The study of women younger than 65 found that four years after treatment for early stage breast cancer, more than one-third who had chemotherapy were out of work compared to just over one-quarter of women who had other treatments.
"Many of us realise the chemotherapy is going to knock the wind out of your sails temporarily. We [as doctors] have tended to assume women bounced back, and the results here suggest that's not the case," said study researcher Dr Reshma Jagsi, associate professor and associate chair of radiation oncology at the University of Michigan in Ann Arbor.
Along with gains in breast cancer survival comes a responsibility for experts to look at treatment effects on a person's life and livelihood, Jagsi said.
Long-term side effects
The long-term link with unemployment surprised her, Jagsi said, although she noted that the study doesn't establish a direct cause-and-effect relationship between the drug therapy for early stage breast cancer and later job loss.
For the study, published online in Cancer, Jagsi and her colleagues evaluated data from US registries on women diagnosed with early stage breast cancer between 2005 and 2007. They sent surveys to over 3 000 women right after diagnosis and four years later.
The study authors focused on the 746 women under age 65 who answered both surveys and who worked for pay before their cancer diagnosis.
Of these, 30% were unemployed at the four-year follow-up, although many said they wanted to work and were job-hunting.
Jagsi's team then looked at the type of treatment and whether it had a bearing on employment status. Those who received chemotherapy were 1.4 times more likely to be unemployed than those who didn't have that treatment, the investigators found.
38% of the chemotherapy patients were unemployed four years later versus 27% of those who didn't get chemo. That difference was statistically significant.
The study didn't go into the reasons for job loss, but Jagsi had some ideas. "It may be that they are experiencing long-term side effects, like nerve problems that can happen after certain kinds of chemotherapy, that can make it hard to drive a bus or type on a keyboard," she said.
Another possibility: "In the current economy, it's really hard to keep your job or get it back after you've missed a lot of work or stopped working during treatment," she said.
Other research has found that cancer survivors can experience long-term "chemo brain" – a kind of mental fogginess – after chemotherapy.
The other take-home message from her study, Jagsi said, is that women must become advocates for themselves and their careers. They should talk to the doctor in depth about the range of treatments and the pros and cons of each, she explained.
"In some cases, the marginal benefit of chemotherapy beyond all the other wonderful treatments we have is relatively small," she said. "And it may be that when all potential downsides are considered – including potential long-term effects on employment – that some women will decide that this benefit doesn't outweigh the risks."
The study findings point to an important issue, agreed Susan Brown, managing director of health and science education for the Susan G. Komen for the Cure, an advocacy organization. "Quality of life after breast cancer treatment is of key importance," she said.
Informed treatment decisions
Currently, "we are not aware that employment implications are something that are generally considered at the time of treatment," Brown said.
Tools such as tumour profiling tests that indicate recurrence risk might help patients and their doctors make informed treatment decisions, she added.
"We encourage all women and men facing breast cancer to have a discussion with their health care provider, and discuss any treatment-related concerns they may have," Brown said.