Lisbon, Portugal: The majority of people living with advanced breast cancer give up working against their will, according to research presented at the Advanced Breast Cancer Seventh International Consensus Conference (ABC 7). [1]
As well as the personal costs of being out of work, the new study shows that there is a significant overall cost to the economy when patients stop working. In Portugal alone, the researchers estimate nearly €29 million is lost in productivity over three years. Similar situations exist in other countries too.
This research was a collaboration between the ABC Global Alliance, the NOVA Medical School, Lisbon, Portugal and the Breast Unit of the Champalimaud Clinical Centre, Lisbon. The researchers, led by Dr Leonor Matos from the Breast Unit at the Champalimaud Clinical Centre, are calling for changes to labour laws to enable people with advanced cancer to stay in employment.
Although advanced breast cancer cannot usually be cured, many people live with the condition for years, during which time they may be well enough to work under the right conditions.
Dr Matos told the Conference: "The symptoms of advanced breast cancer and the burden of ongoing monitoring and treatment can make it harder for patients to hold down a job. But leaving employment often brings financial, social and mental health costs for patients. We wanted to study the economic impact of this problem at the country scale."
The research included a group of 112 working age people who were being treated for advanced breast cancer (ABC) for at least six months at one of nine hospitals in Portugal. Patients were asked about their current work situation and about their work before they were diagnosed.
This showed that the majority of patients (87%) were in paid work at the time of diagnosis. Post-diagnosis, only 38% were still working. The others were either unemployed, on medical leave or retired. The average age of retirement in the group was 49. Only 5% of patients said it was their choice to stop working.
The researchers then used these findings to model the likely economic impact at the country scale. With more than 2,000 people living with ABC in Portugal, the researchers estimate a loss in productivity of €28,676,754 over three years. Added to this is a further €3,468,866 in costs over three years for state pensions and unemployment benefits. In contrast, if patients were able to continue working, the researchers estimate that the cost of government subsidises for part-time work would increase by €11,951,048 over three years but with a €14,338,377 reduction in productivity costs.
Overall, the research suggests that supporting people with ABC to continue in more flexible work would bring an extra €2,431,329 into the Portuguese economy every three years.
Dr Matos said: "This research has allowed us to quantify how many ABC patients are lost from the workplace, even though they would prefer to keep working. It also shows us how much is lost to the economy when this happens and conversely how much financial gain could be made by creating the right conditions to allow people to continue working.
"We know that the loss of employment may derive largely from the lack of willingness or policies to accommodate patients' needs, such as flexible work arrangements. Changing labour laws to give extra support and protection to people with all types of advanced cancer could bring enormous benefits to society as a whole."
Although this research is based on people living in Portugal, the researchers say the issue of ABC patients leaving the workplace and suffering financial hardship is common to most countries.
For example, in a second presentation at ABC 7, Mrs Roberta Lombardi explained the impact of financial support from the US charity Infinite Strength for single mothers on low incomes living with ABC. [2]
She carried out an analysis of the applications for six months' financial support for rent or mortgage payments. Out of the 48 women who qualified for the grants, 26 were African American. All the women had either reduced their working hours or had to give up work as a result of their condition. Seven of the women had experienced homelessness and all were at risk of eviction.
As a result of the financial support, all the women were able to remain in their homes or find a place to live for themselves and their children. However, 28 of the women returned to financial hardship at the end of the six months' support.
Mrs Lombardi, Founder and President of Infinite Strength, who has also been treated for early-stage breast cancer, told the Conference: "This work highlights the tremendous financial burden faced by single mothers living with metastatic breast cancer. Direct financial assistance can provide stability and support for families in this time of significant financial need. But the numbers also suggest that Black women are more likely to return to financial hardship and all the problems that brings once financial support is removed. This highlights the need for long-term support."
The financial support offered by Infinite Strength was initially available to patients living on the east coast of the USA, but the scheme has expanded to become nationwide.
Professor Eric P. Winer is an Honorary Chair of ABC 7 and Director of the Yale Cancer Center, USA and was not involved in the research. He said: "Thanks to improvements in treatment, people with advanced breast cancer are living longer, healthier lives. People with ABC should be able to continue working if they want to, not only for their own financial and mental wellbeing, but also to support their families and their communities.
"Employers have a critical role to play in ensuring that people with cancer are not discriminated against in the workplace. They should provide the appropriate setting to help people with cancer fulfil their job responsibilities. However, this can only be fully achieved with government support to provide patients with adjusted and flexible working options.
"For single mothers the burden of advanced breast cancer, combined with the responsibility of providing for and caring for a family, can be even greater. Women in this situation may need extra support to ensure their quality of life is as good as it can be."
