The Breast Cancer and the Workforce Communication App: A randomized controlled trial of an English/Spanish intervention to promote long-term job retention

摘要 失业是与乳腺癌诊断相关的最具影响力但研究不足的压力因素之一。 长期的财务后果可能包括难以支付账单，债务积累和破产。 重要的是，癌症幸存者的破产与死亡率增加有关。有工作机会的妇女 适应性，如时间表的灵活性，更有可能在化疗期间工作，并保持他们的 从长远来看，工作。同样，有足够病假的妇女可以选择休假，同时保持 工作保障然而，低收入的少数民族不太可能有这样的住宿， 失业率和财务困境。对于这些患者来说，找到一种在治疗期间继续工作的方法是 很危险在关注移民和少数民族妇女的乳腺癌和劳动力研究中， 57%的诊断前就业的低收入妇女在治疗完成后保留了工作， 93%的高收入女性。低收入妇女的这一比例不到高收入妇女的一半。 拥有随和的雇主，只有四分之一的人有可能保住工作。然而，患者 随着时间的推移，要求工作住宿的信心得到了改善， 他们的工作比那些信心没有改善的人。基于这些数据，我们开发了Breast 癌症和劳动力沟通应用程序。父母研究的目标是评估 这个应用程序在促进接受辅助（治疗性）乳腺癌化疗的妇女的工作保留。 至于建议的延长期，我们会在已获资助的研究基础上，把跟进参与者的人数增加至3人， 年，提供了一个长期的工作在治疗后生存期的看法。此外，我们将 评估我们的应用程序对长期整体经济困难的影响，提供关键知识， 将加深我们对工作和经济困难之间关系的理解， 以工作为重点的干预措施（如我们的干预措施）可能会减轻经济困难。拟议 扩展有两个主要组成部分，这将使我们能够研究长期的工作成果，并更好地了解 工资下降和失业对长期经济困难的影响。在目标1中，我们将扩展后- 治疗随访3年，以1）获得乳腺癌工作成果的长期观点 幸存者，2）评估随着时间的推移获得住宿的变化，以及3）评估工作成果， 在接受延长的术后化疗（这已成为一些人的护理标准）时， 自母研究获得资助以来的时间内的患者）。在目标2中，我们将衡量 通过将患者报告的就业变化（工作状态，工作时间， 经济困难的主观和客观指标。此外，我们还将进行半- 与一部分研究参与者进行结构化访谈，以确定导致经济困难的途径， 更好地理解工作和经济困难之间的关系。

ABSTRACT Job loss is one of the most impactful, yet understudied, stressors associated with a breast cancer diagnosis. Long-term financial consequences can include difficulty paying bills, accumulation of debt, and bankruptcy. Importantly, bankruptcy in cancer survivors has been linked to increased mortality. Women with access to work accommodations, such as schedule flexibility, are more likely to work during chemotherapy and to retain their jobs in the long term. Similarly, women with adequate sick leave may choose to take time off while maintaining job security. However, low-income minorities are less likely to have such accommodations, leading to higher rates of job loss and financial distress. For these patients, finding a way to continue to work during treatment is critical. In the Breast Cancer and the Workforce study, which focuses on immigrant and minority women, only 57% of pre-diagnosis employed low-income women retained their jobs after treatment completion, compared to 93% of higher-income women. Low-income women were less than half as likely as higher-income women to have accommodating employers and only one-fourth as likely to retain their jobs. However, patients whose confidence in asking for work accommodations improved over time were more than five times as likely to retain their jobs than those whose confidence did not improve. Based on these data, we developed the Breast Cancer and the Workforce Communication App. The goal of the parent study is to evaluate the effectiveness of this app in promoting job retention among women undergoing adjuvant (curative) breast cancer chemotherapy. For the proposed extension, we will build on the funded study by extending the follow-up of participants to 3 years, providing a long-term view of work in the post-treatment survivorship period. Additionally, we will evaluate the effect of our app on overall financial hardship in the long term, providing critical knowledge that will enhance our understanding of the relationship between work and financial hardship and of the role that interventions focused on work (such as ours) may have in attenuating financial hardship. The proposed extension has two main components that will allow us to study long-term work outcomes and better understand the effect of decreased wages and job loss on long-term financial hardship. In Aim 1, we will extend post- treatment follow-up to 3 years to 1) gain a longer-term perspective of work outcomes in breast cancer survivors, 2) evaluate changes in access to accommodations over time, and 3) evaluate work outcomes based on receipt of extended post-operative chemotherapy (which has become the standard of care for some patients in the time since the parent study was funded). In Aim 2, we will measure the relationship between work and financial hardship by correlating patient-reported changes in employment (work status, work hours, and earnings) to subjective and objective indicators of financial hardship. Additionally, we will conduct semi- structured interviews with a subset of study participants to identify pathways leading to financial hardship and to better understand the relationship between work and financial hardship.