to work over 2-year follow-up. Screening for depressed mood at diagnosis and providing treatment might be an effective strategy to improve continued workforce participation in African American breast cancer patients. Understanding how psychosocial health influences returning-to-work outcomes in breast cancer patients could be particularly powerful for developing new strategies to reduce racial disparities in the quality of breast cancer survivorship. It is our expectation that we will integrate findings from this study to establish criteria for identifying and engaging breast cancer patients who are at high risk for leaving to workforce and, based on such findings, develop an empirically-grounded strategy for improving return-to-work in breast cancer patients. [Description provided by NIOSH]
• Subjects:
  Healthcare Disparities Mental Health Nervous System Occupational Health Race Factors Safety Women
• Keywords:
  TWH; Total Worker Health; Women; Breast cancer; Cancer survivors; Health disparities; Racial factors; Longitudinal study; Mental health; Return to work
• Publisher:
  American Psychological Association
• Document Type:
  Text
• Funding:
  Cooperative Agreement
• Genre:
  Abstract or Summary
• Place as Subject:
  Iowa ; Missouri ; OSHA Region 7
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  24
• NIOSHTIC Number:
  nn:20065899
• Citation:
  Work, Stress and Health 2019, November 6-9, 2019, Philadelphia, Pennsylvania. Washington, DC: American Psychological Association, 2019 Nov; :24
• Federal Fiscal Year:
  2020
• NORA Priority Area:
  Construction ; Services
• Performing Organization:
  University of Iowa
• Peer Reviewed:
  False
• Start Date:
  20060901
• Source Full Name:
  Work, Stress and Health 2019, November 6-9, 2019, Philadelphia, Pennsylvania
• End Date:
  20260831
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:56fced438d8c6b42b61726c981dae68ab0cbd8bdfd4a83521af2f5b7cbcafb58831d8c7bf82c129c6ca6d31bd17b9a044d660169e31b3735c016856a4f5406e4
• Download URL:
  https://stacks.cdc.gov/view/cdc/248962/cdc_248962_DS1.pdf
• File Type:
  [PDF - 104.06 KB ]