Aggressive breast cancer treatment tied to more missed work

(Reuters Health) - Many women with early-stage breast cancer have full-time jobs when they’re diagnosed, and they are more likely to miss at least a month of work when they receive aggressive treatment that includes surgery, a U.S. study suggests.

The majority of women in the study had surgery - either a lumpectomy that removes malignant tissue while sparing the rest of the breast or a mastectomy that removes the entire breast. Afterwards, many of them also got chemotherapy or radiation to destroy any remaining abnormal cells and reduce the risk of cancer coming back.

Women who received the most aggressive treatment - a double mastectomy followed by breast reconstruction surgery - were almost eight times more likely to miss a month or more of work than women who got a lumpectomy, the study found. With a double mastectomy and reconstruction, women were also three times more likely to stop working altogether.

“We know that many of the women who are receiving (double) mastectomy do not have advanced tumors that require mastectomy even on the affected side,” said lead study author Dr. Reshma Jagsi of the University of Michigan in Ann Arbor.

All of the women had early breast cancer, meaning the tumors had not spread beyond the breast and nearby lymph nodes. Survival odds are generally much better for women diagnosed with these early-stage tumors than for patients with tumors that have metastasized, or spread to other organs in the body.

“Many of the women who are considering more aggressive surgery tell me that they are considering this because they want to make sure they will be there for those who depend on them, both at home and at work,” Jagsi said by email. “For most women with early-stage breast cancer, lumpectomy with radiation therapy is an option, will yield equivalent overall survival to mastectomy, and will actually be less likely to disrupt their ability to be there for others.”

For the study, researchers examined data on 1,006 working women diagnosed with early-stage breast cancer in 2014 and 2015. Overall, 84 percent were working full-time before their diagnosis, but only half of them had paid sick leave and just 38 percent had disability benefits.

When women got chemotherapy, they were 30 percent more likely to miss at least a month of work than when they didn’t receive these drugs, the study found. Chemotherapy was also associated with roughly four times the odds that women would stop work altogether.

Among women who missed more than a month of work, 29 percent lost more than $5,000 in income, researchers report in the journal Cancer.

The study wasn’t a controlled experiment designed to prove how different treatment options directly cause missed work or lost wages. Another limitation of the study is that researchers lacked data on why women missed work, and it’s possible some of that time wasn’t related to the type of treatment they received.

Because the vast majority of women diagnosed with breast cancer can be cured, and because more aggressive care doesn’t necessarily improve survival odds, it makes sense for patients to consider the financial or career impacts of treatment to help decide what makes sense for them, said Dr. Michael Hassett of the Dana-Farber Cancer Institute and Harvard Medical School in Boston.

“Women should start by figuring out what treatment has the best chance of curing their cancer,” Hassett, who wasn’t involved in the study, said by email. “If more than one effective treatment exists, then patients should look for the treatment option that has the least impact on employment or whatever is most relevant to her.”

Too often, discussions women have with their doctors about the best treatment options don’t include a conversation about the employment impact, said Dr. Benjamin Smith, of the University of Texas MD Anderson Cancer Center in Houston.

“This needs to change,” Smith, who wasn’t involved in the study, said by email. “Patients need to understand how their choices may influence their employment, and patients need assistance to help ensure their treatment choices are truly shared decisions that weigh the potential employment impact of given treatment options.”

SOURCE: Cancer, online October 9, 2017.