Abstract
Employment status is related to treatment recovery and quality of life in breast cancer survivors, yet little is known about return to work in immigrant and minority survivors. We conducted an exploratory qualitative study using ethnically cohesive focus groups of urban breast cancer survivors who were African-American, African-Caribbean, Chinese, Filipina, Latina, or non-Latina white. We audio- and video-recorded, transcribed, and thematically coded the focus group discussions and we analyzed the coded transcripts within and across ethnic groups. Seven major themes emerged related to the participants’ work experiences after diagnosis: normalcy, acceptance, identity, appearance, privacy, lack of flexibility at work, and employer support. Maintaining a sense of normalcy was cited as a benefit of working by survivors in each group. Acceptance of the cancer diagnosis was most common in the Chinese group and in participants who had a family history of breast cancer; those who described this attitude were likely to continue working throughout the treatment period. Appearance was important among all but the Chinese group and was related to privacy, which many thought was necessary to derive the benefit of normalcy at work. Employer support included schedule flexibility, medical confidentiality, and help maintaining a normal work environment, which was particularly important to our study sample. Overall, we found few differences between the different ethnic groups in our study. These results have important implications for the provision of support services to and clinical management of employed women with breast cancer, as well as for further large-scale research in disparities and employment outcomes.
Similar content being viewed by others
References
Engel, J., Kerr, J., Schlesinger-Raab, A., Eckel, R., Sauer, H., & Holzel, D. (2003). Predictors of quality of life of breast cancer patients. Acta Oncology, 42(7), 710–718.
Bouknight, R. R., Bradley, C. J., & Luo, Z. (2006). Correlates of return to work for breast cancer survivors. Journal of Clinical Oncology, 24(3), 345–353.
Ell, K., Xie, B., Wells, A., Nedjat-Haiem, F., Lee, P. J., & Vourlekis, B. (2008). Economic stress among low-income women with cancer: Effects on quality of life. Cancer, 112(3), 616–625.
Satariano, W. A., & DeLorenze, G. N. (1996). The likelihood of returning to work after breast cancer. Public Health Reports, 111(3), 236–241.
Satariano, W. A., Ragland, D. R., & DeLorenze, G. N. (1996). Limitations in upper-body strength associated with breast cancer: A comparison of black and white women. Journal of Clinical Epidemiology, 49(5), 535–544.
Chlebowski, R. T., Kuller, L. H., Prentice, R. L., et al. (2009). Breast cancer after use of estrogen plus progestin in postmenopausal women. The New England Journal of Medicine, 360(6), 573–587.
Thind, A., Hoq, L., Diamant, A., & Maly, R. C. (2010). Satisfaction with care among low-income women with breast cancer. Journal of Womens Health (Larchmt), 19(1), 77–86.
Albain, K. S., Unger, J. M., Crowley, J. J., Coltman, C. A., & Hershman, D. L. (2009). Racial disparities in cancer survival among randomized clinical trials patients of the southwest oncology group. Journal of National Cancer Institute, 101(14), 984–992.
Ashing-Giwa, K. T., Tejero, J. S., Kim, J., Padilla, G. V., & Hellemann, G. (2007). Examining predictive models of HRQOL in a population-based, multiethnic sample of women with breast carcinoma. Quality of Life Research, 16(3), 413–428.
Baquet, C. R., & Commiskey, P. (2000). Socioeconomic factors and breast carcinoma in multicultural women. Cancer, 88(5 Suppl), 1256–1264.
Bowen, D., Alfano, C., McGregor, B., et al. (2007). Possible socioeconomic and ethnic disparities in quality of life in a cohort of breast cancer survivors. Breast Cancer Research Treatment, 106(1), 85–95.
Gotay, C. C., Holup, J. L., & Pagano, I. (2002). Ethnic differences in quality of life among early breast and prostate cancer survivors [see comment]. Psychooncology, 11(2), 103–113.
Menashe, I., Anderson, W. F., Jatoi, I., & Rosenberg, P. S. (2009). Underlying causes of the black-white racial disparity in breast cancer mortality: A population-based analysis. Journal of National Cancer Institute, 101(14), 993–1000.
Polite, B. N., Cirrincione, C., Fleming, G. F., et al. (2008). Racial differences in clinical outcomes from metastatic breast cancer: A pooled analysis of CALGB 9342 and 9840—Cancer and leukemia group B. Journal of Clinical Oncology, 26(16), 2659–2665.
Satariano, W. A., Belle, S. H., & Swanson, G. M. (1986). The severity of breast cancer at diagnosis: A comparison of age and extent of disease in black and white women. American Journal of Public Health, 76(7), 779–782.
Shinagawa, S. M. (2000). The excess burden of breast carcinoma in minority and medically underserved communities: Application, research, and redressing institutional racism. Cancer, 88(5 Suppl), 1217–1223.
Cohany, S. (2009). Ranks of discouraged workers and others marginally attached to the labor force rise during recession: U.S. Department of Labor, U.S. Bureau of Labor Statistics.
