Journal of Cancer Survivorship

, Volume 8, Issue 1, pp 49–59 | Cite as

Racial differences in quality of life and employment outcomes in insured women with breast cancer

  • Cathy J. BradleyEmail author
  • Amber Wilk



Prior studies indicate that racial disparities are not only present in cancer survival, but also in the quality of cancer survivorship. We estimated the effect of cancer and its treatment on two measures of survivorship quality as follows: health-related quality of life and employment and hours worked for initially employed and insured women newly diagnosed with breast cancer.


We collected employment data from 548 women from 2007 to 2011; 22 % were African-American. The outcomes were responses to the SF-36, CES-D, employment, and change in weekly hours worked from pre-diagnosis to 2 and 9 months following treatment initiation.


African-American women reported a 2.77 (0.94) and 1.96 (0.92) higher score on the mental component summary score at the 2 and 9 month interviews, respectively. They also report fewer depression symptoms at the 2-month interview, but were over half as likely to be employed as non-Hispanic white women (OR = 0.43; 95 % CI = 0.26 to 0.71). At the 9-month interview, African-American women had 2.33 (1.06) lower scores on the physical component summary score.


Differences in health-related quality of life were small and, although statistically significant, were most likely clinically insignificant between African-American and non-Hispanic white women. Differences in employment were substantial, suggesting the need for future research to identify reasons for disparities and interventions to reduce the employment effects of breast cancer and its treatment on African-American women.

Implications for cancer survivors

African-American breast cancer survivors are more likely to stop working during the early phases of their treatment. These women and their treating physicians need to be aware of options to reduce work loss and take steps to minimize long-term employment consequences.


Breast cancer Race Employment Quality of life 



Bradley's research was supported by the National Cancer Institute (NCI) grant number R01-CA122145, “Health, Health Insurance, and Labor Supply.” The authors are grateful to Myra Owens, Ph.D. and Mirna Hernandez for project coordination, Meryl Motika and Scott Barkowski for programming support, the interviewers and medical record auditors that collected the data, and the many subjects who generously donated their time to the project. There are no financial disclosures or conflicts of interest for this manuscript.


