Breast cancer and early retirement: Associations with disease characteristics, treatment, comorbidity, social position and participation in a six-day rehabilitation course in a register-based study in Denmark

Figures & data

Figure 1. Pathway into or out of the workforce after a cancer disease under Danish legislation.

Table I. Descriptive characteristics at time of breast cancer diagnosis of 856 women who later attended rehabilitation and 1 805 frequency-matched comparison women, Denmark, 2002–2007.

	Attended rehabilitation		Comparison group
Characteristic	N	%	N	%	p-value
Age at breast cancer diagnosis (years)
< 40	108	13	211	12
40–50	322	38	653	36
> 50	426	50	941	52
Age when attending rehabilitation (years)
< 40	74	9	–
40–50	295	34	–
> 50	487	57	–
Mean follow-up (years) (5–95% percentile)	2.8	1.0–6.0	2.8	1.0–6.0
Tumor size (mm)					0.8
0–20	490	57	1 038	58
21–50	331	39	685	38
> 51	35	4	82	5
Positive lymph nodes					0.02
0	345	40	846	47
1–3	310	36	617	34
4–9	124	14	201	11
> 10	77	9	141	8
Grade					0.5
I	157	18	361	20
II	336	39	669	37
II	219	26	458	25
Non-ductal carcinoma	124	14	290	16
Missing	20	2	27	1
Receptor status					0.4
Negative	196	23	433	24
Positive	647	76	1 355	75
Missing	13	2	17	1
Menopause status					0.4
Post	329	38	722	40
Surgical method					0.04
Mastectomy	448	52	926	51
Lumpectomy	376	44	840	47
Lumpectomy changed to mastectomy during surgery	32	4	39	2
Adjuvant treatment					0.5
Only surgery	61	7	144	8
Only anti-hormone treatment	135	16	333	18
Only chemotherapy	116	14	245	14
Only radiotherapy	31	4	74	4
Chemotherapy and anti-hormone	199	23	354	20
Chemotherapy and radiotherapy	39	5	88	5
Anti-hormone treatment and radiotherapy	33	4	67	4
Chemotherapy, anti-hormone treatment and radiotherapy	38	4	85	5
Unknown	204	24	415	23
Education					< 0.0001
Basic	193	23	550	30
Vocational	322	38	658	36
Higher	339	40	580	32
Mssing	2	0	17	1
Labor market affiliation at breast cancer diagnosis
Employed	781	91	1 627	90
Unemployed	72	8	164	9
On sick leave^c	3	0	14	1
Income (Euros)					0.008
First quartile	18 134	18 467
Median	22 841	23 694
Third quartile	28 931	30 212
Cohabitation status					0.001
Cohabiting	600	70	1 370	76
Living alone	256	30	434	24
Missing	0	0	1	0
Number of children < 18 years living at home					0.06
0	541	63	1 195	66
1–2	285	33	527	29
> 3	30	4	82	5
Charlson co-morbidity index^b (score)					0.2
0	763	89	1 638	91
1	61	7	111	6
> 2	32	4	56	3
Previous depression^3					0.08
Yes	107	13	184	10
Relapse during follow-up					Log rank p = 0.4
Yes	101	12	168	9
Other malignancy					Log rank p = 0.001
Yes	16	2	10	1
Alive on the 1 January 2007					Log rank p = 0.4
Yes	795	93	1 644	91
Early retirement during follow-up					Log rank p = 0.003
Yes	96	11	135	7

^aTwo or more issues of drugs with an Anatomic Therapeutic Chemical (ATC) code starting with N06A.

^bThis index provides an overall score for co-morbidity on the basis of a composite of values weighted by level of severity assigned to 19 selected conditions, scored from 1 to 6 [14]. We used a modified version containing no cancers [26]. Scores are summarized on the basis of information on hospitalization from 1978 onwards. Score 1: myocardial infarct, congestive heart failure, peripheral vascular disease, cerebrovascular disease, dementia, chronic pulmonary disease, connective tissue disease, ulcer disease, mild liver disease, diabetes type 1 and diabetes type 2. Score 2: hemiplegia, moderate-to-severe renal disease, diabetes with end-organ damage type 1 or type 2. Score 3: moderate-to-severe liver disease. Score 6: AIDS.

^cThe variable “Sick leave year before breast cancer diagnosis” used in analyses as described in text and Table II.

Table II. Adjusted hazard ratios for early retirement for 2 661 women with breast cancer, Denmark, 2002–2007.

	Adjusted HR	95% CI
Tumor size: 10-mm increase	1.04	1.0–1.1
Lymph nodes
Any positive	1	–
None positive	0.80	0.5–1.3
Per additional positive node	1.03	1.0–1.1
Grade
I	1	–
II	1.43	0.7–2.3
III	1.67	0.8–2.7
Non-ductal carcinoma	1.01	0.5–1.7
Receptor status
Negative	1	–
Positive	0.98	0.6–1.7
Menopause
Pre	1	–
Post	0.96	0.6–2.0
Surgery
Mastectomy	1	–
Lumpectomy	0.89	0.6–1.3
Lumpectomy changed to mastectomy during surgery	1.12	0.6–2.5
Adjuvant treatment
Only surgery	1	–
Only anti-hormone treatment	0.76	0.5–1.3
Only chemotherapy	0.49	0.3–0.8
Only radiotherapy	1.02	0.5–1.9
Chemotherapy and anti-hormone	0.50	0.3–0.8
Chemotherapy and radiotherapy	0.62	0.3–2.0
Anti-hormone treatment and radiotherapy	0.70	0.4–3.0
Chemotherapy, anti-hormone treatment and radiotherapy	1.04	0.5–3.0
Education
Basic	1	–
Vocational	0.70	0.5–1.1
Higher	0.56	0.4–1.0
Income (DKr) increased by 20 000	0.93	0.9–1.0
Cohabitation status
Cohabiting	0.70	0.5–0.9
Number of children < 18 years living at home
0	1	–
1–2	0.81	0.5–1.2
1–2	0.81	0.5–1.2
> 3	0.54	0.2–1.2
Charlson co-morbidity index score
0	1	–
1	1.91	1.3–2.9
> 2	1.42	0.7–2.7
Depression before breast cancer diagnosis
Yes	2.29	1.7–3.2
Sick leave year before breast cancer diagnosis^a
Yes	3.75	1.8–7.8
Relapse
None	1
1 year after relapse	2.93	1.3–11.8
2 years after relapse	4.82	1.2–12.9
> 3 years after relapse	3.52	0.9–11.7
Other malignancy^a
No	1	–
Yes	8.68	3.3–22.4

All HRs mutually adjusted. Model includes: Tumor size, lymph nodes, grade, receptor status, menopause, surgery, adjuvant treatment, education, income, cohabiting status, number of children, Charlson comorbidity index, previous depression, sick leave year before breast cancer diagnosis, relapse and other malignancy.

^aBased on few events in the year before breast cancer.

_bBased on 26 events diagnosed after the breast cancer.

Charlson ME, P Pompei, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies; development and validation. J Chronic Dis 1987;40: 373–83.

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