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Changes in health-related quality of life by occupational status among women diagnosed with breast cancer: a population-based cohort study
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
Department of Neurobiology, Care Sciences and Society, Karolinska Institutet.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg. Department of Oncology, Gävle Hospital, Gävle, Sweden.
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2013 (English)In: Psycho-Oncology, ISSN 1057-9249, E-ISSN 1099-1611, Vol. 22, no 10, 2321-2331 p.Article in journal (Refereed) Published
Abstract [en]

Objective:

To investigate whether longitudinal changes in health-related quality of life (HRQoL) among breast cancer patients vary by prediagnosis occupational status or postdiagnosis changes in working time.

Methods:

We identified 1573 patients in the Breast Cancer Quality Register of Central Sweden and asked them to participate in a longitudinal questionnaire study. A total of n = 841 women completed three questionnaires within a mean time of 4, 16, and 38 months postdiagnosis. Generalized estimating equation models were used to examine changes in European Organization for Research and Treatment of Cancer Quality of Life Questionnaire and the Breast Cancer-Specific Quality of Life Questionnaire subscales stratified by prediagnosis occupational status and postdiagnosis changes in working time.

Results:

Over time, the proportion of employed women reporting good functioning increased more, and the proportion reporting a high level of symptoms decreased more compared with women on sick leave/disability pension and retirement pensioners (p < 0.001). The latter two also showed a worsening in several subscales (p < 0.05). Among employed women, more consistent improvements in role and social functioning were observed among those with an increase/no change in working time than among those who had decreased it or stopped working (p < 0.05). A decrease in the proportion reporting pain was observed among women with an increase/no change in working time compared with women with decreased working time, among whom the proportion reporting pain increased (p = 0.008).

Conclusions:

Being employed prediagnosis and resuming work to the same extent as prior to the breast cancer diagnosis are associated with consistent improvements in HRQoL. These results highlight the importance of interventions to improve HRQoL and policies to support return to work following diagnosis.

Place, publisher, year, edition, pages
2013. Vol. 22, no 10, 2321-2331 p.
National Category
Cancer and Oncology
Research subject
Oncology
Identifiers
URN: urn:nbn:se:uu:diva-195706DOI: 10.1002/pon.3285ISI: 000325150400022OAI: oai:DiVA.org:uu-195706DiVA: diva2:608259
Available from: 2013-02-26 Created: 2013-02-26 Last updated: 2017-12-06Bibliographically approved
In thesis
1. Health-Related Quality of Life and Return to Work following Breast Cancer
Open this publication in new window or tab >>Health-Related Quality of Life and Return to Work following Breast Cancer
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aim: The overall aim of this thesis was to study health-related quality of life (HRQoL) and return to work in the first 3 years following a breast cancer diagnosis, and to identify clinical and contextual factors associated with these outcomes.

Method: The four studies were part of a population-based cohort study including women identified in the Breast Cancer Quality Register in central Sweden. Of 1,573 women asked to participate, 69% (n=1,093) responded to a baseline questionnaire, 62% (n=977) responded at the 1st follow-up and 54% (n=856) participated at the 2nd follow-up (mean time 4, 16 and 38 months post-diagnosis, respectively). Studies II and IV only included women aged <63 years at diagnosis. In Study IV, each woman was individually matched to five breast-cancer-free controls. Questionnaire data on HRQoL, socio-demographics and work-related variables were combined with clinical register, normative and social insurance data.

Main findings: Study I: Women with breast cancer, particularly women aged <50 years, experienced poorer HRQoL at baseline than normative data. Chemotherapy, lack of social support, sick leave and a poor financial situation were associated with poorer HRQoL. Study II: Compared with pre-diagnosis working time, 72% of participating women reported no change, 2% had increased their working time, 15% reported a decrease in working time and 11% did not work at the 1st follow-up. Chemotherapy, cancer-related work limitations and less value attached to work increased the odds of job discontinuation/decreased working time. Study III: During the 3 years post-diagnosis, HRQoL generally improved. Less consistent improvements were found among women on sick leave/disability pension pre-diagnosis and women reporting job discontinuation/decreased working time post-diagnosis. Study IV: The proportion of women with breast cancer on sick leave steadily decreased during the 3 years post-diagnosis, but they were more likely to be on sick leave than the controls. Chemotherapy, fatigue and pre-diagnosis sick days predicted sickness absence during the 2nd and 3rd year post-diagnosis.

Conclusions: Most women with breast cancer gradually recover, but there are subgroups of women who may be particularly vulnerable. In a clinical setting, increased attention should be directed towards women undergoing chemotherapy, young women, women on sick leave/disability pension pre-diagnosis and women who do not return to work to the same extent as pre-diagnosis.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2014. 87 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 986
Keyword
breast neoplasms, quality of life, return to work, sick leave, cohort study, population-based
National Category
Medical and Health Sciences
Research subject
Oncology
Identifiers
urn:nbn:se:uu:diva-221264 (URN)978-91-554-8912-0 (ISBN)
Public defence
2014-05-15, Gustavianum, Auditorium Minus, Akademigatan 3, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2014-04-24 Created: 2014-03-27 Last updated: 2014-04-29

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Lundh, Marie HøyerNordin, KarinAhlgren, JohanBergkvist, LeifBerglund, AndersJohansson, Birgitta

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Caring SciencesCentre for Research and Development, GävleborgCentre for Clinical Research, County of VästmanlandDepartment of Surgical SciencesOncology
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