Return to work after treatment for primary breast cancer over a 6-year period: results from a prospective study comparing patients with the general population

Only little research has been conducted on breast cancer survivors returning to work in Germany. This paper explores two questions: (1) Does breast cancer lead to an increased drop-out of paid work? (2) Do other factors, apart from their illness, help explain breast cancer survivors' (temporary) retirement from work? To the best of our knowledge, this is the first comparative and prospective study on breast cancer survivors returning to work in Germany. We consider this work to be a relevant research for three reasons: (1) It exceeds the observation period of previous international studies by another 3 years. (2) By including the comparison with a population sample, it allows to take the specific situation of breast cancer patients into account. This refers to their illness as well as to the socio-economic context. (3) It combines qualitative and quantitative methods in order to receive patients' individual interpretations. The analysis is based on a sample of 227 breast cancer patients, participating in a prospective study on the role of psychosocial factors in the long-term course of breast cancer and a random sample of 647 age-matched women living in northern Germany. Employment and demographic data were observed directly before primary surgery (2002-2004), 1 year later (2003-2005) and again 5 years later (2008-2010). In addition, qualitative interviews at the three different observations served as a basis for quantitative data analyses, which were mainly performed by logistic regression models. One year after primary surgery, nearly three times as many cancer survivors had left their job as compared to the women in the reference group. For breast cancer survivors, a lower level of education, part-time employment, the severity of work-related difficulties and participation in inpatient rehabilitation correlated significantly with the failure to return to work. Six years after surgery, the probability of returning to work was still only half as high among breast cancer survivors than among controls. The main predictor for not returning to work was found to be age; tumour stage and the severity of side effects of treatment also seemed to have an impact. Breast cancer survivorship in Germany increases the risk of dropping out of paid work. The influence of work- and illness-related factors varies considerably between the early and late phases of recovery after breast cancer treatment. The comparative analysis demonstrates the relevance of labour market and pension legislation in Germany.