Factors associated with an adverse work outcome in breast cancer survivors 5–10 years after diagnosis: a cross-sectional study

  • Sietske J. Tamminga
  • Pieter Coenen
  • Carmen Paalman
  • Angela G. E. M. de Boer
  • Neil K. Aaronson
  • Hester S. A. Oldenburg
  • Flora E. van Leeuwen
  • Allard J. van der Beek
  • Saskia F. A. Duijts
  • Michael SchaapveldEmail author



To identify which factors are associated with adverse work outcome 5–10 years after diagnosis.


In this cross-sectional study, breast cancer survivors, treated between 2003 and 2008, completed a questionnaire 5–10 years after diagnosis. Adverse work outcome was defined as not having paid employment or working > 20% less compared to prediagnosis. Logistic regression analyses were conducted.


Of 906 participants, 326 (36%) had an adverse work outcome. In multivariable analyses, the probability of an adverse work outcome increased with age (OR, 1.03; 95% CI, 1.00–1.07), time since diagnosis (OR, 1.19; 95% CI, 1.03–1.37), and was higher among women who stated that work had become less important (OR, 2.99; 95% CI, 1.94–4.62). Factors associated with a lower probability of an adverse work outcome were having sufficient financial resources (OR, 0.23; 95% CI, 0.08–0.66), higher total work ability (OR, 0.61; 95% CI, 0.54–0.69), feeling supported at work (OR, 0.52; 95% CI, 0.33–0.80), and, prior to diagnosis, having more children to take care of (OR, 0.65; 95% CI, 0.54–0.79), being able to adjust working hours (OR, 0.55; 95% CI, 0.36–0.83) and not desiring to work less hours if that were to be financially feasible (OR, 1.8; 95% CI, 1.0–3.2).


Predominantly, work-related factors are associated with adverse work outcomes 5–10 years after diagnosis, whereas clinical factors are not. Our results need validation in prospective cohort studies, after which supportive interventions could be developed.

Implications for Cancer Survivors

Work-related factors should be considered in future interventions to prevent adverse work outcome 5–10 years after diagnosis.


Cancer survivorship Employment Work Breast cancer 


Author contributions

MS, NA, FvL, HO, AdB were responsible for the study concept and design and obtained funding.

PC analysed the data, which was checked by ST.

All authors interpreted the data.

ST, PC and SD drafted the manuscript, which was critically revised by all authors.


This study was funded by the Dutch Pink Ribbon foundation (grant no. 2011.WO17.C102) and the Amsterdam Public Health Research Institute.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

11764_2018_731_MOESM1_ESM.docx (15 kb)
ESM 1 (DOCX 15 kb)
11764_2018_731_MOESM2_ESM.docx (17 kb)
ESM 2 (DOCX 16 kb)


