Abstract PD8-08: Employment status change in a cohort of young women with breast cancer in Mexico
Authors: Villarreal-Garza Cynthia , Ferrigno Ana , Salazar Misael , Enriquez Luis F. , Fonseca Alan , Platas Alejandra , Labra Lucero , Cruz-Ramos Marlid , Miaja Melina , Vaca-Cartagena Bryan , Becerril-Gaitan Andrea , Mesa-Chavez Fernanda , Bargallo-Rocha Enrique , Mohar Alejandro 
Published: March 2023

Abstract
Background: Breast cancer diagnosis and treatment generates disruption in multiple aspects in the life of patients, including work-related outcomes. The disruption in employment may exacerbate the economic burden on patients and their families, contributing to financial toxicity and ultimately impacting quality of life, especially in young women. However, the evidence of employment status at diagnosis for this group and its trajectory thereafter is limited. This study aims to document the first change in employment experienced by Mexican young women with a recent diagnosis of breast cancer and determine which factors are associated with a decrease in work activities. Methods: Mexican women from the Joven & Fuerte prospective multicenter cohort, aged ≤40, diagnosed with stage I-III breast cancer between 2015-2021 with at least 6 months of follow-up were included. Participants with a documented disease recurrence, missing employment status information, diagnosis of a new primary breast cancer or a second type of cancer were excluded from the analysis. Patients completed surveys at baseline, 6 months, and yearly for up to 5 years to assess sociodemographic characteristics, employment status, medical and treatment data. Employment status was categorized on a scale as follows: full-time &gt; part-time &gt; student &gt; medical leave &gt; unemployed. Only the first employment status change was included in this analysis. The Kaplan-Meier failure estimate was employed to calculate the increase or decrease in employment status at 1 year and 2 years post-diagnosis. Competing risk regression models were undertaken to explore variables associated with a decrease in employment status. Results: A total of 142 women with a median age at diagnosis of 36.5 years (IQR 33-39) and median follow-up of 17 months were included in the analysis. Baseline employment status for these patients was: employed - full time (27%), employed - part time (14%), student (1%), medical leave (4%) and unemployed (54%). At 12 months, 18.5% of participants had a reduction in their work activity (95% CI 12.8 - 26.4%) and this proportion further increased to 25.8% at 24 months (95% CI 18.7 - 34.8%). In contrast, 11.8% (95% CI 7.3 - 19.0%) and 23.2% (95% CI 15.9 - 33.2%) of participants exhibited an increase in their work activity at 12 and 24 months, respectively. The most common patterns in first employment status change were from unemployed to employed - full time (19%), employed - full time to employed - part time (13%) and employed - full time to unemployed (13%). In univariable analysis, having a partner at diagnosis demonstrated a lower hazard for experiencing a decrease in work activities; in contrast, postmenopausal status at 1 year was associated with a higher hazard of experiencing a decrease in employment status. However, in a competing-risks model including both partner and menopausal status, only the latter was associated with a higher hazard for experiencing a reduction in work activity (SHR=3.05, 95% CI 1.38 - 6.72, p=0.006). Age, education, monthly income, number of people who contribute to the household, having a partner at diagnosis, number of children, being financially responsible for another person, mastectomy, chemotherapy, radiotherapy and endocrine treatment were not associated with a higher probability of reduction in work activity. Conclusion: This cohort is one of the few initiatives assessing the impact of diagnosis and treatment of BC in young patients, specifically Latin American women. Our results show that there are relevant employment status changes after BC, possibly as a consequence of their treatment. Physical and psychological elements of menopause might influence the decrease in work status. Further studies are needed to deepen our understanding of employment changes in Latin American young women and guide interventions that address unintended limitations of work activities.
Citation Format: Cynthia Villarreal-Garza, Ana Ferrigno, Misael Salazar, Luis F. Enriquez, Alan Fonseca, Alejandra Platas, Lucero Labra, Marlid Cruz-Ramos, Melina Miaja, Bryan Vaca-Cartagena, Andrea Becerril-Gaitan, Fernanda Mesa-Chavez, Enrique Bargallo-Rocha, Alejandro Mohar. Employment status change in a cohort of young women with breast cancer in Mexico [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD8-08.