The rehabilitation process after breast cancer diagnosis : Factors of importance for return to work

Abstract: The most common female cancer in Western countries is breast cancer and women diagnosed with this disease are often under 65 years old. With increasing prevalence of survivors it is important to shed light on problems facing these women after diagnosis and treatment. The overall aim of this thesis was to study the rehabilitation process following a breast cancer diagnosis for women at working age by examining factors related to type of treatment, tumour stage, socio-demographic status, health status, working condition, life satisfaction, and coping skills, and their association with return to work. In this thesis both quantitative and qualitative approaches are represented in three longitudinal cohort studies and a narrative interview study (16 enrolled women). The quantitative studies are based on two different sets of material of women treated for breast cancer (270 respective 102 enrolled women). Study I investigated whether factors such as type of treatment, tumour stage, educational level, matrimonial status, and presence of under-age children were associated with long-term problems in returning to work in women with breast cancer treated with endocrine therapy. The use of adjuvant endocrine therapy was associated with a twofold increase in the odds ratio of not having returned to work, although the confidence interval of this ratio was wide and included unity. Tumour stage (pN1-4+) was negatively associated with work status, possibly because of its association with adjuvant chemotherapy and radiotherapy to the regional nodes. Socio-demographic factors were not significantly associated with return to work. The aim of Study II was to identify factors contributing to a successful return to the labour market using the narratives of women treated for breast cancer. All the women strove to belong to the labour market, but the study also revealed how women´s perceptions of the value of employment changed. The quality of social support received from employers and co-workers differed between women who returned to work and those still sick-listed one year after breast cancer treatment. Study III investigated if treatment type, socio-demographic factors, health status, and work-related factors could predict return to work 10 months after surgery for early-stage breast cancer in women. Axillary node dissection, treatment with chemotherapy, and high demands at work were shown to play an important role in return to work for women with early-stage breast cancer. Socio-demographic factors were not significantly associated with return to work. The aims of Study IV were to generate new knowledge about life satisfaction, coping and rehabilitative measures taken after early-stage breast cancer treatment and the association of these concepts with return to work. Global life satisfaction was higher among the working women at both assessments. The working women used more positive coping resources compared with the sick-listed women, especially if treated with chemotherapy. Few of the sick-listed women received rehabilitation. The principal finding was that most of the studied women successfully returned to work after their active cancer treatments were completed. Type of treatment as well as work-related factors, life satisfaction and coping skills were associated with return to work.