  1. 1.
    Chlebowski RT, Chen Z, Anderson GL, et al. Ethnicity and breast cancer: factors influencing differences in incidence and outcome. JNCI J Natl Cancer Inst. 2005;97:439–48.CrossRefPubMedGoogle Scholar
  2. 2.
    Li CI, Malone KE, Daling JR. Differences in breast cancer stage, treatment, and survival by race and ethnicity. Arch Intern Med. 2003;16:49–56.CrossRefGoogle Scholar
  3. 3.
    Bradley CJ, Given CW, Roberts C. Race, socioeconomic status, and breast cancer treatment and survival. JNCI J Natl Cancer Inst. 2002;94:490–6.CrossRefPubMedGoogle Scholar
  4. 4.
    Roetzheim RG, Pal N, Tennant C, et al. Effects of health insurance and race on early detection of cancer. JNCI J Natl Cancer Inst. 1999;91:1,409–15.CrossRefGoogle Scholar
  5. 5.
    Ward E, Jemal A, Cokkinides V, et al. Cancer disparities by race/ethnicity and socioeconomic status. Cancer J Clinicians. 2004;54:78–93.CrossRefGoogle Scholar
  6. 6.
    Paskett ED, Alfano CM, Davidson MA, et al. Breast cancer survivors' health-related quality of life. Cancer. 2008;113:3,222–30.CrossRefGoogle Scholar
  7. 7.
    Janz NK, Mahasin MS, Hawley ST, et al. Racial/ethnic differences in quality of life after diagnosis of breast cancer. J Cancer Surviv. 2009;3:212–22.CrossRefPubMedGoogle Scholar
  8. 8.
    Bradley CJ, Bednarek HL, Neumark D. Short-term effects of breast cancer on labor market attachment: results from a longitudinal study. J Health Econ. 2005;24:137–60.CrossRefPubMedGoogle Scholar
  9. 9.
    Fantoni SQ, Peugniez C, Duhamel A, Skrzypczak J, Frimat P, Leroyer A. Factors related to return to work by women with breast cancer in northern France. J Occup Rehabil. 2010;20:49–58.CrossRefPubMedGoogle Scholar
  10. 10.
    Hoyer M, Nordin K, Ahlgren J, et al. Change in working time in a population-based cohort of patients with breast cancer. J Clin Oncol. 2012;30:2853–60.CrossRefPubMedGoogle Scholar
  11. 11.
    Torp S, Nielsen RA, Gudbergsson SB, et al. Sick leave patterns among 5-year cancer survivors: a registry-based retrospective cohort study. J Cancer Surviv. 2012;6:315–23.CrossRefPubMedGoogle Scholar
  12. 12.
    Ahn E, Cho J, Shin DW, et al. Impact of breast cancer diagnosis and treatment on work-related life and factors affecting them. Breast Cancer Res Treat. 2009;116:609–16.CrossRefPubMedGoogle Scholar
  13. 13.
    Lauzier S, Maunsell E, Drolet M, et al. Wage losses in the year after breast cancer: extent and determinants among Canadian women. J Natl Cancer Inst. 2008;100:321–32.CrossRefPubMedGoogle Scholar
  14. 14.
    Mujahid MS, Janz NK, Hawley ST, et al. Racial/ethnic differences in job loss for women with breast cancer. J Cancer Surviv. 2011;5:102–11.PubMedCentralCrossRefPubMedGoogle Scholar
  15. 15.
    Johnsson A, Fornander T, Rutqvist LE, Olsson M. Work status and life changes in the first year after breast cancer diagnosis. Work. 2011;38:337–46.PubMedGoogle Scholar
  16. 16.
    Blinder VS, Patil S, Thind A, et al. Return to work in low-income Latina and non-Latina white breast cancer survivors: a 3-year longitudinal study. Cancer. 2012;118:1664–74.PubMedCentralCrossRefPubMedGoogle Scholar
  17. 17.
    Bouknight RR, Bradley CJ, Luo Z. Correlates of return to work for breast cancer survivors. J Clin Onc. 2006;24:345–53.CrossRefGoogle Scholar
  18. 18.
    Satariano WA, DeLorenze GN. The likelihood of returning to work after breast cancer. Public Health Rep. 1996;111:236–41.PubMedCentralPubMedGoogle Scholar
  19. 19.
    Carlsen K, Jensen AJ, Regulies R, et al. Self-reported work ability in long-term breast cancer survivors. A population-based questionnaire study in Denmark. Acta Oncol. 2013;52:423–9.CrossRefPubMedGoogle Scholar
  20. 20.
    Hewitt M, Greenfield S, Stovall E. Cancer patient to cancer survivor: lost in transitions. Washington: The National Academy Press; 2006.Google Scholar
  21. 21.
    Bradley CJ, Oberst K, Schenk M. Absenteeism from work: the experience of employed breast and prostate cancer patients in the months following diagnosis. Psychooncology. 2006;15:739–47.CrossRefPubMedGoogle Scholar
  22. 22.
    Bradley CJ, Neumark D, Luo Z, Schenk M. Employment and cancer: findings from a longitudinal study of breast and prostate cancer survivors. Cancer Invest. 2007;25:47–54.CrossRefPubMedGoogle Scholar
  23. 23.
    Short PF, Vasey JJ, Tunceli K. Employment pathways in a large cohort of adult cancer survivors. Cancer. 2005;103:1292–301.CrossRefPubMedGoogle Scholar
  24. 24.
    Gilleskie DB, Lutz BF. The impact of employer-provided health insurance on a dynamic employment transitions. J of Human Res. 2002;37:129–62.CrossRefGoogle Scholar
  25. 25.
    Kapur K. The impact of health on job mobility: a measure of job lock. Ind Labor Relat Rev. 1998;51:282–98.CrossRefGoogle Scholar
  26. 26.
    Bradley CJ, Neumark D, Barkowski S. Does employer-provided health insurance constrain labor supply adjustments to health shocks? New evidence on women diagnosed with breast cancer. J Health Econ. 2013;32:833–49.PubMedCentralCrossRefPubMedGoogle Scholar
  27. 27.
    Ware JE, Snow KK, Kosinski M. (eds): SF-36 health survey: manual and interpretation guide. Boston, MA, The Health Institute, New England Medical Center, 1993.Google Scholar
  28. 28.
    Irwin M, Artin KH, Oxman MN. Screening for depression in the older adult: criterion validity of the 10-item Center for Epidemiological Studies Depression Scale (CES-D). Arch Intern Med. 1999;159:1701–4.CrossRefPubMedGoogle Scholar
  29. 29.
    Weiss DJ, Dawis RV, England GW. Manual studies in vocational rehabilitation. Manual for the Minnesota Satisfaction Questionnaire. 1967;22:1–20.Google Scholar
  30. 30.
    Health and retirement study. (2013). Retrieved from
  31. 31.
    SAS Institute, Inc, SAS 9.2, SAS Institute Inc., Cary, NC, 2000–2008.Google Scholar
  32. 32.
    Samsa GP, Matchar DB. Relationships between test frequency and outcomes of anticoagulation: a literature review and commentary with implications for the design of randomized trials of patients' self-management. J Thromb Thrombolysis. 2000;9:283–92.CrossRefPubMedGoogle Scholar
  33. 33.
    Wyrwich KW, Tierney WM, Babu AN, Kroenke K, Wolinsky FD. A comparison of clinically important differences in health-related quality of life for patients with chronic lung disease, asthma, or heart disease. Health Serv Res. 2005;40:577–91.PubMedCentralCrossRefPubMedGoogle Scholar
  34. 34.
    Lewis PE, Sheng M, Rhodes MM, Jackson KE, Schover LR. Psychological concerns of young African-American breast cancer survivors. J Psychosoc Oncol. 2012;30:168–84.PubMedCentralCrossRefPubMedGoogle Scholar
  35. 35.
    Blinder VS, Murphy MM, Vahdat LT, Gold HT, de Melo-Martin I, Hayes MK, et al. Employment after a breast cancer diagnosis: a qualitative study of ethnically diverse urban women. J Community Health. 2012;37:763–72.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Department of Healthcare Policy and Research and the Massey Cancer CenterVirginia Commonwealth UniversityRichmondUSA
  2. 2.Department of BiostatisticsVirginia Commonwealth UniversityRichmondUSA

Personalised recommendations