Many factors are significantly associated with and may predict unemployment for women with breast cancer after surgery, according to a study published in the Journal of Clinical Oncology.1

Other than the physical and psychological burden experienced by women after breast cancer surgery, another major challenge associated with breast cancer survivorship is unemployment. Unemployment is known to reduce the quality of life and increase mortality among survivors; understanding various factors associated with unemployment may help to guide breast cancer management to increase the rate of returning to work. 

In this systematic review, investigators searched 4 major databases (MEDLINE, EMBASE, CINAHL, PsycINFO) and selected 26 eligible cohort studies for analysis, which represented 46,927 patients total. More than half of the selected studies reported that all patients were employed at baseline, but the employment rates ranged from 40.3% to 100% among the various studies. The median duration of follow-up was 30.0 months. 

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The authors studied the association of 127 independent variables with unemployment post-surgery. 

Analysis showed that the rate of unemployment was 26.6% among women who had access to universal health compare compared with 15.4% of women who did not (P= .05).

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High-quality evidence suggested that other predictors significantly associated with unemployment after breast cancer surgery were high psychological job demands (job strain, low job decision control, psychological constraints at work), childlessness, lower education level, lower income level, advanced cancer stage (II, III, IV), and undergoing mastectomy compared with breast-conserving surgery.

Moderate-quality evidence demonstrated that jobs that were highly physically demanding, African-American race, and undergoing chemotherapy, were factors associated with unemployment. 

Factors with the most prominent associations with unemployment were high psychological job demand (22% absolute increase in risk of unemployment) and physical job demand (9% increase).

No significant associations were found with blue-collar work, positive lymph nodes, part-time employment, and radiotherapy or endocrine therapy according to high-quality evidence, and moderate-quality evidence showed no association between unemployment and age, marital status, or axillary lymph node dissection. 

The authors concluded that “addressing high physical and psychological job demands may be important in reducing unemployment after breast cancer surgery.”


  1. Wang L, Hong BY, Kennedy SA, et al. Predictors of unemployment after breast cancer surgery: a systematic review and meta-analysis of observational studies[published online May 14, 2018]. J Clin Oncol. doi: 10.1200/JCO.2017.77.3663