Journal of the National Cancer Institute Advance Access originally published online on February 26, 2008
JNCI Journal of the National Cancer Institute 2008 100(5):321-332; doi:10.1093/jnci/djn028
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© The Author 2008. Published by Oxford University Press.
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Wage Losses in the Year After Breast Cancer: Extent and Determinants Among Canadian Women
Affiliations of authors: Unité de recherche en santé des populations, Centre de recherche du Centre Hospitalier Affilié Universitaire de Québec, Québec, Canada (SL, EM, JB, BA); Department of Social and Preventive Medicine, Université Laval, Québec, Canada (EM, JB, BA); Institut national de santé publique du Québec, Québec, Canada (MD); Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada (DC); Institut national de santé publique du Québec, Montréal, Qúebec, Canada (NHC); Fred Hutchinson Cancer Research Center, Seattle, WA (BM); Centre intégré du cancer du sein, Centre hospitalier de l’Université de Montréal, Montréal, Qúebec, Canada (AR); Centre des maladies du sein Deschênes-Fabia, Hôpital du Saint-Sacrement, Québec, Canada (SL, EM, JB, JR)
Correspondence to: Elizabeth Maunsell, Unité de recherche en santé des populations, Hôpital du Saint-Sacrement, 1050 chemin Ste-Foy, Québec, Canada, G1S 4L8 (e-mail: elizabeth.maunsell{at}uresp.ulaval.ca).
Background: Wage losses after breast cancer may result in considerable financial burden. Their assessment is made more urgent because more women now participate in the workforce and because breast cancer is managed using multiple treatment modalities that could lead to long work absences. We evaluated wage losses, their determinants, and the associations between wage losses and changes for the worse in the family's financial situation among Canadian women over the first 12 months after diagnosis of early breast cancer.
Methods: We conducted a prospective cohort study among women with breast cancer from eight hospitals throughout the province of Quebec. Information that permitted the calculation of wage losses and information on potential determinants of wage losses were collected by three pretested telephone interviews conducted over the year following the start of treatment. Information on medical characteristics was obtained from medical records. The main outcome was the proportion of annual wages lost because of breast cancer. Multivariable analysis of variance using the general linear model was used to identify personal, medical, and employment characteristics associated with the proportion of wages lost. All statistical tests were two-sided.
Results: Among 962 eligible breast cancer patients, 800 completed all three interviews. Of these, 459 had a paying job during the month before diagnosis. On average, these working women lost 27% of their projected usual annual wages (median = 19%) after compensation received had been taken into account. Multivariable analysis showed that a higher percentage of lost wages was statistically significantly associated with a lower level of education (Ptrend = .0018), living 50 km or more from the hospital where surgery was performed (P = .070), lower social support (P = .012), having invasive disease (P = .086), receipt of chemotherapy (P < .001), self-employment (P < .001), shorter tenure in the job (Ptrend < .001), and part-time work (P < .001).
Conclusion: Wage losses and their effects on financial situation constitute an important adverse consequence of breast cancer in Canada.
| CONTEXT AND CAVEATS Prior knowledge Wage losses for breast cancer patients and the factors associated with the proportion of wages lost because of breast cancer had not been assessed adequately. Study design In this prospective cohort study, breast cancer patients were interviewed via telephone about their cancer treatment, work absence, and compensation received. Analysis of variance was used to identify factors associated with the proportion of annual wages lost in the year after diagnosis. Contribution This study provides an estimate of the proportion of wages lost for a large number of women that takes compensation into account and provides needed information on some potential determinants of the proportion of wages lost. Implications Lost wages are an important issue for women with breast cancer, one that patients should be made aware of. The results should inform reflection in Canada and elsewhere on changes to public policies concerning insurance that would help workers facing severe illness. Limitations Potential wage losses due to failure to obtain job promotions or to receive cost-of-inflation pay increases were beyond the scope of this study.
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Manuscript received July 11, 2007; revised December 10, 2007; accepted January 18, 2008.
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J Natl Cancer Inst 2008 100: 287.
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