Low-Income Women Less Likely to Keep Jobs After Breast Cancer Treatment

Job loss is an often overlooked side effect of undergoing breast cancer treatment, as an estimated 20% to 30% of survivors do not go back to work 3 to 18 months after diagnosis. Previous research has found that the odds of having a job to return to after treatment are significantly better for women whose employers made accommodations for them during treatment, like providing schedule flexibility around chemotherapy appointments.

However, most studies on job retention after breast cancer have examined white, middle-class women with health insurance. Research on breast cancer’s effects on low-income and minority women has been limited, but a study of Medicaid-insured breast cancer survivors in California found just 60% were working 3 years after their diagnosis.

A study recently published in Health Affairs set out to analyze the relationship between income and job retention for racial/ethnic minority and low-income women who were being treated for breast cancer in New York City. After oversampling to include more low-income and minority women, the researchers asked 319 participants about their employment status, household income, insurance type, job tenure, and other sociodemographic characteristics. The dependent variable, measured in a follow-up survey 4 months after the end of treatment, was job retention defined as having a job or being on sick or disability leave from work at that time.

The total proportion of women working at follow-up was relatively high at 81%, but income-based disparities in job retention were profound. Just 57% of the low-income women (defined as household income less than 200% of the federal poverty level) had kept their jobs, compared to 90% of middle-income and 95% of high-income women. Race was also a factor in job retention; 98% of white women kept their jobs, while only 68% of Chinese women and 73% of Korean women returned to work.

After performing multivariable analysis, the researchers found that the women had significantly lower probabilities of job retention if they were Chinese or low-income, but were 6 times more likely to return to work if they had employer-sponsored health insurance than if they had public insurance or were uninsured.

Women who had accommodating employers were more than twice as likely to return to work after treatment, but the presence of this factor also varied based on sociodemographic characteristics. Being in the low-income group and being Chinese were both associated with lower chances of having an accommodating employer. When controlling for race and ethnicity, women who spoke primarily English or had worked at their jobs for a longer time were more likely to state that their place of employment had been accommodating of their treatment.

The Americans with Disabilities Act was designed to provide job protection for employees with disabilities and illnesses like cancer, but the study authors reported that over half of the low-income women surveyed were not covered under this law because their workplace employed less than 15 people. They recommended expanding the act to include all workers by providing tax credits to small businesses that accommodate their disabled workers.

“Breast cancer survivors who do not continue to work during treatment or return to work soon after its completion are likely to suffer long-term job loss,” the authors noted. “Therefore, job protections are critical to an already vulnerable population of low-income women.”