Women who get chemotherapy for breast cancer may end up unemployed for a very long time, researchers reported on Monday.
A few may lose their jobs because they cannot work consistently — although it's usually illegal to fire someone for being ill. But many may underestimate just how much chemotherapy can take out of you, doctors said.
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Dr. Reshma Jagsi of the University of Michigan Health System and her colleagues studied 2,290 women in the Los Angeles and Detroit areas diagnosed with breast cancer between 2005 and 2007. They spoke with more than 1,500 of them four years later.
About 1,000 of the women were under 65 and interviewed both times, and of them, 76 percent had paid jobs before they were diagnosed.
The women who got chemo were less likely to still be working four years later, they reported in the journal Cancer. The researchers found that 38 percent of the women who were able to skip chemo had jobs four years later, versus 27 percent of the women who got chemo.
And some lost their jobs or stopped working soon after diagnosis. Two years after they were diagnosed, 30 percent of the women who got chemo were unemployed, compared to 14 percent of the women who did not.
The findings suggest that even though women want to get back to work as soon as they can, chemo may be changing their lives more than they think, Jagsi said.
"We also need to ensure that patients who are deciding on whether to receive chemotherapy understand the potential long-term consequences of receiving treatment, including possible implications for their employment and financial outcomes," she said.
Most didn't quit on purpose. Of the 127 women who had not worked since they were diagnosed, more than half said it was important for them to work, and 39 were actively looking for a job, the researchers wrote.
It happened to Kris Snow of Ann Arbor, Michigan. She was diagnosed with Stage III breast cancer in 2008, and her doctors recommended chemotherapy before she had surgery, to help shrink her tumor and make it easier to remove.
"You send an army in to weaken it and beat the crap out of it and then surgically take it out. So I said OK," Snow told NBC News
At first, it wasn't so bad.
"Other than being extremely fatigued I didn't get that nauseous," Snow said. "When they started taxol, immediately I got numbness and tingling in (my) fingers and toes and hands," she added.
Snow, a former scientist, had reinvented herself as a home remodeler but couldn't set up contracts because of the side-effects.
"I couldn't work. I was weak and tired," she said. "The tiles and boards I picked up were heavy ... I couldn't even do painting because I was too tired." And clients were demanding the work be done immediately.
Now Snow, who is 53 and who has a 14-year-old son, is on disability. "Basically, I lost my business," she says.
The findings don't surprise breast cancer experts. "For the vast majority of patients, side effects are manageable and they can improve after, but some patients don't feel fully functional for the long term," said Dr. Jennifer Litton, a breast oncologist at MD Anderson Cancer Center in Houston.
"So I think it's really good that the study looked at employment as long as four years after diagnosis."
Side-effects include "chemo brain" — a fogginess that's been documented — and neuropathy, which is a numbness or pain in the arms, legs and feet that can affect a person's ability to do some jobs, such as driving.
"I can think of a patient of mine, a nurse who had chemotherapy, she felt foggy, and she felt unsafe dispensing drugs to her patients, so we had to go back and forth talking to her and her employer," Litton told NBC News.
"I sometimes have to advocate for long-term disability on behalf of my patients."
People who are in poor health often have less money because their illness has affected their ability to work, says James Smith, chair of labor markets and demographic studies for the think tank RAND Corp.
—By Judy Silverman of NBC News