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Journal Articles Journal of Clinical Oncology Year : 2020

Impact of Breast Cancer Treatment on Employment: Results of a Multicenter Prospective Cohort Study (CANTO)

Mayssam El Mouhebb
  • Function : Author
Antonio Di Meglio
; Mayssam
  • Function : Author
El Mouhebb
  • Function : Author
Charles Coutant
  • Function : Author
Paul Cottu
Anne Lesur
  • Function : Author
Florence Lerebours
  • Function : Author
Olivier Tredan
  • Function : Author
Laurence Vanlemmens
  • Function : Author
Christelle Levy
  • Function : Author
Jerome Lemonnier
  • Function : Author
Christelle Mesleard
  • Function : Author
Fabrice Andre
  • Function : Author
Gwenn Menvielle
  • Function : Author


PURPOSE Adverse effects of breast cancer treatment can negatively affect survivors’ work ability. Previous reports lacked detailed clinical data or health-related patient-reported outcomes (PROs) and did not prospectively assess the combined impact of treatment and related sequelae on employment. METHODS We used a French prospective clinical cohort of patients with stage I-III breast cancer including 1,874 women who were working and ≥ 5 years younger than legal retirement age (≤ 57 years) at breast cancer diagnosis. Our outcome was nonreturn to work (non-RTW) 2 years after diagnosis. Independent variables included treatment characteristics as well as toxicities (Common Toxicity Criteria Adverse Events [CTCAE] v4) and PROs (European Organization for Research and Treatment of Cancer [EORTC] Quality of life Questionnaires, Breast cancer module [QLQ-BR23] and Fatigue module [QLQ-FA12], Hospital Anxiety and Depression Scale) collected 1 year after diagnosis. Logistic regression models assessed correlates of non-RTW, adjusting for age, stage, comorbidities, and socioeconomic covariates. RESULTS Two years after diagnosis, 21% of patients had not returned to work. Odds of non-RTW were significantly increased among patients treated with combinations of chemotherapy and trastuzumab (odds ratio [OR] v chemotherapy-hormonotherapy: for chemotherapy-trastuzumab, 2.01; 95% CI, 1.18 to 3.44; for chemotherapy-trastuzumab-hormonotherapy, 1.62; 95% CI, 1.10 to 2.41). Other significant associations with non-RTW included grade ≥ 3 CTCAE toxicities (OR v no, 1.59; 95% CI, 1.15 to 2.18), arm morbidity (OR v no, 1.59; 95% CI, 1.19 to 2.13), anxiety (OR v no, 1.47; 95% CI, 1.02 to 2.11), and depression (OR v no, 2.29; 95% CI, 1.34 to 3.91). CONCLUSION Receipt of systemic therapy combinations including trastuzumab was associated with increased odds of non-RTW. Likelihood of unemployment was also higher among patients who reported severe physical and psychological symptoms. This comprehensive study identifies potentially vulnerable patients and warrants supportive interventional strategies to facilitate their RTW.
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hal-03088680 , version 1 (26-12-2020)



Ines Vaz Luis, Mayssam El Mouhebb, Antonio Di Meglio, Agnès Dumas, Inês Matias Luís, et al.. Impact of Breast Cancer Treatment on Employment: Results of a Multicenter Prospective Cohort Study (CANTO). Journal of Clinical Oncology, 2020, 38 (7), pp.734-743. ⟨10.1200/jco.19.01726⟩. ⟨hal-03088680⟩
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