Nearly one-third of breast cancer survivors who were working when they began treatment were unemployed 4 years later, according to a new study. Women who received chemotherapy were most affected.

Researchers from the University of Michigan Comprehensive Cancer Center in Ann Arbor surveyed woman in Detroit and Los Angeles with early-stage breast cancer. They narrowed their sample to the 746 women who reported working at the time of diagnosis. Participants were surveyed about 9 months after diagnosis, and then given a follow-up survey about 4 years later.

Overall, 30% of the women who were working at the time of diagnosis said they were no longer working at the time of the 4-year follow-up survey. Those who had received chemotherapy were more likely to report that they were no longer working on the later survey.

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Many of these women reported that they want to work: 55% of those not working said it was important for them to work and 39% said they were actively looking for work. Those who were not working were significantly more likely to report they were worse off financially. Results of the study appeared in Cancer (2014; doi:10.1002/cncr.28607).

“Many doctors believe that even though patients may miss work during treatment, they will ‘bounce back’ in the longer term. The results of this study suggest otherwise. Loss of employment is a possible long-term negative consequence of chemotherapy that may not have been fully appreciated to date,” said lead study author Reshma Jagsi, MD, DPhil, associate professor of radiation oncology at the University of Michigan Medical School.

Many patients take time off from work during chemotherapy treatment to deal with the immediate side effects of the therapy. The researchers say it is possible this may lead to long-term employment problems. In addition, chemotherapy treatments can cause long-term side effects such as neuropathy or cognitive issues, which might also affect job prospects.

The findings point to the need to reduce the burden of breast cancer treatment, and reinforce current efforts to develop better strategies for identifying patients less likely to benefit from chemotherapy.