Abstract PS7-72: Will it work? Opportunities for physicians and employers to assist breast cancer patients in addressing non-medical barriers to care
Authors: Castellow Fran , Gallagher Kathleen , Angove Rebekah 
Published: February 2021

Abstract
Background: Advances in cancer treatments have improved the prognosis for many people and enabled some to work during treatment. Although physicians have conversations with cancer patients about care preferences, conversations often do not include the impact of treatment on the non-medical aspects of patients’ lives. In particular, work disruption has the potential to exacerbate existing hardships and has been proven to be a significant barrier to care and attaining optimal wellbeing. For many patients, returning to work is viewed as a key milestone. This study evaluated the impact of breast cancer on work activities, return-to-work decision-making, and the opportunity for employers to accommodate and support employees with cancer. Methods: A cross-sectional survey of patients served by Patient Advocate Foundation in 2018-2019. Descriptive statistics were calculated using frequencies for categorical variables. Results: Of 677 breast cancer patients surveyed, &gt;6-months of treatment-related work absence was experienced by 53%; 32% utilized FMLA; 32% short-term disability; 40% unpaid leave. One fifth retired early; 23% reduced hours worked; 8% changed careers and 66% discussed treatment impact with HR. Almost two-thirds of employers (60%) made reasonable adjustments to work duties; 68% were supportive during the entire illness. Half (51%) of the patients reported that their provider initiated a conversation about the impact of treatment on their ability to work; 54% considered work impact when deciding on their first treatment; and 53% reported that their treatment ‘always’ or frequently’ reduced their ability to work. Work disruption had a negative impact on monthly income; 68% of patients stating that it had ‘a lot of impact’ and 46% reported lost wages &gt;$750. Survey respondents were 65% Caucasian, 20% African American, and 15% Other or Undisclosed. Nearly half (44%) were &lt;55 years old, and 77% reported income &lt;$48,000. Two thirds (63%) reported full time employment, 73% age &lt;60 years and half reported stage 0-2 (49%) at time of diagnosis; 47% were employer insured. Discussion: Patients with cancer struggle to afford needed medical care alongside daily financial obligations due to rising healthcare costs. It is important for provider care conversation to expand beyond just the decision around clinical care. Employers were reported to be supportive and flexible about return to work and most cancer survivors in this study were satisfied with their employers’ responses to their needs. The large percentage of patients that did not discuss the impact of cancer treatment on work activities may indicate their reluctance to have these conversations with HR and highlight how the threat of reduced financial status may change treatment decisions. Conclusions: Health system-level solutions will require person-centered policies focused on expanding shared decision making by integrating what matters to patients in the context of their lived experience with illness. Care conversations must incorporate all aspects of the patient’s situation and preferences to ensure the alignment of treatment, personal and financial goals. It is imperative that clinicians recognize and discuss the impact of treatment choices on a patient’s ability to work, as employment changes place patients at increased risk for negative financial impact. Similarly, employers should develop and implement worksite wellness policies that encourage (and protect) patients facing changes in health that impact work and support flex scheduling for persons with chronic conditions. The adoption of such policy could minimize the need for extensive time off or loss of job. This in turn could avert lost wages, lost productivity, and early retirement of employees, as well as potentially decreasing the costs associated with employee turnover.
Citation Format: Fran Castellow, Kathleen Gallagher, Rebekah Angove. Will it work? Opportunities for physicians and employers to assist breast cancer patients in addressing non-medical barriers to care [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS7-72.