Use of Sickness Benefits by Patients With Metastatic Breast Cancer – A Swedish Cohort Study

Background Advances in the treatment of metastatic breast cancer (mBC) have led to improved life expectancy. Many cancer survivors desire to return to paid work to enhance their sense of well-being. For patients with mBC, little is known about how the diagnosis impacts ability to work or the factors that increase the need for sickness benefits. Patients and methods Data were collected from two Swedish national registers, for females ages 18 to 63 years in the Stockholm-Gotland healthcare region with a new diagnosis of mBC from 1997 through 2011. Type of first-line palliative treatment was identified in medical records of a subset of the study population. Use of sickness absence (SA) and disability pension (DP) by these patients during the year before and one and two years after mBC diagnosis was determined from a third register. Regression analysis was performed to ascertain which covariate factors were associated with long-term (> 30 days) SA. Results A total of 1,240 patients were evaluated the year before and the first year after mBC diagnosis; only 805 patients were still alive and evaluated the second year after diagnosis. The proportions of patients having SA and DP were 56.0% and 24.8% the year before, 69.9% and 28.9% the first year after, and 64.0% and 34.7% the second year after diagnosis, respectively. Adjusted odds of having long-term SA were significantly higher at 1 and 2 years after diagnosis for patients with age < 45 years (AOR = 3.43 and AOR = 1.70, respectively), early calendar year of diagnosis (AOR = 1.72 and AOR = 1.79, respectively), metachronous mBC (AOR = 4.85 and AOR = 4.52, respectively), and SA ≥ 90 days the year before diagnosis (AOR = 3.44 and AOR = 1.98, respectively). Odds were also significantly higher the second after diagnosis for patients treated with chemotherapy (AOR = 1.81) or radiotherapy (AOR = 2.23), compared to those treated with hormonal therapy, Conclusions Rates of SA and DP increase after a diagnosis of mBC. Women who are younger, develop metachronous mBC, use SA heavily before mBC, and receive chemotherapy or radiotherapy have a greater need for sickness benefits after an mBC diagnosis.