Return to work trajectories after early breast cancer diagnosis: A population-based cohort study in the French National Healthcare Insurance database

Return to work (RtW) is important for quality of life after breast cancer (BC), and a difficult challenge for many patients (pts). Current evidence relies mainly on selected populations and limited indicators. We aimed to construct RtW indicators based on sickness leave (SL) and disability pension (DP) benefits, and to explore RtW trajectories. We conducted a retrospective cohort study using data from a random sample of 1/97th beneficiaries of the French National Health System. All women aged 25-55 years with a first early BC diagnosis between 2013 and 2016 were included and followed-up for 3 years. We constructed RtW indicators based on literature review, data availability and stakeholders’ expertise in the national context. Descriptive analyses were performed on sample characteristics and RtW indicators. Longitudinal RtW trajectories were explored using sequence analysis and clustered using optimal matching. Data from 306 pts (56% HR+/HER2-, 24% triple-negative, 14% HER2+, 6% in situ) were extracted. (Neo)adjuvant chemotherapy, trastuzumab and endocrine therapy were administered in 59%, 14% and 66% of pts, respectively. Median time with compensation until full and sustainable (> 28 days) RtW was 242 days. Median cumulative lengths of all-type and full-time sickness absence during follow-up were 450 days and 313 days, respectively. Full-time or partial RtW was achieved by 57% of pts at 1-year, 82% at 2-year and 85% at 3-year after diagnosis. Three RtW trajectories were identified: “RtW within a year” (48% of the population) with pts experiencing RtW during the 1st year and limited subsequent work interruption, “RtW supported by partial SL or DP” (38%) with pts typically returning to work during the 2nd year after a partial SL period or with a partial DP, and “continued compensation” (14%) with pts receiving either complete SL benefit or DP at 3-year. Identification of RtW trajectories based on French medico-administrative databases seems feasible. It revealed large individual variability and identified three distinct groups of RtW trajectories. Further exploration of trajectory determinants and lived experience is needed to develop targeted RtW interventions.