Abstract PR03: Disparities in work status after treatment for breast cancer: A controlled, longitudinal study
Authors: Blinder Victoria S. , Patil Sujata , Eberle Carolyn , Jung Gabriel , Kampel Lewis J. , Hwang Caroline , Bao Ting , Robson Mark E. , Malik Manmeet , Gany Francesca 
Published: August 2020

Abstract
Low-income and minority groups appear to be at increased risk of post-treatment job loss and its sequelae, including financial strain and bankruptcy. However, the drivers of disparities in job loss are not understood. We surveyed employed women aged 18-64 with stage I-III breast cancer who spoke Chinese, English, Korean, or Spanish. Baseline surveys (telephone or online) were administered during adjuvant treatment; follow-up surveys were conducted 4 months after completion of active treatment except endocrine and targeted therapy (i.e., trastuzumab with or without pertuzumab). The primary outcome was post-treatment work status (working full- or part-time vs. any other work status). We used healthy peers to control for disparities in non-cancer unemployment and multivariable analyses to identify predictors of work status in patients. Our sample (n=479) was 28% Latina, 23% black, 21% non-Latina white, 19% Chinese, and 7% Korean; 56% were foreign-born. Overall, 31% had a household income &lt;200% of the federal poverty level; 26% were under-/uninsured; 33% worked in service/manufacturing jobs at baseline, 19% in sales/administrative jobs, and 47% in management/profession jobs. Most underwent chemotherapy (85%). Four months after treatment completion, 71% of the survivors reported that they were working. The proportion of working patients versus controls was 0.69 for Chinese, 0.73 for Korean, 0.75 for Latinas, 0.78 for blacks, and 0.98 for non-Latina whites. Independent predictors of not working among patients were receipt of chemotherapy (OR 2.20; 95% CI 1.04-4.64); older age (OR 1.06; 95% CI 1.03-1.09); black (OR 2.37; 95% CI 1.01-5.56), Chinese (OR 2.91; 95% CI 1.20-7.05), or Korean (OR 3.68; 95% CI 1.24-10.98) race (vs. non-Latina white); household income &lt;200% of poverty (OR 3.00; 95% CI 1.68-5.35); and service/manufacturing job-type at baseline (OR 2.41; 95% 1.30-4.44, vs. manager/professional). Having an employer who was not accommodating also predicted not working post-treatment (OR 3.05; 95% CI 1,88-4.95). Breast cancer exerts a disparate negative impact on work status in minority and low-income women, which persists after controlling for disparities in background unemployment. Women who work in service or manufacturing jobs are at greater risk. Furthermore, receipt of chemotherapy is a predictor of job loss, even after controlling for race and income. However, employer accommodations appear to abrogate the negative impact of chemotherapy on work status. Interventions are needed to promote job retention in minority and low-income women, particularly those who lack work accommodations or are in high-risk jobs.
This abstract is also being presented as Poster A100.
Citation Format: Victoria S. Blinder, Sujata Patil, Carolyn Eberle, Gabriel Jung, Lewis J. Kampel, Caroline Hwang, Ting Bao, Mark E. Robson, Manmeet Malik, Francesca Gany. Disparities in work status after treatment for breast cancer: A controlled, longitudinal study [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr PR03.