After breast cancer, most women return to work, we learn from an epidemiological study highlighted on the occasion of Pink October. But their return to work trajectories, notably the number and duration of work stoppages, as well as the difficulties they encounter from diagnosis to return to work, vary.
Breast cancer represents 33% of cancers diagnosed in women, with 61,000 new cases per year over the period 1990-2023 in France. Over the past decades, screening programs and advances in treatment have made it possible toimprove survival women with breast cancer.
Many breast cancer diagnoses occur in working-age women, and many of them experience difficulty returning to work after treatment. However, returning to work is associated with better quality of life in the long term.
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After breast cancer, most women return to work
We drove a epidemiological study called CROSSINGS (Care trajectories and return to work after the diagnosis of breast cancer: data from the National Health Data System for support) which highlights the great variability of individual situations.
Our study focused on a representative sample of 317 women aged 25 to 55 who had received a first diagnosis of early-stage breast cancer, whose return to work path we traced in the three years following diagnosis.
Above all, our figures show that most women are returning to work. Our results revealed that:
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the number of periods of sick leave varied from 1 to 25 sick leave periods per patient
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half of the women have had one or two stops
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the total number of days off varied between 3 days and 3 years
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half of women return to work within a year of diagnosis.
By grouping the individual pathways, we observed three distinct groups of return-to-work trajectories:
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half of the women returned to work during the first year after diagnosis;
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38% of women returned to work full-time during the second year, generally after a period of returning to part-time work;
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finally, 13% of women had periods of complete leave (sick leave or disability pension) until the 3e year following breast cancer diagnosis.
These results underline that support must be thought of differently to support these women in their return to employment.
Use a large health insurance database
Return to work is important for quality of life after breast cancer. However, its analysis at the population level remains limited in France because it is difficult to have precise information on individual patient journeys. As part of public research, it is nevertheless possible to have access to Health Insurance data.
Unique in Europe, even in the world, the National Health Data System (SNDS) constitutes a gold mine for carrying out studies on the health of the French population. This large database, managed by the National Health Insurance Fund (CNAM), includes healthcare consumption data in hospital and in the city as well as daily allowance reimbursement data for all affiliated people. to Health Insurance, that is to say more than 98% of the French population.
Information on the dates and duration of work stoppages can be reconstructed for employees from this database.
Studying return-to-work trajectories
We therefore conducted the TRAVERSÉES study based on a representative sample of this SNDS database. The project aimed to analyze the data to learn more about the temporality of return to work after breast cancer diagnosed between 2013 and 2016 in France and to develop indicators and trajectories for return to work.
We have reconstituted work stoppages financially compensated by daily allowances or by the receipt of disability pensions. We calculated when and for how long these work stoppages were prescribed and observed whether they were full-time or part-time.
Also collect the experience of patients and caregivers
We used a mixed approach combining, on the one hand, the use of SNDS data to define quantitative indicators on return to work and, on the other hand, the collection of stakeholders’ points of view on the interpretation , the usefulness and limits of the constructed indicators.
These approaches prove to be very complementary, because they make it possible to understand the experiences of patients and health professionals facing this problem of returning to work, and thus to exploit their experiential knowledge.
Stakeholder views were collected during focus groups (focus group) and interviews with five patients who had breast cancer and six health professionals involved in the management of this pathology (surgery, medical oncology, radiotherapy, occupational medicine, psycho-oncology and nursing).
Return to work: a complex process that depends on factors related to illness, employment, etc.
We asked for the opinion of stakeholder experts on the return to work indicators calculated from SNDS data. Health professionals and patients alike concluded that these indicators well illustrated the complex process of returning to work.
They also underlined the importance of personalizing the support of each patient because each return to work journey is individual and depends on a large number of factors (type of treatment for cancer, but also the characteristics of the individuals, their context life and work).
Indeed, scientific literature tells us that after breast cancer, return to work is influenced by several sociodemographic factors, linked to illness and workwhich makes resuming the professional environment more or less complex depending on each situation.
These factors are notably linked:
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socio-demographic characteristics of women (age, socio-economic level, etc.)
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the disease (in particular the type of breast cancer treatments that the woman will have undergone, chemotherapy or others)
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to the professional activity she carries out (physically arduous work will, for example, have a certain impact)
The contribution of stakeholder points of view to understanding the return to work experience
It is very important to study how the return to work went for the people concerned. This feedback is useful to patients to manage their personal and professional lives but also to health professionals in order to better plan care pathways.
The advice of the stakeholder experts (i.e. the caregivers and patients who participated in the groups and brought their knowledge linked to their experience, Editor’s note) to patients: do not hesitate to be supported in your return to work. Their advice to healthcare professionals: assess with patients what their different needs are, when discussing returning to work.
Health professionals involved in cancer care as well as occupational health and human resources services must interact so that this recovery takes place under the best conditions. They are responsible for organizing the best possible care and support for patients during and after their treatments.
Tools to measure the evolution of return to work over time
From a methodological point of view, this study showed that it is feasible to calculate return-to-work indicators and identify return-to-work trajectories using national health insurance data (SNDS).
These indicators could be followed over time in order to measure the evolution of return to work among these women with breast cancer, and to see if we are progressing in terms of return to work. The approach used in the TRAVERSÉES study and the indicators could also be applied in studies on other pathologies.
