Return to Work and Mortality in Breast Cancer Survivors: A 11-Year Longitudinal Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population
2.2. Covariates
2.3. Outcome Assessment
2.4. Statistical Analysis
3. Results
3.1. Characteristics of the Study Population
3.2. Univariate Analysis of Independent Factors Associated with RTW in Cox Proportional Hazards Models
3.3. Multivariate Analysis of Independent Factors Associated with RTW in Cox Proportional Hazards Models
3.4. Influence of RTW on Survival Outcomes
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristic | All | RTW | % | Non-RTW | % |
---|---|---|---|---|---|
Age (year) mean ± SD (range) | 48.2 ± 7.8 (19–86) | 47.9 ± 7.6 (19–86) | 49.2 ± 8.6 (19–84) | ||
Age group | |||||
<40 | 2107 | 1726 | 13.1 | 381 | 12.7 |
40–49 | 6826 | 5668 | 43.2 | 1158 | 38.7 |
50–59 | 6170 | 5049 | 38.5 | 1121 | 37.5 |
60–69 | 916 | 609 | 4.6 | 307 | 10.2 |
≥70 | 64 | 44 | 0.3 | 20 | 0.6 |
Comorbidities | |||||
Disorders of lipoid metabolism | 1272 | 1007 | 7.6 | 265 | 8.8 |
Obesity | 45 | 36 | 0.2 | 9 | 0.3 |
Hypertension | 2129 | 1686 | 12.8 | 443 | 14.8 |
Congestive heart failure | 104 | 84 | 0.6 | 20 | 0.6 |
Peripheral vascular disease | 91 | 74 | 0.5 | 17 | 0.5 |
Cerebrovascular disease | 170 | 139 | 1 | 31 | 1 |
Chronic pulmonary disease | 485 | 390 | 2.9 | 95 | 3.1 |
Rheumatologic disease | 202 | 170 | 1.2 | 32 | 1 |
Peptic ulcer disease | 854 | 685 | 5.2 | 169 | 5.6 |
Mild liver disease | 822 | 671 | 5.1 | 151 | 5 |
Hemiplegia or paraplegia | 13 | 10 | 0.07 | 3 | 0.1 |
Renal disease | 129 | 105 | 0.8 | 24 | 0.8 |
Psychoses | 71 | 55 | 0.4 | 16 | 0.5 |
Depression | 433 | 354 | 2.7 | 79 | 2.6 |
Comorbidity | |||||
0 | 11,423 | 9351 | 71.4 | 2072 | 69.3 |
1 | 2837 | 2295 | 17.5 | 542 | 18.1 |
2 | 1307 | 1036 | 7.9 | 271 | 9 |
≥3 | 516 | 414 | 3.1 | 102 | 3.4 |
Treatment | |||||
OP | 15,108 | 12,321 | 94 | 2787 | 93.3 |
RTB | 7011 | 5687 | 43.4 | 1324 | 44.3 |
CH | 6881 | 5390 | 41.1 | 1491 | 49.9 |
HORM | 6937 | 5453 | 41.6 | 1484 | 49.6 |
Monthly income (USD) | |||||
≤960 | 10,110 | 8851 | 67.5 | 1259 | 42.1 |
>960~1273 | 2735 | 2307 | 17.6 | 428 | 14.3 |
>1273 | 3238 | 1938 | 14.7 | 1300 | 43.5 |
Employee’s industry | |||||
Agriculture | 794 | 705 | 5.3 | 89 | 2.9 |
Manufacturing | 5112 | 4236 | 32.3 | 876 | 29.3 |
Electricity and Gas Supply | 19 | 12 | 0.09 | 7 | 0.2 |
Water Supply | 72 | 60 | 0.4 | 12 | 0.4 |
Construction | 1063 | 918 | 7 | 145 | 4.8 |
Wholesale and Retail Trade | 2175 | 1663 | 12.6 | 512 | 17.1 |
Transportation and Storage | 672 | 549 | 4.1 | 123 | 4.1 |
