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Monday, March 5, 2018

3 Questions on…How a Cancer Diagnosis Affects Women’s Work

With Reshma Jagsi, MD, DPhil, at the University of Michigan

By Sarah DiGiulio

Some people work to put food on the table. Some people work because they love their jobs. Some people work because it gives them a sense of purpose. And a lot of people work for some combination of all of those reasons and more. Getting diagnosed with breast cancer, among other conditions, can cause huge disruptions to this otherwise routine and important part of many people's lives.

That's what led a group of researchers at University of Michigan to investigate how different breast cancer treatments and making different breast cancer treatment decisions affected women's employment. The study was recently published in the journal Cancer (2017;123(24):4791-4799).

"Many more women are undergoing aggressive surgical procedures to treat early-stage unilateral breast cancer these days," the study's lead author Reshma Jagsi, MD, DPhil, Professor and Deputy Chair in the Department of Radiation Oncology and Director of the Center for Bioethics and Social Sciences in Medicine at University of Michigan, Ann Arbor, shared with Oncology Times. Yet, the procedure has not necessarily been shown to improve survival for these women, she added. "Professional societies and physicians are worried about overtreatment because more aggressive procedures do have additional risks."

And the new data she and her colleagues collected show those more intensive treatments can also bear an effect upon employment opportunities and trajectories for women.

"That's why we think the findings of this study are important," Jagsi stated. "When patients are being counseled about surgical treatment options, the potential impact on employment outcomes should be discussed in order to ensure that patients are making choices fully informed about potential consequences."

For the study, the researchers analyzed survey responses from 1,006 women between 20 and 79 who had had a prior stage 0 to stage II breast cancer who had been working before their diagnosis. The survey inquired about treatment decisions, how the women's treatment affected how much work was missed, and whether or not treatment affected the women's decision to stop work during or after treatment.

Here's what Jagsi said are the most important findings—and some key implications of the work.

1. What are the key findings from this study that were not previously known about how breast cancer treatment affects women's work?

"In the relatively recent sample of working-aged women in our study, more than one in five had undergone bilateral mastectomy.

"And we observed a strong association between more aggressive treatments, especially more aggressive surgery, and missed work. Women who had bilateral mastectomy with reconstruction to treat their early-stage breast cancer had nearly eight times the odds of missing over a month of work, and three times the odds of stopping work altogether, as compared to women who received lumpectomy.

"I found the financial impact of missed work to be striking. Nearly one in five (19%) of the patients in our study reported losing 10 percent or more of their annual household income because of missed work since diagnosis of breast cancer."

2. What do these data say about what breast cancer treatments women should choose and how they should make those decisions?

"Women diagnosed with early-stage breast cancer have a dizzying array of options from which to choose. What is important is for them to be fully informed of what to expect, both in terms of benefits and in terms of risks, from each approach. And impact on employment is a potentially important consideration that women should be given information about so they can take that into account when making their decisions.

"Further research needs to evaluate interventions that help physicians communicate clearly about the information needed by patients making complex treatment decisions like these. Follow-up research to examine the longer-term outcomes of the patients in the current study will also be important to provide a more complete picture of their experiences, which can be valuable in guiding patients making similar decisions in the future."

3. What would you say is most important for all practicing oncologists and cancer care providers to know about this research?

"Practical actions by clinicians are essential in order to reduce the overuse of aggressive treatments.

"It may be very helpful for practitioners to have access to data on the real-life employment experiences of other women for use when counseling patients about what they might expect with different treatment decisions. After all, understanding the employment effects of different surgical decisions is critically important to the many patients who consider surgical treatments more aggressive than medically necessary to treat their cancer.

"Surgeons who treat patients with breast cancer can now provide compelling evidence that women who undergo mastectomy experience considerably higher risks of missed work than those who receive breast-conserving therapy. Moreover, the current data allow quantification of the financial impact of this missed work, and these data may be very useful in helping patients understand the full impact of treatment decisions."