Return to work among self-employed breast cancer survivors from the CANTO cohort

The aim of this study was to assess return to work (RTW) after breast cancer (BC) by baseline employment status. Using data from the CANTO cohort (NCT01993498), we examined RTW among women below age 57 at BC diagnosis 2 and 4 years after BC diagnosis. We also assessed continuous work between years 2 and 4 post-diagnosis. Poisson regression models investigated associations between baseline employment (self-employed vs. employees) and RTW outcomes, adjusting for clinical, sociodemographic, and work-related factors and quality of life. We used education (above high school; high school or lower) as a proxy to further distinguish between white collar self-employees vs. blue collar self-employees (vs. employees). About 8% of women were self-employed at diagnosis. RTW was slightly higher among the self-employed compared to employees 2 years (N = 3178; PR = 1.04, 95%CI 0.98–1.10) and 4 years after diagnosis (N = 2329; PR = 1.05, 0.99–1.12). This effect was limited to white collar self-employed women. Among those who returned to work 2 years after diagnosis (N = 1683), self-employed women showed a 1.15 (1.01–1.31) higher prevalence of continuous work until year 4 post-diagnosis than employees. Self-employed women do not strongly differ from employees when assessing RTW at specific time points, however once returned to work, they experience fewer work interruptions than employees. This was observed in adjusted models, showing the intrinsic importance of job status in the RTW process. These findings highlight the importance of viewing RTW as an ongoing process, in order to provide appropriate and sustained support.