Accommodation | 737 | 623 | 4.7 | 114 | 3.8 |
Information and Communication | 277 | 201 | 1.5 | 76 | 2.5 |
Financial and Insurance Activities | 758 | 568 | 4.3 | 190 | 6.3 |
Real Estate Activities | 190 | 165 | 1.2 | 25 | 0.8 |
Technical Activities | 531 | 389 | 2.9 | 142 | 4.7 |
Support Service Activities | 403 | 322 | 2.4 | 81 | 2.7 |
Public Administration | 385 | 283 | 2.1 | 102 | 3.4 |
Education | 364 | 290 | 2.2 | 74 | 2.4 |
Human Health and Social Work Activities | 652 | 486 | 3.7 | 166 | 5.5 |
Arts, Entertainment and Recreation | 198 | 176 | 1.3 | 22 | 0.7 |
Other Service Activities | 1681 | 1450 | 11 | 231 | 7.7 |
Company scale | |||||
Company closed | 1430 | 1122 | 8.5 | 308 | 10.3 |
Small | 1308 | 1003 | 7.6 | 305 | 10.2 |
Medium | 3676 | 2797 | 21.3 | 879 | 29.4 |
Large | 9669 | 8174 | 62.4 | 1495 | 50 |
Pathological stage | |||||
0 | 2094 | 1711 | 13 | 383 | 12.8 |
1 | 5270 | 4350 | 33.2 | 920 | 30.8 |
2 | 5880 | 4867 | 37.1 | 1013 | 33.9 |
3 | 2515 | 1958 | 14.9 | 557 | 18.6 |
4 | 324 | 210 | 1.6 | 114 | 3.8 |
Characteristic | 2-Year RTW | |
---|---|---|
HR (95% CI) | p Value | |
Age (year) mean ± SD (range) | 0.996 (0.994–0.998) | 0.0004 |
Age group | ||
<40 | Reference | |
40–49 | 1.04 (0.985–1.098) | 0.1535 |
50–59 | 1.027 (0.972–1.085) | 0.337 |
60–69 | 0.782 (0.713–0.858) | <0.0001 |
≥70 | 0.821 (0.609–1.107) | 0.1966 |
Comorbidities (Reference: no) | ||
Disorders of lipoid metabolism | 0.965 (0.905–1.029) | 0.2811 |
Obesity | 0.973 (0.701–1.349) | 0.868 |
Hypertension | 0.966 (0.918–1.017) | 0.1847 |
Congestive heart failure | 1 (0.807–1.239) | 1 |
Peripheral vascular disease | 1.009 (0.803–1.268) | 0.9369 |
Cerebrovascular disease | 1.01 (0.855–1.194) | 0.9065 |
Chronic pulmonary disease | 0.988 (0.893–1.093) | 0.8114 |
Rheumatologic disease | 1.055 (0.907–1.227) | 0.4862 |
Peptic ulcer disease | 0.981 (0.909–1.06) | 0.6331 |
Mild liver disease | 1.007 (0.932–1.088) | 0.858 |
Hemiplegia or paraplegia | 0.949 (0.511–1.764) | 0.8693 |
Renal disease | 1.016 (0.839–1.231) | 0.8704 |
Psychoses | 0.996 (0.878–1.129) | 0.9467 |
Depression | 0.941 (0.722–1.226) | 0.6542 |
Comorbidity | ||
0 | Reference | |
1 | 0.991 (0.946–1.037) | 0.6858 |
2 | 0.964 (0.904–1.028) | 0.2644 |
≥3 | 0.985 (0.892–1.086) | 0.7572 |
Treatment (Reference: no) | ||
OP | 1.032 (0.96–1.11) | 0.3934 |
RTB | 0.987 (0.954–1.022) | 0.4682 |
CH | 0.91 (0.879–0.942) | <0.0001 |
HORM | 0.917 (0.886–0.95) | <0.0001 |
Monthly income (USD) | ||
≤960 | Reference | |
>960~1273 | 0.952 (0.91–0.997) | 0.0369 |
>1273 | 0.595 (0.566–0.625) | <0.0001 |
Employee’s industry | ||
