Dumas, Vaz Luis, Bovagnet, El Mouhebb, Di Meglio, Pinto, Charles, Dauchy, Delaloge, Arveux, Coutant, Cottu, Lesur, Lerebours, Tredan, Vanlemmens, Levy, Lemonnier, Mesleard, Andre, Menvielle (2020) Impact of Breast Cancer Treatment on Employment: Results of a Multicenter Prospective Cohort Study (CANTO) Journal of clinical oncology : official journal of the American Society of Clinical Oncology 38(7) 734-743


Adverse effects of breast cancer treatment can negatively affect survivors' work ability. Previous reports lacked detailed clinical data or health-related patient-reported outcomes (PROs) and did not prospectively assess the combined impact of treatment and related sequelae on employment. We used a French prospective clinical cohort of patients with stage I-III breast cancer including 1,874 women who were working and ≥ 5 years younger than legal retirement age (≤ 57 years) at breast cancer diagnosis. Our outcome was nonreturn to work (non-RTW) 2 years after diagnosis. Independent variables included treatment characteristics as well as toxicities (Common Toxicity Criteria Adverse Events [CTCAE] v4) and PROs (European Organization for Research and Treatment of Cancer [EORTC] Quality of life Questionnaires, Breast cancer module [QLQ-BR23] and Fatigue module [QLQ-FA12], Hospital Anxiety and Depression Scale) collected 1 year after diagnosis. Logistic regression models assessed correlates of non-RTW, adjusting for age, stage, comorbidities, and socioeconomic covariates. Two years after diagnosis, 21% of patients had not returned to work. Odds of non-RTW were significantly increased among patients treated with combinations of chemotherapy and trastuzumab (odds ratio [OR] v chemotherapy-hormonotherapy: for chemotherapy-trastuzumab, 2.01; 95% CI, 1.18 to 3.44; for chemotherapy-trastuzumab-hormonotherapy, 1.62; 95% CI, 1.10 to 2.41). Other significant associations with non-RTW included grade ≥ 3 CTCAE toxicities (OR v no, 1.59; 95% CI, 1.15 to 2.18), arm morbidity (OR v no, 1.59; 95% CI, 1.19 to 2.13), anxiety (OR v no, 1.47; 95% CI, 1.02 to 2.11), and depression (OR v no, 2.29; 95% CI, 1.34 to 3.91). Receipt of systemic therapy combinations including trastuzumab was associated with increased odds of non-RTW. Likelihood of unemployment was also higher among patients who reported severe physical and psychological symptoms. This comprehensive study identifies potentially vulnerable patients and warrants supportive interventional strategies to facilitate their RTW.

乳腺癌治疗的不利影响会对幸存者的工作能力产生负面影响。先前的报告缺乏详细的临床数据或与健康相关的患者报告的结局(PRO),并且未前瞻性评估治疗和相关后遗症对就业的综合影响。我们对法国的I-III期乳腺癌患者进行了前瞻性临床队列研究,其中包括1,874名正在工作且在诊断乳腺癌时比法定退休年龄(≤57岁)年轻≥5岁的女性。我们的结果是诊断后2年不再恢复工作(非RTW)。自变量包括治疗特征,毒性(常见毒性标准不良事件[CTCAE] v4)和PRO(欧洲癌症研究和治疗组织[EORTC])生活质量问卷,乳腺癌模块[QLQ-BR23]和疲劳模块诊断后1年收集[QLQ-FA12],医院焦虑症和抑郁量表。 Logistic回归模型评估了非RTW的相关性,并根据年龄,阶段,合并症和社会经济协变量进行了调整。诊断后两年,有21%的患者未恢复工作。化疗和曲妥珠单抗联合治疗的患者中非RTW的几率显着增加(赔率[OR]相对于化疗-激素疗法:曲妥珠单抗为2.01; 95%CI为1.18至3.44;化疗-曲妥珠单抗-激素治疗, 1.62; 95%CI,1.10至2.41)。与非RTW的其他重要关联包括≥3级CTCAE毒性(OR v否,1.59; 95%CI,1.15至2.18),手臂发病率(OR v no,1.59; 95%CI,1.19至2.13),焦虑症(OR v no,1.47; 95%CI,1.02至2.11)和抑郁症(OR v no,2.29; 95%CI,1.34至3.91)。接受包括曲妥珠单抗在内的全身治疗组合与非RTW几率增加相关。在报告严重的生理和心理症状的患者中,失业的可能性也更高。这项全面的研究确定了潜在的弱势患者,并需要采取辅助性干预策略来促进其RTW。



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