Impact of workplace accommodations on long-term work outcomes in a diverse sample of breast cancer survivors.
Authors: Blinder Victoria Susana , Finik Jackie , Wu Minlun , Claros Maria , Suarez Jennifer , Narang Bharat , Patil Sujata , Gany Francesca 
Published: October 2023

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Background: Low-income and racial/ethnic minority workers in the US have limited access to work accommodations, such as schedule flexibility, if they become ill. Access to such accommodations is a key predictor of work status immediately after treatment for breast cancer. We evaluated the impact of accommodations on long-term work outcomes in a demographically diverse cohort of breast cancer survivors. Methods: We surveyed pre-diagnosis employed women, aged 18-64, who spoke Chinese, English, Korean, or Spanish and were undergoing treatment for stage I-III breast cancer in New York City. Recruitment was enriched for racial/ethnic minority and immigrant status. Surveys were administered (telephone or online) during treatment (baseline) and 4 months after completion of primary therapy. Long-term work status was evaluated in brief surveys 1 and 2 years later. The primary outcome was post-treatment work status (working full- or part-time vs. any other work status). We used X2 and Fisher's Exact Tests to examine associations between participant characteristics and work status, and logistic regression to adjust for relevant characteristics in multivariable analyses. Results: From 06/2012 to 08/2018, 497 participants completed baseline surveys; 479 completed 4-month post-treatment surveys, and 401 and 387 reported on their work status 1 and 2 years later. Overall, 22% self-identified as Black, 22% Chinese, 7.1% Korean, 27% Latina, 19% non-Latina white, and 2.7% as other; 58% were born outside of the US. Post-treatment work status remained relatively stable over time: 29% were not working 4 months after treatment completion, and 26% and 25% were not working 1 and 2 years later. Non-Latina white women were most likely to be working after treatment completion (89%), followed by Korean (74%), Black (73%), Chinese (69%), and Latina women (61%; overall p<0.001). Similar trends were observed 1 and 2 years later. Participants who reported that their employer had been accommodating in their 4-month post-treatment survey were more likely to be working 4 months after completion of treatment (83% vs. 57% of those with unaccommodating employers, p<0.001) and 1 year (85% vs. 60%, p<0.001) and 2 years later (84% vs. 65%, p<0.001). The relationship between employer accommodations and post-treatment work status across all time points remained significant after controlling for age, race/ethnicity, language, household income as a % of the Federal Poverty Level, job type, and receipt of chemotherapy. Conclusions: In this diverse cohort of breast cancer survivors, relative to work status 4 months post-treatment, work status was relatively stable 1 and 2 years later. Women whose employers had been accommodating during treatment were more likely to be working 1 and 2 years later. Increasing access to accommodations could improve long-term work outcomes and abrogate disparities in patients who undergo cancer therapy.