The Role of Work in Breast Cancer Patients

doi:10.4236/jct.2013.48157

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Journal of Cancer Therapy, 2013, 4, 1330-1334

http://dx.doi.org/10.4236/jct.2013.48157 Published Online October 2013 (http://www.scirp.org/journal/jct)

The Role of Work in Breast Cancer Patients

Manuela Pennisi1, Giuseppe Chisari2, Marco Vacante3, Francesco Lucca3, Salvatore Spitaleri3,

Giulia Malaguarnera4*, Giuseppe Grosso4, Filippo Drago4, Vito Catania5, Alfre d o Conso li5,

Mariano Malaguarnera3

1Department of Neurosciences, University of Catania, Catania, Italy; 2Department of Biomedical Sciences, University of Catania,

Catania, Italy; 3Research Center “The Great Senescence”, University of Catania, Catania, Italy; 4International PhD Programme in

Neuropharmacology, University of Catania, Catania, Italy; 5Department of General Surgery, University of Catania, Catania, Italy.

Email: *[email protected]

Received June 10th, 2013; revised July 9th, 2013; accepted July 17th, 2013

which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Background: Since the survival rates of cancer have increased considerably, the long-term side effects of cancer and

cancer-related treatments may impact survivors’ capability to regain normal lives. The aim of this study was to evaluate

the effects of the breast cancer on the job satisfaction and the quality of life. Methods: We enrolled 130 women di-

vided into four groups: 1) 40 breast cancer survivors (aged 39 - 50); 2) 44 women diagnosed with breast cancer (aged

35 - 49); 3) 46 women in good health status (aged 37 - 48). Job satisfaction was measured with the Warr-Cook-Wall

(WCW) Job satisfaction scale that measures overall job satisfaction and satisfaction with nine aspects of work. Results:

Compared to healthy subjects, breast cancer survivors reported a poorer number of hours of work (p < 0.05) and a sig-

nificant amount of variety in job (p < 0.01), opportunity to use abilities (p < 0.001), income (p < 0.01). Compared to

patients with breast cancer at diagnosis, breast cancer survivors reported a significant amount of variety in job (p <

0.05), opportunity to use abilities (p < 0.05), amount of responsibility (p < 0.05), income (p < 0.05). In our study, the

comparison between breast cancer survivors, breast cancer at diagnosis, and healthy subjects does not differ signifi-

cantly in overall job satisfaction. Conclusions: Understanding the job problems associated with cancer can provide

relevant information regarding potential treatment and psychological support in breast cancer survivors.

Keywords: Breast Cancer; Job Satisfaction; Quality of Life; Cancer Survivors; Work; Absenteeism; Presenteeism

1. Introduction

Breast cancer is the most common malignancy in women

with annual incidence rates ranging from 11.8 per

100,000 in eastern China to 86.3 per 100,000 in North

America [1]. Early screening for breast cancer saves pa-

tient’s breasts and improves their chances and full recov-

ery [2]. Compared with women of similar age without a

history of cancer, a slightly higher proportion of breast

cancer survivors reduced work ability [3] or work per-

formance. The prolonged work absenteeism has a rele-

vant economic impact on the patient and her family.

These outcomes can regrettably lead to a cascade of

problems for the survivor, the workplace and the society

[4]. Even in patients who have node-negative breast can-

cer and are considered to be at low risk, the 10-year re-

currence rate following exclusive local therapy is 15% -

45%, while in patients with node-positive disease, the

rate reaches levels as high as 25% - 90% [5]. Survivors

may have ongoing emotional problems due to fears of

recurrence or death and changes in social relationships

[6]. Various studies demonstrated that exercise and

physical activity can improve many of the symptoms and

health problems experienced by breast cancer survivors

[7,8]. The aim of this study was to evaluate the work-

directed intervention on work productivity, on job satis-

faction and consequently on absenteeism and presentee-

ism.

2. Methods

All eligible subjects to participate in this study were

women, presenting for initial breast tumor evaluation at

Cannizzaro Hospital from January 2008 to December

2010. Questionnaires were used to determine partici-

pants’ demographic (age, education and marital status)

and health information (non-cancer medical history,

cancer disease stage at diagnosis, recurrence, cancer

*Corresponding author.

