Get Cancer. Lose Your Job?
Let’s start with this fact: If you are employed and get a breast cancer diagnosis, it’s less likely you’ll be working at your job four years later. A newly-published study of women in Los Angeles and Detroit found that among women less than 65 years with limited-stage breast cancer, 76 percent had a paying job at the time of their diagnosis. Based on follow-up surveys of the same women four years later, the number employed was reduced by 30 percent. That’s a huge drop.
The study was just published on-line in the Cancer Journal. The authors, including a corresponding and lead author in a department of radiation oncology at the University of Michigan, make a point in the paper’s title, Impact of Adjuvant Chemotherapy on Long-Term Employment of Survivors of Early-Stage Breast Cancer, that chemotherapy may be to blame. And there’s some truth in this. Chemotherapy causes fatigue and, occasionally lasting problems such as neuropathy, heart weakness and chemobrain that might limit or impair a person’s capacity to work effectively.
On the other hand, the likelihood of developing many of those chemo-related effects depend on the dose and regimen selected. Radiation, often, causes fatigue, and – when administered to the chest, can cause premature heart disease (atherosclerosis) and lung problems, besides secondary tumors as a late consequence of treatment. It happens, though, that hormonal treatments, like Tamoxifen, can cause chemobrain too.
As someone trained to give chemotherapy, I’ll point out that none of these options for adjuvant treatment (what’s given to patients with limited disease to lessen the likelihood of recurrence) is a walk in the park. Each bears the potential for short and long-term toxicity. So I don’t blame chemotherapy in particular, although the study authors emphasized that as a culprit based on a low-level statistical correlation.
More broadly –
This news comes as no surprise. I know too well how women at work may be treated after a breast cancer diagnosis. I am privy to the stories of dozens of women who say they were unduly turned down for promotions or good assignments, opportunities…Upon returning to work, if they took time off (which some didn’t, such as your author, during her BC treatment), they – if they take pride in their work – find themselves missing their own doctors’ appointments, exercise and other aspects of survivorship care, just to “prove” that they’re still valuable to their office, team, business.
The harsh reality is that people who have had cancer treatment are sometimes perceived as a burden on a working group: a consultant who can’t travel quite so much, a sales rep who looks less beautiful, a nurse who has to take an occasional half-day off for a check-up. Some bosses worry, although you’d be hard-pressed to find this in writing, that an employee who had cancer treatment may suffer a recurrence, and so she can’t be counted on – no matter how capable and motivated she may be – to lead a fellowship program, or to complete an ambitious project.
What would help is for doctors to guide patients with more nuanced advice, to avoid over-treatment. And patients should ask their physicians, based on their circumstances, for the least therapy that makes sense based on the size and molecular details of their tumor, to avoid long-term toxicity. And for employers to treat their workers who have illness – and not just breast cancer – as potentially valuable workers, contributors, over the long haul.
Thanks so much for your perspectives on this study. The main takeaway seems to be the importance of choosing a treatment that is appropriate based on tumor biology and risk of recurrence but that is also the least aggressive/least toxic to minimize long term adverse effects. This seems to underline how important it is for patients to be fully informed about the benefits and risks of treatment options so they can make decisions with their doctors that balance these different considerations. Thanks again for this very helpful post.
Thanks so much for this, Dr. S. When you advise: “patients should ask their physicians, based on their circumstances, for the least therapy that makes sense based on the size and molecular details of their tumor, to avoid long-term toxicity” – it makes me wonder why on God’s green earth it is up to the patient to request this as opposed to the physicians who are deciding on their treatments?
The statement somehow implies that this is not already happening, or that physicians are providing therapies that are more toxic than they need to be.
This issue is critically important whether you are in the workforce or not, isn’t it?
You’re perfectly right, that ideally doctors would be thinking in these terms. But not all do. Also, for some conditions there’s a range of doses and regimens, i.e. treatment intensity and modes of treatment (e.g. +/- radiation, if and how much chemo…). Some patients may worry more about neuropathy, or hair loss…My point, which I think we share, is that patients need be their own advocates in these decisions, to make sure the doctors take their preferences into account.
It occurs to me – as I suspect it registered with you, that this employment problem isn’t just about breast cancer, or cancer. If you have a serious health condition about which your employer is aware, it may hurt your job security (even if the law says it shouldn’t.)