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Associations between workability and patient-reported physical, psychological and social outcomes in breast cancer survivors: a cross-sectional study

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Abstract

Purpose

Workability is of increasing importance especially in Asia given the increasing incidence rates and young age of onset of breast cancer. This study explores the determinants of employment and suboptimal workability. And evaluate the association between workability and patient-reported physical, psychological, and social outcomes.

Methods

In a hospital-based cross-sectional study, 327 breast cancer survivors, < 65 years of age and > 1 year post-diagnosis were recruited. Employed survivors filled out the workability index, which measures a person’s capacity to meet work demands in relation to current health status. The EORTC-QLQ-C30, EORTC-QLQ-BR23, hospital anxiety and depression scale, multidimensional fatigue inventory, and brief pain index were administered. Fisher’s exact test and Kruskal-Wallis test were used to test for associations of workability and employment status with demographic, clinical characteristics, and patient-reported outcomes. Linear models with standardised scores for patient-reported outcomes were fitted to study the associations of workability with patient-reported outcomes.

Results

Of the 327 survivors, < 65 years of age (working age), 140 (43%) were in full-time and 34 (10%) in part-time employment. Employed survivors were younger at time of diagnosis and at time of survey. Employment status was not associated with time since diagnosis, ethnicity, or clinical characteristics. Suboptimal workability was present in 37% of employed survivors of the working age, and more common in jobs that include physical work activities. Higher level of depression, financial difficulty and physical fatigue, more breast symptoms, and poorer global health status were independently associated with poorer workability.

Conclusions

Lower employment and reduced workability in breast cancer survivors is common, and reduced workability is associated with higher levels of depression, financial difficulty and physical fatigue, more breast symptoms, and poorer global health status. Longitudinal research on psychosocial support with workability in Asia may find tailored approach to improve or maintain workability in employed breast cancer patients.

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Acknowledgements

We thank our research coordinators, Li Ling Tan, Ying Qian, Charlotte Ong, and Wen Min Hong, for the recruitment and in conducting of the interviews.

Funding

The study was carried-out with the support from the National University Hospital, Singapore, Clinician Scientist Award, National Medical Research Council R-608-000-093-511, and Asian Breast Cancer Research Fund N-176-000-023-091.

Author information

Authors and Affiliations

  1. Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore

    Peh Joo Ho, Mikael Hartman & Alex R. Cook

  2. Department of Surgery, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore

    Mikael Hartman

  3. Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands

    Sofie A. M. Gernaat

  4. National Health System, National University Cancer Institute, Singapore, Singapore

    Soo Chin Lee

  5. Nyenrode Business University, Breukelen, The Netherlands

    Leon Hupkens

  6. Imaging Division, University Medical Center Utrecht, Utrecht, The Netherlands

    Helena M. Verkooijen

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  1. Peh Joo Ho
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Contributions

MH, HMV, and PJH designed the study. MH provided study material. HMV and MH provided epidemiological expertise. ARC provided statistical expertise. PJH performed data analyses and wrote the manuscript. All authors discussed and interpreted the data and revised the manuscript.

Corresponding author

Correspondence to Mikael Hartman.

Ethics declarations

This study was performed with institutional ethics approval from the National University Hospital and with the 1964 Helsinki declaration.

Conflict of interest

The following authors do not have conflict of interest to disclose, Peh Joo Ho, Mikael Hartman, Sofie A.M. Gernaat, Alex R. Cook, Soo Chin Lee, and Helena M Verkooijen. Leon Hupkens has an immediate family member employed in and is paid honoraria by a for-profit health care company, Dokter Hupkens Esthelieh.

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Ho, P.J., Hartman, M., Gernaat, S.A.M. et al. Associations between workability and patient-reported physical, psychological and social outcomes in breast cancer survivors: a cross-sectional study. Support Care Cancer 26, 2815–2824 (2018). https://doi.org/10.1007/s00520-018-4132-2

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  • DOI: https://doi.org/10.1007/s00520-018-4132-2

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