Data related to medical history, including comorbidities, were collected at baseline (ie, diagnosis of breast cancer), along with patient socioeconomic characteristics, and physical and psychological symptoms as assessed by validated PRO measures. At the end of primary treatment, information related to tumor classification and treatments received were recorded, and patients subsequently attended 2 post-treatment visits. Physical toxicities according to the Common Terminology Criteria for Adverse Events (CTCAE) and physical and psychological symptoms according to PROs were assessed at first post-treatment visit, which occurred 3 to 6 months following the end of primary treatment. Finally, RTW history was assessed at the second post-treatment visit, which occurred 1 and 2 years following the first post-treatment visit and breast cancer diagnosis, respectively.

Baseline patient characteristics included a mean age at breast cancer diagnosis of 47 years. Three-quarters of patients worked full time, with 39.4% and 24.6% reporting employment as a clerk or a manager, respectively. Of note, approximately one-third of women reported 1 or more comorbidities at baseline.

At the first post-treatment visit, at least 1 severe physical CTCAE toxicity was present in 15.5%, and physical, cognitive, and emotional fatigue was reported by 22.8%, 15.7%, and 17.8% of patients, respectively. In addition, 20.4% of study respondents reported being anxious.

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Approximately one-fifth of patients had not returned to work by the second post-treatment visit, with nearly three-fourths of these patients on sick leave at that time. In addition, 23.6% of patients who worked full time at cancer diagnosis reported part-time employment on follow-up.

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On multivariable analyses, factors association with non-RTW were a baseline Charlson Comorbidity Index of 1 or higher (odds ratio [OR], 1.52; 95% CI, 1.08-2.14) treatment with chemotherapy plus trastuzumab compared with chemotherapy plus hormone therapy (OR, 2.01; 95% CI, 1.18-3.44), treatment with chemotherapy plus trastuzumab plus hormone therapy compared with chemotherapy plus hormone therapy (OR, 1.62; 95% CI, 1.10-2.41), at least 1 severe CTCAE toxicity (OR vs no, 1.59; 95% CI,  1.16 -2.18), severe arm morbidity (OR vs no, 1.59; 95% CI, 1.19-2.13), anxiety (OR vs no, 1.47; 95% CI, 1.02-2.11), and depression (OR vs no, 2.29; 95% CI, 1.34-3.91).

In their concluding remarks, the study authors commented that “this comprehensive study identified potentially vulnerable patients and thus warrants additional research focusing on these patients who lag behind and on supportive interventional strategies to facilitate their RTW.”


Dumas A, Vaz Luis I, Bovagnet T, et al. Impact of breast cancer treatment on employment: Results of a multicenter prospective cohort study (CANTO)[WU1]  [published online December 13, 2019]. J Clin Oncol. doi:10.1200/JCO.19.01726