Agriculture | 0.999 (0.847–1.178) | 0.9897 |
Manufacturing | 0.894 (0.769–1.04) | 0.1454 |
Electricity and Gas Supply | 0.634 (0.354–1.138) | 0.127 |
Water Supply | 0.881 (0.657–1.181) | 0.3964 |
Construction | 0.955 (0.813–1.122) | 0.5747 |
Wholesale and Retail Trade | 0.79 (0.676–0.923) | 0.003 |
Transportation and Storage | 0.881 (0.743–1.044) | 0.1426 |
Accommodation | 0.92 (0.779–1.088) | 0.3314 |
Information and Communication | 0.729 (0.596–0.893) | 0.0022 |
Financial and Insurance Activities | 0.775 (0.655–0.918) | 0.0032 |
Real Estate Activities | 0.937 (0.757–1.158) | 0.5452 |
Technical Activities | 0.745 (0.624–0.891) | 0.0012 |
Support Service Activities | 0.842 (0.701–1.012) | 0.0667 |
Public Administration | 0.754 (0.625–0.911) | 0.0033 |
Education | 0.811 (0.672–0.978) | 0.0283 |
Human Health and Social Work Activities | 0.761 (0.64–0.904) | 0.0019 |
Arts, Entertainment and Recreation | Reference | |
Other Service Activities | 0.955 (0.817–1.117) | 0.5678 |
Company scale | ||
Company closed | 0.869 (0.816–0.925) | <0.0001 |
Small | 0.857 (0.802–0.915) | <0.0001 |
Medium | 0.846 (0.811–0.884) | <0.0001 |
Large | Reference | |
Pathological stage | ||
0 | 1.338 (1.159–1.544) | <0.0001 |
1 | 1.357 (1.182–1.559) | <0.0001 |
2 | 1.36 (1.185–1.562) | <0.0001 |
3 | 1.259 (1.092–1.452) | 0.0015 |
4 | Reference |
Characteristics | 2-Year RTW | |
---|---|---|
HR (95% CI) | p Value | |
Age (year) mean ± SD (range) | 0.995 (0.993–0.997) | <0.0001 |
Age group | ||
<40 | Reference | |
40-49 | 1.027 (0.973–1.085) | 0.3347 |
50-59 | 1.003 (0.947–1.062) | 0.9261 |
60-69 | 0.773 (0.702–0.851) | <0.0001 |
≥70 | 0.744 (0.55–1.006) | 0.0543 |
Comorbidity | ||
0 | Reference | |
1 | 0.991 (0.946–1.038) | 0.6998 |
2 | 0.973 (0.911–1.039) | 0.4177 |
≥3 | 1.005 (0.909–1.111) | 0.9211 |
Treatment (Reference: no) | ||
OP | 1.032 (0.959–1.11) | 0.4052 |
RTB | 1.015 (0.979–1.052) | 0.4107 |
CH | 0.926 (0.887–0.965) | 0.0003 |
HORM | 0.957 (0.92–0.996) | 0.0296 |
Monthly income (USD) | ||
≤960 | Reference | |
>960~1273 | 0.985 (0.94–1.032) | 0.5237 |
>1273 | 0.612 (0.58–0.646) | <0.0001 |
Employee’s industry | ||
Agriculture | 0.937 (0.794–1.106) | 0.4435 |
Manufacturing | 0.919 (0.79–1.069) | 0.2743 |
Electricity and Gas Supply | 0.814 (0.453–1.462) | 0.4905 |
Water Supply | 0.929 (0.693–1.246) | 0.6244 |
Construction | 0.956 (0.813–1.123) | 0.5816 |
Wholesale and Retail Trade | 0.904 (0.772–1.059) | 0.212 |
Transportation and Storage | 0.922 (0.778–1.093) | 0.3523 |
Accommodation | 0.895 (0.757–1.058) | 0.1943 |