The Role of Work in Breast Cancer Patients 1331

treatment and other medical information) (Table 1). The

inclusion criteria were at least 30 years of age, employed

full or part time. The exclusion criteria were as follows:

patients who have alarming symptoms and signs, includ-

ing weight loss, anaemia, headache; asthma or chronic

obstructive pulmonary disease; chronic hepatitis or liver

cirrhosis; angina, myocardial infarction or heart failure;

malignancy; neurosis or psychosis; dementia. Partici-

pants were initially recruited to participate in a study

examining work and ability and health related quality of

life. After obtaining informed, written consent, demo-

graphic, laboratory and clinic-pathological data were

obtained from medical record review and patient inter-

view and incorporated into a clinical database. Job satis-

faction was measured with the Warr-Cook-Wall (WCW)

Job satisfaction scale developed by Warr [9]. The WCW

instrument measures overall job satisfaction and satisfac-

tion with nine aspects of work (amount of variety in job,

opportunity to use abilities, freedom of working method,

amount of responsibility, physical working condition,

hours of work, income, recognition for work, and col-

leagues and fellow workers) with each item rated on a

7-point Likert scale (1 = extreme dissatisfaction to 7 =

extreme satisfaction). A higher overall mean score indi-

cates higher job satisfaction. Absenteeism and presentee-

ism were evaluated in all subjects. Absenteeism was ex-

Table 1. Demographic char ac teristics of subjects include d in the study.

Characteristics Breast Cancer Survivors (Group 1) Breast Cancer at diagnosis (Group 2) Healthy subjects (Group 3)

Patients (n) 40 44 46

Age (years) 44.7 ± 5.2 41.8 ± 6.7 42.9 ± 5.4

HR (bpm) 74 ± 5 77 ± 6 76 ± 4

SBP (mmHg) 132 ± 12 136 ± 8 135 ± 6

DBP (mmHg) 80 ± 8 78 ± 9 79 ± 8

BMI (Kg/m2) 25.8 ± 2.4 26.2 ± 2.0 25.7 ± 2.6

Education

<High School 12 (30%) 14 (31%) 12 (26%)

High School 18 (45%) 18 (40%) 14 (30%)

>High School 10 (25%) 12 (27%) 20 (43%)

Marital status

Married 24 (60%) 27 (61%) 28 (60%)

Single 6 (15%) 4 (9%) 6 (13%)

Divorced/Separated 4 (10%) 6 (14%) 4 (8%)

Widow/Widower 6 (15%) 7 (15%) 8 (17%)

Employment

Working full time 30 (75%) 31 (70%) 30 (65%)

Working part time 10 (25%) 13 (29%) 16 (35%)

Smoking

No 15 (37%) 12 (27%) 12 (26%)

Current 20 (50%) 22 (50%) 18 (39%)

Ex 5 (12%) 10 (23%) 16 (35%)

Alcohol

No 22 (55%) 25 (56%) 26 (56%)

Current 4 (10%) 6 (14%) 4 (8%)

Ex 14 (35%) 13 (29%) 16 (35%)

The Role of Work in Breast Cancer Patients

1332

pressed as both the total work time lost (the sum of total

hours absent for breast cancer symptoms) and the per-

centage of work time lost during employed time for the

past seven days. Presenteeism was expressed as both

total limited work time and the percentage of limited

productivity whilst at work [10].

Statistical Analysis

Results are expressed as means +/− standard deviations.

Comparisons of quantitative data were made using the

Student’s t-test or Mann-Whitney test. Qualitative data

were analyzed using the chi-square test. A P value of

<0.05 was considered as indicating a statistically signifi-

cant difference. All data management and statistical cal-

culations were performed using SPSS 15.0 statistical

package (Chicago, IL).

3. Results

Demographic characteristics of subjects included in the

study are reported in Table 1. There were not significant

differences between groups at baseline with respect to

sex, age, education, marital status, type of employment

(full or part time), smoking and alcohol consumption.

Subjects working full time were 75% in Group 1, 70% in

Group 2 and 65% in Group 3; subjects working part time

were in the three groups respectively 25%, 29% and

35%.

Compared to healthy subjects, breast cancer survivors

reported a poorer numbers of hours of work (p < 0.05)

and a significant amount of variety in job (p < 0.01), op-

portunity to use abilities (p < 0.001), income (p < 0.01).

