Return to work after breast cancer treatment in state public employees in Brazil: a cross-sectional observational study

Abstract

Objective: The aim of the study was to evaluate the return-to-work (RTW) rate in public employee patients in the State of
São Paulo with breast cancer who underwent surgical treatment in a single institution. Methodology: This is an observational, descriptive, cross-sectional, and single-institution study involving public employees, with non-metastatic breast
cancer who underwent surgical treatment at the State Public Servant Hospital of São Paulo from October 2021 to December
2022. To assess the quality of life, the following instruments were used: the EORTC QLQ-30 and QLQ-BR-22 questionnaires. The study was submitted through Plataforma Brazil and approved (CAAE 68337823.4.0000.5463). Results: Of the 339
eligible patients, 300 (88.2%) were still working at the time of diagnosis. The RTW rate in this study was 74.41%. A significant majority of patients (80.6%) resumed employment within 6 months, whereas 15.1% returned between 6 and 12 months, and 12.8% between 12 and 18 months, respectively. The predominant reason cited for RTW was personal satisfaction with financial necessity prompting. In the EORTC BR-23 sub-questionnaire, referring to functional scales, patients
who returned to work had a higher score in the body image assessment, an average of 76.0 vs. 52.3, when compared with
patients who did not RTW (p=0.032). It was shown that the type of surgical treatment impacts the RTW rate (p<0.001).
Among patients who RTW, 87.5% underwent BCS compared with 9.1% of those who did not RTW. In this same group,
it was observed that 45.5% underwent radical and oncoplastic surgery. Adjuvant treatment also correlated with RTW;
patients undergoing adjuvant chemotherapy have a 6.25-fold increased risk of not returning to work when compared with
patients who did not undergo adjuvant chemotherapy. Conclusion: The RTW rate among state public employees in the
state of São Paulo was 74.41%. It was observed that oncological treatment (surgical, chemotherapy, and radiotherapy) has
a statistically significant association with the RTW rate. Socially, the offer of adjustment by the employer influences the
RT decision, in addition to the patient’s personal and work satisfaction. Returning to work is associated with the quality
of life of women surviving BC.