  1. 1.
    Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J, Rosso S, Coebergh JW, Comber H, et al. Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012. Eur J Cancer. 2013;49(6):1374–403. Scholar
  2. 2.
    Netherlands Cancer Registry 2017. Available from: Accessed Dec 2017.
  3. 3.
    Paalman CH, van Leeuwen FE, Aaronson NK, de Boer AG, van de Poll-Franse L, Oldenburg HS, et al. Employment and social benefits up to 10 years after breast cancer diagnosis: a population-based study. Br J Cancer. 2016;114(1):81–7. CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Tamminga SJ, de Boer AG, Verbeek JH, Frings-Dresen MH. Breast cancer survivors’ views of factors that influence the return-to-work process--a qualitative study. Scand J Work Environ Health. 2012;38(2):144–54. Scholar
  5. 5.
    Timperi AW, Ergas IJ, Rehkopf DH, Roh JM, Kwan ML, Kushi LH. Employment status and quality of life in recently diagnosed breast cancer survivors. Psychooncology. 2013;22(6):1411–20. Scholar
  6. 6.
    Wells M, Williams B, Firnigl D, Lang H, Coyle J, Kroll T, et al. Supporting ‘work-related goals’ rather than ‘return to work’ after cancer? A systematic review and meta-synthesis of 25 qualitative studies. Psychooncology. 2013;22(6):1208–19. Scholar
  7. 7.
    Disler PB, Pallant JF. Vocational rehabilitation. BMJ. 2001;323(7305):121–3.CrossRefGoogle Scholar
  8. 8.
    Islam T, Dahlui M, Majid HA, Nahar AM, Mohd Taib NA, Su TT, et al. Factors associated with return to work of breast cancer survivors: a systematic review. BMC Public Health. 2014;14(Suppl 3):S8. Scholar
  9. 9.
    van Muijen P, Weevers NL, Snels IA, Duijts SF, Bruinvels DJ, Schellart AJ, et al. Predictors of return to work and employment in cancer survivors: a systematic review. Eur J Cancer Care (Engl). 2013;22(2):144–60. Scholar
  10. 10.
    von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Epidemiology. 2007;18(6):800–4. Scholar
  11. 11.
    Feuerstein M, Todd BL, Moskowitz MC, Bruns GL, Stoler MR, Nassif T, et al. Work in cancer survivors: a model for practice and research. J Cancer Surviv. 2010;4(4):415–37. Scholar
  12. 12.
    Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30(6):473–83.CrossRefGoogle Scholar
  13. 13.
    Aaronson NK, Muller M, Cohen PD, Essink-Bot ML, Fekkes M, Sanderman R, et al. Translation, validation, and norming of the Dutch language version of the SF-36 Health Survey in community and chronic disease populations. J Clin Epidemiol. 1998;51(11):1055–68.CrossRefGoogle Scholar
  14. 14.
    Ilmarinen J, Tuomi K. Work ability of aging workers. Scand J Work Environ Health. 1992;18(Suppl 2):8–10.PubMedGoogle Scholar
  15. 15.
    Crespi CM, Ganz PA, Petersen L, Castillo A, Caan B. Refinement and psychometric evaluation of the impact of cancer scale. J Natl Cancer Inst. 2008;100(21):1530–41. Scholar
  16. 16.
  17. 17.
    Huysmans MA, Eijckelhof BHW, Garza JLB, Coenen P, Blatter BM, Johnson PW, et al. Predicting forearm physical exposures during computer work using self-reports, software-recorded computer usage patterns, and anthropometric and workstation measurements. Ann Work Expo Health. 2017;62(1):124–37. Scholar
  18. 18.
    Grewal R, Cote JA, Baumgartner H. Multicollinearity and measurement error in structural equation models: implications for theory testing. Mark Sci. 2004;23(4):519–29. Scholar
  19. 19.
    SPSS. Statistics for Windows [computer program]. Version 22.0. Armonk: IBM Corp; 2013.Google Scholar
  20. 20.
    Oerlemans S, Mols F, Issa DE, Pruijt JH, Peters WG, Lybeert M, et al. A high level of fatigue among long-term survivors of non-Hodgkin’s lymphoma: results from the longitudinal population-based PROFILES registry in the south of the Netherlands. Haematologica. 2013;98(3):479–86. Scholar
  21. 21.
    Leijten FR, de Wind A, van den Heuvel SG, Ybema JF, van der Beek AJ, Robroek SJ, et al. The influence of chronic health problems and work-related factors on loss of paid employment among older workers. J Epidemiol Community Health. 2015;69(11):1058–65. Scholar
  22. 22.
    Greidanus MA, de Boer A, de Rijk AE, Tiedtke CM, Dierckx de Casterle B, Frings-Dresen MHW, et al. Perceived employer-related barriers and facilitators for work participation of cancer survivors: a systematic review of employers’ and survivors’ perspectives. Psycho-Oncology. 2018;27(3):25–733. Scholar
  23. 23.
    Tiedtke CM, Dierckx de Casterle B, Frings-Dresen MHW, De Boer A, Greidanus MA, Tamminga SJ, et al. Employers’ experience of employees with cancer: trajectories of complex communication. J Cancer Surviv. 2017;11(5):562–77. Scholar
  24. 24.
    Zaman AC, Bruinvels DJ, de Boer AG, Frings-Dresen MH. Supporting cancer patients with work-related problems through an oncological occupational physician: a feasibility study. Eur J Cancer Care (Engl). 2017;26(5):e12378. Scholar
  25. 25.
    de Jong F, Frings-Dresen MH, Dijk NV, van Etten-Jamaludin FS, van Asselt KM, de Boer A. The role of the general practitioner in return to work after cancer-a systematic review. Fam Pract. 2018;35(5):531–41. Scholar
  26. 26.
    Mosadeghrad AM. Quality of working life: an antecedent to employee turnover intention. Int J Health Policy Manag. 2013;1(1):43–50. Scholar
  27. 27.
    Statistics Netherlands. Accessed May 2018.
  28. 28.
    Duijts S, Dalton SO, Lundh MH, Horsboel TA, Johansen C. Cancer survivors and return to work: current knowledge and future research. Psycho-Oncology. 2017;26(5):715–7. Scholar
  29. 29.
    Austin PC, Steyerberg EW. The number of subjects per variable required in linear regression analyses. J Clin Epidemiol. 2015;68(6):627–36. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Sietske J. Tamminga
    • 1
    return OK on get
  • Pieter Coenen
    • 2
  • Carmen Paalman
    • 3
    • 4
  • Angela G. E. M. de Boer
    • 1
  • Neil K. Aaronson
    • 3
  • Hester S. A. Oldenburg
    • 5
  • Flora E. van Leeuwen
    • 3
  • Allard J. van der Beek
    • 2
  • Saskia F. A. Duijts
    • 2
    • 3
    • 6
  • Michael Schaapveld
    • 3
    • 4
    Email author
  1. 1.Amsterdam UMC, Coronel Institute of Occupational Health, Amsterdam Public Health Research InstituteUniversity of AmsterdamAmsterdamThe Netherlands
  2. 2.Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
  3. 3.Division of Psychosocial Research and EpidemiologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands
  4. 4.Netherlands Comprehensive Cancer Organisation (IKNL)UtrechtThe Netherlands
  5. 5.Department of Surgical OncologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands
  6. 6.Department of General PracticeUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands

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