The role of cognitive impairments in patients' return to work and quality of working life after treatment of breast or gynecologic cancer.

purposeWe examined the impact of cancer-related cognitive impairment (CRCI) after systemic or radiation therapy for breast or gynaecologic cancer on return to work (RTW) and quality of working life (QWL).

methodsThe analyses included 147 women diagnosed with breast or gynecologic cancer from the CogniFiT study who were 18-65 years old and employed at diagnosis. We assessed objective cognitive function (visual search, executive function, and verbal memory), subjective cognitive function (FACT-Cog), and other patient-reported outcomes before primary systemic or radiation therapy (T0), at the end of it (T1), and 1 year later (T2). Patients reported on RTW until T2 and, if applicable, QWL (QWLQ-CS). Logistic regressions on RTW and multiple regressions on QWL were calculated separately for each cognitive variable and patient-reported outcome and were adjusted for education, age, marital status, and chemotherapy.

resultsAt T2, 77.6% of patients had returned to work. Higher impairments in executive function, i.e., working memory (OR = 0.45, 95% CI [0.23-0.80]) and task-switching ability (OR = 0.48, 95% CI [0.25-0.82]) at T1, were associated with a lower likelihood for RTW at T2. Subjective cognitive impairments were not associated with RTW, but with lower QWL (β = - 0.35, 95% CI [- 0.53 to - 0.16]). Other patient-reported outcomes also showed no associations with RTW but were associated with QWL.

conclusionsDeficits in executive function, but not other domains, may hinder return to work. Subjective and objective measures of cognition relate to work outcomes differently. IMPLICATIONS FOR CANCER SURVIVORS: Clinicians should openly address cognitive impairments as affected survivors may need additional support and workplace adaptations when returning to work.