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、但尚未得到充分研究的压力源之一。 长期的财务后果可能包括支付账单困难、债务积累和破产。 重要的是，癌症幸存者的破产与死亡率的增加有关。有工作机会的妇女 调节，如时间表的灵活性，更有可能在化疗期间起作用，并保留他们的 从长远来看，就业机会。同样，有足够病假的女性可能会选择休假，同时保持 工作有保障。然而，低收入的少数族裔不太可能有这样的住宿，导致更高的 失业和财务困境的比率。对于这些患者来说，在治疗期间找到继续工作的方法是 危急时刻。在关注移民和少数族裔女性的乳腺癌和劳动力研究中，只有 57%的确诊前受雇的低收入女性在治疗完成后保住了工作，相比之下 93%的高收入女性。低收入女性比高收入女性更有可能 有通融的雇主，只有四分之一的人有可能保住他们的工作。然而，患者的 随着时间的推移，对要求改善工作环境的信心是保持信心的五倍以上 他们的工作比那些信心没有改善的人更多。基于这些数据，我们开发了乳房 巨蟹座与员工沟通应用。家长研究的目标是评估 这款应用程序在促进接受辅助(根治性)乳腺癌化疗的女性保住工作方面发挥了作用。 对于拟议的延期，我们将在已获资助的研究的基础上，将参与者的跟进时间延长至3 多年来，提供了对治疗后存活期工作的长期看法。此外，我们还将 评估我们的应用程序对长期整体财务困难的影响，提供以下关键知识 将加深我们对工作和经济困难之间的关系以及 专注于工作的干预(比如我们的工作)可能会在减轻经济困难方面起到作用。建议数 扩展有两个主要组成部分，使我们能够研究长期工作成果并更好地理解 工资下降和失业对长期经济困难的影响。在目标1中，我们将延长后继 治疗随访3年至1)对乳腺癌患者的工作成果有更长远的认识 幸存者，2)评估住宿条件随时间的变化，以及3)评估工作成果 在接受延长的术后化疗(这已成为一些人的标准护理 自父母研究资助以来的时间内的患者)。在目标2中，我们将衡量两者之间的关系 通过将患者报告的就业变化(工作状态、工作时间、 和收入)到财务困难的主观和客观指标。此外，我们还将进行半 对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和 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.