Poor women undergoing breast cancer treatment are four times more likely to lose their jobs than their high-income peers, a new study suggests.
The findings were consistent with stories Molly MacDonald hears at the Pink Fund, a Rochester Hills, Michigan, nonprofit she started to offer financial help to women with breast cancer in 2006, after treatment for the disease left her jobless and bankrupt.
"While fighting for their lives, many patients lose their livelihoods," MacDonald said in a phone interview.
The loss disproportionately strikes poor women, probably because low-wage hourly workers tend to be more easily replaceable, and their employers are less likely to accommodate their needs as they go through time-consuming and draining treatment, MacDonald said.
Dr. Victoria Blinder, a breast cancer oncologist at Memorial Sloan Kettering Cancer Center in New York City, led a team of researchers who analyzed the job status of 267 racially and ethnically diverse women treated for invasive breast cancer between 2010 and 2016.
Income and employers' willingness to make workplace accommodations were the driving factors in whether women retained their jobs four months after finishing breast cancer treatment, the researchers found.
Low-income women were only half as likely as higher-income women to have accommodating employers and only one-fourth as likely to keep their jobs, according to the results in Health Affairs.
"We showed that if they're able to obtain work accommodations, they're more likely to retain their jobs," Blinder said in a phone interview. "The key is to try to help women so they advocate for themselves and optimize their chances of staying on a job they want to keep."
Patients have told her that when they're not working, they're often in bed thinking about cancer.
"The psychological impact of going through a diagnosis and these treatments can be profound. Work for a lot of people is a way to escape that and to feel like they are in control," she said.
Race and ethnicity had little impact on whether women kept their jobs, the study found, although Chinese participants were less likely to continue working than white women, a statistic diluted by the small number of women in both categories.
"The value of the paper is there does not seem to be much ethnic or racial bias here," said Dr. Patricia Ganz, professor at the UCLA Fielding School of Public Health in Los Angeles.
"The more important thing is the kind of employment. If you're low income, your employer is more likely going to be inflexible about keeping your spot," she said in a phone interview.
"It's a social and equity issue," she said.
Ganz and Blinder both said they frequently write letters to employers on behalf of patients who need help advocating for themselves. In some cases, the fix is as simple as providing more breaks or allowing time off for treatment.
In other cases, MacDonald said, saving a job could be impossible, if, for example, a bus driver who underwent a mastectomy feels pain every time she shifts gears while driving.
Blinder is working on developing a mobile health app that would coach women on negotiation strategies for accommodations.
Under the Americans with Disabilities Act, government employers and private employers with 15 or more employees must make "reasonable accommodations" for workers diagnosed with cancer.
Nearly one in eight American women will be diagnosed with breast cancer in her lifetime, the authors write.
A 2016 study in the Journal of Clinical Oncology found that people who underwent cancer treatment and filed for bankruptcy protection were more likely to die than those who remained financially healthy.
A previous Health Affairs report found that one-third of working-age cancer survivors go into debt, and 3 percent file for bankruptcy.