Noting that “limited data exist on the association of symptom burden, daily activity impairment, and work productivity in patients with advanced breast cancer,” Charles Cleeland, PhD, MD Anderson McCullough Professor of Cancer Research at The University of Texas MD Anderson Cancer Center in Houston, TX, and colleagues conducted a cross-sectional analysis in patients with either locally recurrent or metastatic breast cancer who were receiving first-line hormonal therapy or chemotherapy and/or targeted therapy.3
Among the 152 patients who replied to questionnaires—104 in the chemotherapy cohort and 48 in the hormonal therapy cohort—the most common severe symptoms were fatigue, decreased sexual interest, disturbed sleep, emotional distress, and drowsiness, which were moderate- to severe- in intensity in 38.8% to 52.0%. For these patients, mean percent daily activity impairment was 30%, with impaired work productivity ranging from 20% to 40% across indices among the 58 patients who were employed.
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These results indicated that patients who received treatment for metastatic breast cancer “are symptomatic with significant daily activity and/or work productivity impairment,” they wrote. “Symptom severity and interference, functional status, and overall health-related quality of life were moderately correlated with perceived work-related ability.”
For the 40% of US workers who have no paid sick leave, taking time off from work for treatment not only increases their personal financial burden but can lead to job loss, reported Arden M. Morris, MD, MPH, of the University of Michigan Health System, Ann Arbor, and colleagues in JAMA. Neither the Affordable Care Act nor the Family Medical Leave Act mandate paid sick leave, and it is not a part of health insurance coverage.4
They found that 55% of the 567 respondents who were employed retained their jobs
in their survey of adults with stage 3 colorectal cancer reported to the Surveillance, Epidemiology, and End Results cancer registries of Georgia and metropolitan Detroit, MI, between August 2011 and March 2013.
Those who did were significantly more likely to be “men, white, married, without comorbid disease, and were more highly educated and were more likely to have a higher annual income, private health insurance, and access to paid sick leave.” Fifty-nine percent of those with paid sick leave retained their jobs versus 33% without paid sick leave (P < .001).
Compared with those without a history of cancer, survivors of colorectal and female breast cancer had higher annual excess medical expenditures linked to productivity losses, Zhiyuan Zheng, PhD, of the American Cancer Society in Atlanta, GA, and colleagues noted.5
Colorectal cancer survivors had 13.6% excess employment disability and 7.2 days of productivity loss at work (both P < 0.001), while breast cancer survivors reported 4.8% (P = .001) and 3.3 days (P = .002).
An online Harris Poll of 913 patients with cancer and cancer survivors found that 73% want to work; however, 59% of those who worked through treatment believed they had no choice.
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The poll, commissioned by Cancer and Careers, a national nonprofit organization that trains oncology health care professionals with the goal of helping people with cancer “thrive in their workplaces,” also found that when balancing work and cancer, 42% reported fatigue; 26%, managing discomfort from physical posttreatment side effects; and 23%, taking longer to complete work tasks. Working during treatment also had positive effects: 73% said it helped them cope.6