Compared to patients with breast cancer at diagnosis,

breast cancer survivors reported a significant amount of

variety in job (p < 0.05), opportunity to use abilities (p <

0.05), amount of responsibility (p < 0.05), income (p <

0.05) (Table 2). Both the mean absenteeism and mean

presenteeism were similar in all groups. In breast cancer

survivors the overall job satisfaction was significantly

increased in married and employed working full time. In

patients with breast cancer at diagnosis the overall job

satisfaction was significantly decreased in both married

and working part-time subjects.

4. Discussion

The improvement of social environmental condition,

medical care, screening and diagnostic parameters caused

an increase of survival in breast cancer patients [11].

Since the survival rates of cancer have increased consid-

erably, the long-term side effects of cancer and cancer-

related treatments may impact survivors’ capability to

regain normal lives. This implies that some forms of can-

cer are becoming chronic diseases entailing both poorer

overall quality of life compared to the general population

and disabling long-term residual symptoms, such as fa-

tigue, depression, pain and functional limitation [12].

This condition determines a high impact on the quality of

life, including, physical and mental health, on work and

return to work. A large body of psychosocial cancer re-

search has noted the importance of distressing factors,

individual coping attempts, psychosocial burden and re-

sources in understanding both health-related quality of

life and psychological adjustment to cancer. The objec-

tive of our study was to evaluate the elements that have

the main impact on overall job satisfaction separated

from breast cancer survivors, breast cancer, and healthy

workers. Advances in diagnosis and treatment of breast

cancer have created a large population of survivors

Table 2. Job satisfaction scores in breast cancer survivors.

Breast Cancer Survivors

(Group 1; n = 40)

Breast Cancer at diagnosis

(Group 2; n = 44) Healthy subjects (Group 3; n = 46)

Amount of variety in job 5.45 ± 1.21 4.87 ± 1.44** 4.76 ± 1.61B

Opportunity to use abilities 5.87 ± 1.04 5.21 ± 1.08** 5.04 ± 1.02C

Freedom of working method 5.21 ± 1.44 5.44 ± 1.09* 5.10 ± 1.10A

Amount of responsibility 5.75 ± 1.67 5.10 ± 1.22** 5.21 ± 1.36A

Physical working condition 4.82 ± 1.87 5.00 ± 1.46* 5.12 ± 1.22A

Hours of work 4.67 ± 1.44 4.96 ± 1.38* 5.28 ± 1.20B

Income 4.44 ± 1.65 5.24 ± 1.31** 5.31 ± 1.41B

Recognition for work 5.04 ± 1.20 5.10 ± 1.28* 5.25 ± 1.32A

Colleagues and fellow workers 5.61 ± 1.08 5.44 ± 1.12* 5.36 ± 1.18A

Overall job satisfaction 5.41 ± 1.04 5.20 ± 1.18* 5.28 ± 1.25A

Comparison between group 1 and group 2: *p = NS; **p < 0.05; ***p < 0.001. Comparison between group 1 and group 3: Ap = NS; Bp < 0.05; Cp < 0.001.

The Role of Work in Breast Cancer Patients 1333

requiring long-term follow-up care [1,2]. The risk of dis-

ease recurrence peaks during the first 5 years after pri-

mary therapy, but may continue for up to 30 years after

that. Work plays an important role in the psychological

treatment for many patients. As a result, breast cancer is

increasingly viewed as a chronic illness [9-11]. Our cul-

ture continues to perpetuate the healthy subject view that

an individual with cancer is somehow now defective.

Work intervention has been found to have significant

positive effects on functional capacity and physical func-

tioning, fatigue, body image, psychological adjustment,

sleep problems and overall health and quality of life [12-

16]. In our study, the comparison between breast cancer

survivors, breast cancer at diagnosis, and healthy subjects

does not differ significantly in overall job satisfaction.

Job satisfaction was often stated as a strong motivator for

social status and for social contacts. Changes in the life

of the person with cancer (e.g. being away from work or

not being able to do the usual roles at home) may affect

the person’s self-esteem [2]. Yet employers continue to

perceive cancer survivors as poor risks for advancement

and cancer survivors are at high risk for job loss. A limi-

tation of this study was the small number of included

subjects. Understanding job problems associated with

cancer can provide relevant information regarding poten-

tial treatment and psychological support in breast cancer

survivors. More systematic investigation is needed vary-

ing the dimensions of activity explored in this study.

5. Acknowledgements

GM was supported by the International PhD programme

in Neuropharmacology, University of Catania. The au-

thors declare that they have no competing interests.

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