Beyond toxicity

For early stage breast cancer, treatment decisions frequently center on maximizing treatment effectiveness in terms of survival or cure. However, through advances in early detection and treatment, the risk of recurrence for many patients can be reduced to the point that some treatment options are of only marginal benefit. Patients and clinicians may be faced with complex decisions in which a small reduction in recurrence risk must be weighed against likely short-term toxicities and the potential for rare but serious longterm risks. Database-driven models and genetic predictors of recurrence risk are designed to inform such decision making; however, frequently, difficult choices remain. Because the majority of patients will experience long-term survival after a breast cancer diagnosis, increased attention is focused appropriately on the full spectrum of challenges faced by patients after the initial stages of treatment. In this context, an important area for consideration is the impact of treatment choices on the patient’s ability to continue employment after diagnosis of breast cancer. Although prospective clinical trials frequently include assessment of quality of life, in addition to direct measures of efficacy and toxicity, and most tools take ability to work and degree of difficulty at work into account, to our knowledge few directly address actual changes in employment status. In this issue of Cancer, Hassett et al add to an important literature that examines the association between treatment for breast cancer and employment. On the basis of identifying adult women aged 63 years with incident cases of invasive breast cancer in the Medstat MarketScan Commercial Claims and Encounters Research Database, they evaluated changes in employment status during the 12 months after diagnosis and examined the demographic, disease-related, and treatment-related factors that correlated with employment changes. Specifically, they observed an association between treatment type (chemotherapy) and employment disruption and demonstrated that older women in this cohort, particularly those ages 58 years to 63 years, were more likely to experience an employment change than younger women.