The impact of metastatic breast cancer (mBC) treatment on patient reported productivity loss among patients with HER2+ mBC in the U.S.
Authors: Mehta Sandhya , Brown-Bickerstaff Cherrishe , McAllister Lindsay , Lam Clara , Negley Sonya , Ormerod Catherine L. , Kwong Jackie , Feinberg Bruce A. 
Published: October 2023

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Background: Little is known about the impact of treatments and other factors on productivity loss among HER2+ mBC patients. This study aimed to assess the work productivity and activity impairment among employed women with HER2+ mBC. Methods: A cross-sectional survey was completed by the members of two patient advocacy organizations in the U.S. Those who were employed for paid work (≥20 hours/week) and receiving systemic treatments for HER2+ mBC for the past 3-months were recruited. Participants self-reported their sociodemographic, clinical and treatment history, time burden related to disease management, and completed the work productivity and activity impairment (WPAI) and Functional Assessment of Cancer Therapy Breast (FACT-B) quality of life (QoL) questionnaires. Patients were grouped based on their current regimen: (1) Oral only, (2) one parenteral drug (1 IV), (3) 2 IVs, (4) 3+ IVs. Association between WPAI scores and sociodemographic and clinical characteristics was assessed using simple linear regression. Results: A total of 118 HER2+ mBC patients participated [mean (SD) age 47.2 (9.5) years, 69.5% were employed full-time and 30.5% part-time, 89% were White, 13.6% resided in rural area]. Among 118 patients, 38 (32.2%) were on 1 IV, 38 (32.2%) on 2 IVs, 31 (26.6%) on 3+ IVs and 11 (9.3%) on oral only regimen. The median travel time (4 hrs vs. 6 hrs) and time spent at healthcare visits (7.3 hrs vs.13.4 hrs) was numerically higher among those on 3+ IVs than those on 1 IV. The median percent work time missed (7.7% vs. 5.8%), overall work impairment (38.2% vs.31.3%) and activity impairment (40.0% vs. 30.0%) in the past 7 days was numerically higher in patients on 3+ IVs than on 1 IV. Working part-time, residing in rural area, having low household income (<25K vs. >75K) and non-commercial insurance was associated with greater overall work impairment (all p-values <0.05). Longer time since mBC diagnosis, longer time on treatment and higher QoL score were associated with lower overall work impairment (all p-values <0.05). Working part-time, low household income, non-commercial insurance, longer time on treatment and higher QoL score were similarly associated with activity impairment (all p-values <005). Conclusions: Socioeconomic and geographical factors were important determinants of work productivity loss among HER2+ mBC patients. IV treatment is the mainstay of therapy for HER2+ mBC patients and being on a simpler regimen for a longer time is likely to reduce work productivity loss and activity impairment. Improving access to novel monotherapy infusion treatment in rural community oncology practices may offer an opportunity to reduce patient time burden and work productivity loss among HER2+ mBC patients and improve health-related quality of life. Additional research from a larger diverse sample is warranted to further understand health disparities in HER2+ mBC patients.