Work outcomes of breast cancer survivors who returned to work after treatment: CANTO cohort

Abstract Background As survival rates among breast cancer patients improve there is an increasing need to address breast cancer survivors’ (BCS) issues, professional life being a key aspect. Return to work (RTW) of BCS has been largely studied, but studies on job maintenance and its determinants are scarce. We aim to study job maintenance after RTW and the associated factors among BCS. Methods We used data from the CANTO cohort, a French prospective cohort of BCS. We included 1643 BCS aged <57 at diagnosis (dx) who returned to work two years after dx. We excluded self-employed BCS. Using multinomial logistic models, we assessed the association between activity status one year after they return to work. (i.e. active, sick leave, or unemployed, retired or invalidity) and sociodemographic, clinical, health status and work-related factors. Results Overall, 87% of BCS were active, 10% were on sick leave and 3% were on unemployment, retirement or invalidity one year after they return to work. In the fully adjusted model being on sick leave was associated with stage III at dx (OR: 1.89, 95% CI: 1.11-3.22), being severely fatigued at the moment of returning to work (OR: 1.53, 1.04-2.27), and having workplace accommodations (OR: 1.79, 1.14-2.81). The unemployed, retired, invalidity status was negatively associated with professional life being more than or as important as one’s personal life (OR: 0.51, 0.26-0.98) and being <50 years old (OR: 0.51, 0.27-0.96), and positively associated with having a fixed-term contract (OR: 2.69, 1.39-5.18) and working for a small company (OR: 2.73, 1.24-6.02). Conclusions A non-negligible proportion of BCS are non-active one year after they return to work. While clinical factors are associated with sick leave, work related factors are associated with the unemployed, retired, and invalidity status. RTW should not be regarded as the ultimate goal and future policies should focus on ensuring people are ready to return to work and maintain their jobs. Key messages • A non-negligible proportion of breast cancer survivors are non-active one year after they return to work. • Future policies should ensure job maintenance along with return to work.


Background:
Mechanisms through which retirement and later-life job loss lead to subsequent weight change are poorly understood, and include changes to one's health behaviours (HBs) after employment changes.Our study assessed the potential role of HBs in the impact of employment transitions (ET) on waist circumference (WC), by gender.

Methods:
We used two waves of survey data from a Canadian sample of 45-to 85-year-olds with objectively measured WC.For 10,117 participants who were working at baseline, we categorized them into three ET statuses: stayed working, entered retirement, and stopped working.Changes in HBs [sleep, smoking, drinking, and physical activity (PA)] were coded by comparing baseline and follow-up responses.Change in WC was analyzed using multivariable linear regression and multinomial logistic regression models (5% gain or loss, no change).

Results:
Multivariable models showed that the addition of change in HBs did not alter the effect sizes of ETs on WC change.Regardless of ET status, women who quit smoking had an increased WC compared to persistent non-smokers (1.43cm, 95% Confidence Interval 0.07 -2.79).Women who became habitual drinkers showed more increases in WC compared to non-habitual drinkers (1.43cm, 0.16 -2.69).Changes to sleep duration were not associated with WC change; however, women who became satisfied with their sleep had greater WC increases compared to already satisfied sleepers (0.79cm, 0.12 -1.46).Men who increased their PA by > 1hr to 2hrs were less likely to gain 5% weight compared to men with no PA change (OR = 0.75, 0.57 -0.99).Women who increased their

Background:
As survival rates among breast cancer patients improve there is an increasing need to address breast cancer survivors' (BCS) issues, professional life being a key aspect.Return to work (RTW) of BCS has been largely studied, but studies on job maintenance and its determinants are scarce.We aim to study job maintenance after RTW and the associated factors among BCS.

Methods:
We used data from the CANTO cohort, a French prospective cohort of BCS.We included 1643 BCS aged <57 at diagnosis (dx) who returned to work two years after dx.We excluded self-employed BCS.Using multinomial logistic models, we assessed the association between activity status one year after they return to work.(i.e.active, sick leave, or unemployed, retired or invalidity) and sociodemographic, clinical, health status and work-related factors.

Results:
Overall, 87% of BCS were active, 10% were on sick leave and 3% were on unemployment, retirement or invalidity one year after they return to work.In the fully adjusted model being on sick leave was associated with stage III at dx (OR: 1.89, 95% CI: 1.11-3.22),being severely fatigued at the moment of returning to work (OR: 1.53, 1.04-2.27), and having workplace  accommodations (OR: 1.79, 1.14-2.81).The unemployed, retired, invalidity status was negatively associated with 15th European Public Health Conference 2022 professional life being more than or as important as one's personal life (OR: 0.51, 0.26-0.98)and being <50 years old (OR: 0.51, 0.27-0.96),and positively associated with having a fixed-term contract (OR: 2.69, 1.39-5.18)and working for a small company (OR: 2.73, 1.24-6.02).

Conclusions:
A non-negligible proportion of BCS are non-active one year after they return to work.While clinical factors are associated with sick leave, work related factors are associated with the unemployed, retired, and invalidity status.RTW should not be regarded as the ultimate goal and future policies should focus on ensuring people are ready to return to work and maintain their jobs.

Key messages:
A non-negligible proportion of breast cancer survivors are non-active one year after they return to work.Future policies should ensure job maintenance along with return to work.

Background:
Many studies on contextual health effects suffer from compositional bias and selective migration into neighbourhoods.
Longitudinal natural experiments have the potential to overcome these limitations, and there are several opportunities for this research design in the migration context.We aimed to synthesize evidence from natural experiments among migrants studying the effect of contextual factors on health and healthcare.

Methods:
Peer-reviewed literature in English or German was systematically searched in four major databases in December 2021.Following systematic abstract-and fulltext-screening, 32 studies were included for analysis.Evidence on contextual impacts on physical and mental health, mortality, and healthcare was narratively synthesized and quality appraisal conducted.

Results:
We found four types of contextual health effects: factors of the place of residence in receiving countries (n = 6), migrationcontext interactions (n = 10), policy environments (n = 15) and cultural factors (n = 1).Results show the negative impacts of post-migratory contexts on physical health and mortality and the favourable impacts on child health.Impacts on mental health are mixed.Analyses of policy contexts indicate the negative impacts of restrictive migration and social policies on healthcare utilization, mental health and mortality as well as the positive effects when restrictions are lifted.

Conclusions:
Natural experiments can serve as powerful tools in disentangling the effect of context on health and reducing bias through self-selection.Results demonstrate the negative impacts for health which lie at the nexus of migration and neighbourhood disadvantage.At the same time, studies uncover the potential of health, welfare and visa programs to counteract such disadvantages and create healthy post-migratory contexts.
With careful consideration of causal pathways, results from migration contexts can serve as a magnifying glass for effects of context in other population groups.

Key messages:
Natural experiments can serve as powerful tools in disentangling the effect of context on health and reduce bias through self-selection.

Conclusions:
Obesity has a significantly impact on recommended participation in a nationally provided breast screening program, despite obesity being a risk factor for post-menopausal breast cancer.
Optimising participation among higher risk and underscreened women in under utilised breast cancer screening programs is warranted.Development of targeted interventions to increase screening participation among these higher risk women is needed.

Key messages:
Women living with obesity and less likely to participate in recommended breast screening.
Targeted interventions are needed to optimise participation in breast screening to ensure these higher risk women are not at higher risk of adverse outcomes due to breast cancer.