Three quarters (75.5%) were working full-time at the time of breast cancer diagnosis and 24.5% were working part-time; the mean age was 50.8 (SD
7.8); and 16.5%, 15.5%, and 68.0% were Latina, African American, and White respectively (Table ). The majority of women were married (61.6%), had no co-morbidities (56.3%), received a lumpectomy (71.6%), radiation therapy (70.7%), and chemotherapy (54.5%). Among women receiving chemotherapy, 64.8% of women had completed treatment and 63.9% of women receiving radiation therapy had also completed treatment (not shown in Table ). More than half of women had paid sick leave (54.6%) or a flexible work schedule (61.5%) available at the time of diagnosis and 40.5% of women had both (Table ). The mean time from diagnosis to survey completion was 8.9 months (range: 1 month–26 months).
Job loss after diagnosis (quitting or losing one’s job) was reported by 10.4% of working women and among these women, 84.6% did not work during breast cancer treatment. Job loss was associated with race/ethnicity in bivariate analyses (p
0.001). Latina women had the highest prevalence of job loss followed by African American and White women (24.1%, 10.1%, and 6.9% respectively). There was also racial/ethnic variation in all sociodemographic, clinical, and treatment factors (excluding breast cancer stage at diagnosis and surgical procedure). African American women were most likely to have two or more co-morbidities and least likely to be married. Latinas had the lowest levels of education and income, were most likely to receive chemotherapy, and least likely to have paid sick leave or a flexible work schedule available through work.
Table shows the adjusted odds ratios of job loss by categories of race/ethnicity controlling for sociodemographic, clinical, and treatment factors. In initial models adjusted for study site, age, and time from breast cancer diagnosis. (Model 1), the relative odds of job loss (as compared to Whites) was 4.3 [95% C.I.: 2.6–7.0] for Latinas. There were no significant differences in job loss between African American and White women in Model 1 (OR, 95% C.I. 1.5 [0.9–2.8]). When additional sociodemographic factors (education, income, number supported by family income, marital status, and paid sick leave and/or flexible work schedule) were included, the relative odds of job loss (as compared to Whites) were substantively reduced to 2.2 [95% C.I: 1.2–4.1] for Latinas and remained statistically insignificant for African Americans. In final models (Model 3) adjusting for treatment and clinical factors, we found a statistically significant interaction between race/ethnicity and receipt of chemotherapy (p
0.007). The relative odds of job loss (as compared to Whites) was 3.8 [95% C.I: 1.7–8.2) for Latinas and 1.3 [95% C.I.: 0.5–3.3] for African Americans, among women who received chemotherapy. However, there were no significant differences between Latinas and Whites (OR
0.5, 95% C.I: 0.1–1.7) or African Americans and Whites (OR
0.3, 95% C.I.: 0.1–1.3) among women who did not receive chemotherapy. In final models, the number of co-morbidities, and employment support (paid sick leave/flexible work schedule) were also significantly associated with job loss. Women with two or more co-morbidities were more likely to experience job loss when compared to women with none (OR
2.5 [95% C.I.:1.3–4.9]). Women who did not have employment support (neither paid sick leave nor flexible work schedule) and women who had only one source of employment support were more likely to experience job loss as compared to women who had both sources of support (OR
7.3 [95% C.I: 3.6–14.9 for no source of support; OR
2.4 [95% C.I.: 1.1–4.9] for one source of support).
Adjusted odds ratio [95% C.I] of job loss by sociodemographic, and clinical/treatment factors
The interaction between race/ethnicity and chemotherapy is further illustrated in Fig. . Among women who received chemotherapy, job loss was most prevalent in Latinas with 15.7% reporting job loss as compared to only 6.0% of African American women and 4.7% of White women (independent of sociodemographic, treatment, and clinical factors). However, among women who did not receive chemotherapy, there were minimal differences in job loss across racial/ethnic groups (7.5%, 3.7%, and 2.6% among White, Latina, and African American women respectively) and no statistically significant differences between Latinas and White women or African American and White women. In investigating the interplay between race/ethnicity, receipt of chemotherapy, and employment support (paid sick leave/flexible work schedule), we found no statistically significant interactions between employment support and race/ethnicity or employment support and chemotherapy. The three way interaction between race/ethnicity, employment support, and receipt of chemotherapy was also not statistically significant (all p’s >0.10)
Fig. 1 Adjusted percent job loss by race/ethnicity and chemotherapy. Model includes: age, race/ethnicity, chemotherapy, race/ethnicity*chemotherapy interaction term, education, family income, number supported by family income, full-time employment, employment (more ...)
Job loss was highly associated with most financial strain measures (except use of savings) even after adjusting for sociodemographic, clinical, and treatment factors (Fig. ). Women who experienced job loss compared to women who did not, more often reported that they could not make credit card payments or other bills (27.0% vs. 10.9%), had to cut down on purchasing food and clothing (57.5% vs. 31.6%), and had to cut down on general expenses (76.4% vs. 52.8%). The only racial/ethnic differences in financial strain was for difficulty paying bills (p
0.005). African American women reported having more difficulty paying bills as compared to Whites after adjusting for sociodemographic, clinical, and treatment related factors (OR [95% C.I.]: 2.2 [1.3–3.6]).