Work Transitions in Breast Cancer Survivors and Effects on Quality of Life

  • Rola Hamood
  • Hatem Hamood
  • Ilya Merhasin
  • Lital Keinan-Boker


Purpose Work transitions among breast cancer survivors remain an underexplored area. We aimed to examine prevalence and determinants of changes in work status, and the effect of these changes on quality of life of breast cancer survivors. Methods A cross-sectional study of 410 female breast cancer survivors randomly drawn from a larger study sample pool (n = 2644), members of “Leumit” healthcare fund, who were diagnosed with primary nonmetastatic invasive breast cancer in the years 2002–2012. The study questionnaire included questions on work characteristics and health-related quality-of-life and was completed by all women contacted. Work transition was defined as a downgrade (from full-time to part-time), termination, or retirement, and was contrasted to no change in work status (retention of full-time or part-time). Work transition was assessed at two intervals: between breast cancer diagnosis and treatment, and between breast cancer diagnosis and time of the survey. Results A total of 206 breast cancer survivors (50%) were employed prior to their diagnosis, of whom 12% stopped working, and 79% downgraded to part-time during treatment. At the time of survey (mean 8 ± 3 years post-diagnosis), 33% of those employed prior to their diagnosis stopped working or retired, 48% downgraded to part-time, and 19% had no change in their work situation. Work transition between diagnosis and time of the survey was significantly associated with poorer quality-of-life. In multivariable analyses, work transition between diagnosis and time of the survey was positively associated with being immigrant compared to native-born Israeli (odds ratio (OR) 4.65; 95% confidence interval (CI) 1.91–11.37; P = .001), and inversely with education level of college or over compared to high school or less (OR 0.27; 95% CI 0.09–0.86; P = .026). Conclusions Breast cancer survivors with characteristics pointing at underprivileged social circumstances more often experienced changes in work status after surviving breast cancer, irrespective of diagnosis, comorbidity or treatment. Breast cancer patients with immigrant status and/or lower educational attainment need more support to be able to keep their job.


Breast cancer Work Employment Survivorship Quality of life 



Breast cancer survivors


Confidence interval




Israel National Cancer Registry


Leumit Health Services


Odds ratio


P value




Standard deviation


Standardized employment ratio


36-Item short-form health survey


Work transition


Chi square



Appreciation is expressed to the PhD advisory committee and all breast cancer survivors who participated in this study. We are grateful to Dr. Natan Kahan for his assistance and support with data acquisition and study approval.

Author Contributions

RH had full access to all of the data in the study, performed the statistical analysis, interpreted the data, and drafted the manuscript. HH participated in the study concept and design, helped in data acquisition, evaluated the manuscript, and acted as the corresponding author. IM was responsible for data acquisition, participated in the statistical analysis, and helped to evaluate and edit the manuscript. LKB had substantial contribution to the study concept, its formalization and development, interpreted the data, and assisted in the drafting and refinement of the manuscript. All authors take responsibility for the integrity of the data and the accuracy of the data analysis, have read and approved the final manuscript. This work has been done in partial fulfillment of the requirements for a PhD degree of RH (supervised by LKB) in the School of Public health, in the University of Haifa.


Funding of this study was in part provided by a grant from the Council for Higher Education (Grant No. 11658745) in collaboration with the Graduate Studies Authority at the University of Haifa (Grant No. 11658760).

Compliance with Ethical Standards

Conflict of interest

The authors report no conflicts of interest.

Ethical Approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional review boards of LHS and University of Haifa 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

10926_2018_9789_MOESM1_ESM.docx (30 kb)
Online Appendix (DOCX 29 KB)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.School of Public HealthUniversity of HaifaHaifaIsrael
  2. 2.Leumit Health ServicesKarmielIsrael
  3. 3.Ministry of HealthIsrael Center for Disease ControlRamat GanIsrael
  4. 4.Leumit Health ServicesNetanyaIsrael

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