Information and Communication | 0.859 (0.701–1.053) | 0.1429 |
Financial and Insurance Activities | 0.99 (0.834–1.175) | 0.9068 |
Real Estate Activities | 0.999 (0.808–1.236) | 0.994 |
Technical Activities | 0.865 (0.723–1.036) | 0.1145 |
Support Service Activities | 0.868 (0.722–1.043) | 0.1315 |
Public Administration | 0.854 (0.706–1.033) | 0.1035 |
Education | 0.852 (0.705–1.029) | 0.0963 |
Human Health and Social Work Activities | 0.853 (0.717–1.015) | 0.0723 |
Arts, Entertainment and Recreation | Reference | |
Other Service Activities | 0.943 (0.807–1.103) | 0.4663 |
Company scale | ||
Company closed | 0.898 (0.841–0.96) | 0.0015 |
Small | 0.877 (0.819–0.941) | 0.0002 |
Medium | 0.888 (0.848–0.931) | <0.0001 |
Large | Reference | |
Pathological stage | ||
0 | 1.368 (1.182–1.584) | <0.0001 |
1 | 1.405 (1.222–1.616) | <0.0001 |
2 | 1.384 (1.204–1.589) | <0.0001 |
3 | 1.261 (1.093–1.455) | 0.0015 |
4 | Reference |
Characteristic | Fully Adjusted HR (95% CI) | p Value |
---|---|---|
RTW (Ref: non-RTW) | 0.585 (0.526–0.649) | <0.0001 |
Age (Ref: age <40) | ||
40–49 | 0.735 (0.643–0.84) | <0.0001 |
50–59 | 0.901 (0.789–1.029) | 0.1245 |
60–69 | 0.949 (0.744–1.164) | 0.6154 |
≥70 | 2.232 (1.444–3.451) | 0.0003 |
Treatment (Ref: no) | ||
OP | 0.698 (0.603–0.809) | <0.0001 |
RTB | 0.822 (0.75–0.901) | <0.0001 |
CH | 1.013 (0.908–1.13) | 0.8179 |
HORM | 0.692 (0.617–0.775) | <0.0001 |
Monthly income (Ref: ≤$960) | ||
>960~1273 | 0.879 (0.775–0.995) | 0.0418 |
>1273 | 0.71 (0.62–0.812) | <0.0001 |
Pathological stage (Ref: stage 4) | ||
0 | 0.014 (0.01–0.019) | <0.0001 |
1 | 0.037 (0.031–0.045) | <0.0001 |
2 | 0.089 (0.076–0.103) | <0.0001 |
3 | 0.283 (0.244–0.329) | <0.0001 |
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Yang, Z.-Y.; Chen, W.-L.; Wu, W.-T.; Lai, C.-H.; Ho, C.-L.; Wang, C.-C. Return to Work and Mortality in Breast Cancer Survivors: A 11-Year Longitudinal Study. Int. J. Environ. Res. Public Health 2022, 19, 14418. https://doi.org/10.3390/ijerph192114418
Yang Z-Y, Chen W-L, Wu W-T, Lai C-H, Ho C-L, Wang C-C. Return to Work and Mortality in Breast Cancer Survivors: A 11-Year Longitudinal Study. International Journal of Environmental Research and Public Health. 2022; 19(21):14418. https://doi.org/10.3390/ijerph192114418
Chicago/Turabian StyleYang, Zhe-Yu, Wei-Liang Chen, Wei-Te Wu, Ching-Huang Lai, Ching-Liang Ho, and Chung-Ching Wang. 2022. "Return to Work and Mortality in Breast Cancer Survivors: A 11-Year Longitudinal Study" International Journal of Environmental Research and Public Health 19, no. 21: 14418. https://doi.org/10.3390/ijerph192114418