Gabor, M. (2007). Labor force characteristics by race and ethnicity: U.S. Department of Labor 2007. Report No.: 1005.
Mulligan, C. (2009). What caused the recession of 2008? Hints from labor productivity: National Bureau of Economic Research.
Ashing-Giwa, K. T., Padilla, G., Tejero, J., et al. (2004). Understanding the breast cancer experience of women: A qualitative study of African-American, Asian American, Latina and Caucasian cancer survivors. Psychooncology, 13(6), 408–428.
Blinder, V., Patil, S., Thind, A., et al. (2011). Return to work in low-income Latina non-Latina White breast cancer survivors: A three-year longitudinal study. Cancer (in press). Accepted July 12, 2011.
Mujahid, M. S., Janz, N. K., Hawley, S. T., Griggs, J. J., Hamilton, A. S., & Katz, S. J. (2010). The impact of sociodemographic, treatment, and work support on missed work after breast cancer diagnosis. Breast Cancer Research Treatment, 119(1), 213–220.
Patton, M. Q. (1987). How to use qualitative methods in evaluation. Newbury Park: SAGE Publications, Inc.
Rossouw, J. E., Anderson, G. L., Prentice, R. L., et al. (2002). Risks and benefits of estrogen plus progestin in healthy postmenopausal women—Principal results from the women’s health initiative randomized controlled trial. JAMA-Journal of the American Medical Association, 288(3), 321–333.
Muhr, T. (2002–2008). ATLAS.ti. 5.2 ed. Berlin: ATLAS.ti Scientific Software Development GmbH.
Mujahid, M. S., Janz, N. K., Hawley, S. T., et al. (2011). Racial/ethnic differences in job loss for women with breast cancer. Journal of Cancer Survive, 5(1), 102–111.
Feuerstein, M., Todd, B. L., Moskowitz, M. C., et al. (2010). Work in cancer survivors: A model for practice and research. Journal of Cancer Survive, 4(4), 415–437.
Maunsell, E., Brisson, C., Dubois, L., Lauzier, S., & Fraser, A. (1999). Work problems after breast cancer: An exploratory qualitative study. Psychooncology, 8(6), 467–473.
Molina Villaverde, R., Feliu Batlle, J., Villalba Yllan, A., et al. (2008). Employment in a cohort of breast cancer patients. Occupational Medicine (London), 58(7), 509–511.
Rasmussen, D. M., & Elverdam, B. (2008). The meaning of work and working life after cancer: An interview study. Psychooncology, 17(12), 1232–1238.
Spelten, E. R., Verbeek, J. H., Uitterhoeve, A. L., et al. (2003). Cancer, fatigue and the return of patients to work-a prospective cohort study. European Journal of Cancer, 39(11), 1562–1567.
Yarker, J., Munir, F., Bains, M., Kalawsky, K., & Haslam, C. (2010). The role of communication and support in return to work following cancer-related absence. Psychooncology, 19(10), 1078–1085.
Johnsson, A., Fornander, T., Rutqvist, L. E., & Olsson, M. (2010). Factors influencing return to work: A narrative study of women treated for breast cancer. European Journal of Cancer Care (England), 19(3), 317–323.
Taskila, T., Lindbohm, M. L., Martikainen, R., Lehto, U. S., Hakanen, J., & Hietanen, P. (2006). Cancer survivors’ received and needed social support from their work place and the occupational health services. Supportive Care in Cancer, 14(5), 427–435.
Pryce, J., Munir, F., & Haslam, C. (2007). Cancer survivorship and work: Symptoms, supervisor response, co-worker disclosure and work adjustment. Journal of Occupational Rehabilitation, 17(1), 83–92.
Gregg, J. A., Callaghan, G. M., Hayes, S. C., & Glenn-Lawson, J. L. (2007). Improving diabetes self-management through acceptance, mindfulness, and values: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 75(2), 336–343.
Kabat-Zinn, J., Lipworth, L., & Burney, R. (1985). The clinical use of mindfulness meditation for the self-regulation of chronic pain. Journal of Behavioral Medicine, 8(2), 163–190.
Hewitt, M., Greenfield, S., & Stovall, E. (2006). From cancer patient to cancer survivor: Lost in transition. Committee on cancer survivorship: Improving care and quality of life NCPB, Institute of Medicine, and National Research Council, editor. Washington, DC: National Academies Press.
Acknowledgments
This study was supported by The Anne Moore Breast Cancer Research Fund. Dr. Blinder was partially supported by an Amgen Oncology Institute Hematology/Oncology Fellowship Award. Dr. Mazumdar was partially supported by the Clinical Translational Science Center (CTSC) (NIH UL1-RR024996) and the Collaborative Program in Nutrition and Cancer Prevention (R25CA105012).
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Blinder, V.S., Murphy, M.M., Vahdat, L.T. et al. Employment After a Breast Cancer Diagnosis: A Qualitative Study of Ethnically Diverse Urban Women. J Community Health 37, 763–772 (2012). https://doi.org/10.1007/s10900-011-9509-9
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10900-011-9509-9