Employment after curative breast cancer treatment: the breast cancer and the workforce cohort study

PURPOSE: Breast cancer can disrupt employment, with a disproportionate negative impact on women from low-income, immigrant, or minoritized groups. Despite known associations between job loss, financial hardship, and inferior clinical outcomes, there is limited information on post-treatment employment among diverse populations. METHODS: Breast Cancer and the Workforce (BCW) is a prospective cohort study of pre-diagnosis employed women aged 18-64 undergoing treatment for stage I-III breast cancer in New York City. Participants completed surveys at baseline and 4 months post-treatment completion; work status was reassessed 1 and 2 years later. We additionally compared 4-month post-treatment work status between breast cancer survivors and their peers without cancer to control for disparities in noncancer unemployment. Multivariable logistic regression was used to assess predictors of working 4 months post-treatment. RESULTS: Among 489 participants, 68.6% were working 4 months post-treatment, 76.1% at 1 year, and 77.3% at 2 years. Compared to non-Latina white women, Black, Chinese, and Latina women were less likely to be working at 4 months (benchmarked to their same race/ethnicity peers), indicating a disparate negative impact of cancer on work status. In multivariable analyses, older age, receipt of chemotherapy, and demands at work were inversely associated with working at 4 months, while higher income, sick leave access, and an accommodating employer were positively associated. Race/ethnicity was not associated with working. CONCLUSION: Breast cancer can negatively impact employment, especially among certain subpopulations. Increased access to workplace accommodations, including paid sick leave, may be a critical target to improve equitable survivorship outcomes.