Unmet Employment Related Needs of Metastatic Breast Cancer Survivors: A Work System Analysis

Metastatic breast cancer (MBC) is incurable breast cancer (i.e., stage IV) affecting approximately 165,000 women in the US, some of whom will live for years with MBC. Survivors living with MBC frequently experience functional impairments and sickness relating to treatment and their disease progression. Unlike “curable” cancers, MBC survivors are likely to deal with ongoing and/or evolving impairments due to cancer and cancer treatment until end of life, which presents challenges to work and employment. Little is known about the work-related needs of MBC survivors and the factors that impact individual survivors’ decisions to stay-or-leave work. The objective of this study is to understand the work system barriers and facilitators facing MBC survivors who were working at the time of MBC diagnosis. We conducted a survey of MBC survivors as a part of a larger research project to explore the importance of work and work-related decisions in this population. We conducted a secondary, deductive content analysis of a free-text response survey question guided by the Work System model. We identified a total of 77 excerpts, grouped into 12 barriers and 5 facilitators from survey responses of 133 MBC survivors. The person work system element resulted in the most barriers and facilitators, with numerous barriers relating to a lack of information available for MBC survivors. We only identified one excerpt relating to the technology work system element. Given the rapidly growing capabilities of technologies, there is a missed opportunity to design technologies that can support MBC survivors. The increased use of dedicated personnel (e.g., social work, navigators or financial counselors) and the development of patient-facing health IT may better support the unique needs of MBC survivors.