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Work-Health Conflict among Breast Cancer Survivors: Associations with Cancer Self-Management, Quality of Life, and Anticipated Turnover

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Abstract

Breast cancer and its treatment can affect a survivor’s work role, potentially resulting in job loss or work withdrawal. Survivors are encouraged to adopt self-management behaviors as part of their health role to minimize treatment after-effects, prevent cancer recurrence, and improve health-related quality of life. We examined work-health conflict, an under-recognized form of inter-role conflict that occurs when work role demands make it difficult to engage in the health role. We hypothesized that work-health conflict is directly associated with poorer quality of life and anticipated turnover, and indirectly associated with both outcomes through self-management behaviors. An online cross-sectional survey was administered to working breast cancer survivors. We conducted ordinary least square regressions path analysis to test hypothesized associations of work-health conflict, quality of life, anticipated turnover, and cancer self-management. Respondents (n = 157) had a mean age of 51 and were primarily female (98%), White and non-Hispanic (85%), married or partnered (74%), and college-educated (94%). Hypothesis-testing showed that work-health conflict had direct effects on health-related quality of life and anticipated turnover, as well as indirect effects through self-management. We provide evidence for the adverse health and work impacts of work-health conflict, a potentially modifiable variable that is of growing interest within the literature on work-life interface. Employers should focus on supporting survivors’ long-term health-related quality of life and opportunities for health-supporting activities, which may promote work retention. Upstream interventions may be needed to address sources of work-health conflict, and may include minimizing spillover of work stress and reducing drains on time and energy resources.

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Data Availability

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

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The code that supports the findings of this study are available on request from the corresponding author.

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Acknowledgements

We gratefully acknowledge assistance with data collection efforts received from the Carole and Ray Neag Comprehensive Cancer Center at UConn Health, the Hartford HealthCare Cancer Institute at Hartford Hospital, and the Connecticut Cancer Partnership. We particularly appreciate the assistance of Dr. Lisa Rusch and Amanda Katzman in recruiting participants for our survey. The authors would also like to thank the members of the design team of breast cancer survivors, cancer clinicians, and researchers who participated in our study.

Funding

This research was supported by the Connecticut Breast Health Initiative, Inc. and the Connecticut Convergence Institute for Translation in Regenerative Engineering (formerly known as the Connecticut Institute for Clinical and Translational Science). Preparation of this publication was funded by Grant Number K01OH011596-01-00 from the U.S. National Institute for Occupational Safety and Health (NIOSH). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of NIOSH.

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Authors and Affiliations

  1. Department of Medicine, Division of Occupational and Environmental Medicine, University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT, 06030, USA

    Alicia G. Dugan, William S. Shaw & Martin G. Cherniack

  2. SHRM, Alexandria, VA, USA

    Ragan E. Decker

  3. Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA

    Hannah L. Austin

  4. Department of Health Science, College of Health and Wellness, Johnson & Wales University, 8 Abbott Park Place, Providence, RI, USA

    Sara Namazi

  5. Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA

    Keith M. Bellizzi & Thomas O. Blank

  6. Neag Comprehensive Cancer Center, UConn Health, Farmington, CT, USA

    Susan H. Tannenbaum

  7. Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, USA

    Helen Swede & Jennifer M. Cavallari

  8. Hematology and Medical Oncology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA

    Jasmin Hundal

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  1. Alicia G. Dugan
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Contributions

AD, KB, TB, and MC contributed to the original study conception and design. AD, RD, HA, and SN contributed to the design and conceptualization for the analytic approach used in this publication. WS, ST, JH, HS and JC helped to interpret results. The first full draft of the manuscript was written by AD, RD, and HA, and authors commented on several versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Alicia G. Dugan.

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Relevance to special issue

Improving health outcomes and work retention for workers living with chronic health conditions such as cancer requires an understanding of barriers to maintaining employment and managing health. We examined a novel variable within the work-life interface literature – work-health conflict – which has been linked to poor work outcomes, but has not been examined in relation to health behavior or outcomes. In our study of breast cancer survivors, work-health conflict had direct effects on health-related quality of life and anticipated turnover, as well as indirect effects through cancer self-management. Work-health conflict is unlike other constructs used to assess cancer survivors who want to maintain employment because it provides a platform for informing and evaluating employer-based interventions. Evidence from our study suggests that directly reducing work-health conflict (e.g., decreasing work’s drain on time and energy resources), may be promising approach for employers who want to help cancer survivors to better manage work and health.

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All procedures were reviewed and approved by the Institutional Review Board of the University of Connecticut Health Center All study participants provided written consent.

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Dugan, A.G., Decker, R.E., Austin, H.L. et al. Work-Health Conflict among Breast Cancer Survivors: Associations with Cancer Self-Management, Quality of Life, and Anticipated Turnover. Occup Health Sci (2024). https://doi.org/10.1007/s41542-024-00172-4

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