Work Ability, Anxiety, and Depression Among Long-Term Breast Cancer Survivors of Northern Kerala, India; A Historical Cohort Study

Background: Increasing number of breast cancer cases, and improved survival due to advancements in early detection, and treatment resulted in an increase in women living beyond a cancer diagnosis. Survivors have to face long-term physical effects as well as psychosocial issues post-treatment. This study aims to study survivourship in terms of work ability, anxiety and depression.

Methods: Retrospective cohort study on female breast cancer survivors from Hospital Based Cancer Registry (HBCR) of a Tertiary Cancer Centre (TCC). Data from 2016 (n=534) were collected from the medical records, and a follow-up survey (n=209) was conducted in 2022 to study their survivorship issues.

Results: In 2022, the mean age of the cohort (n=209) was 55.45 ± 9.36. The mean work ability score was 40.7±5.73 (95% CI 39.92 to 41.48).  In the multivariate binary logistic regression model, those who were married (OR 7.15, 95%CI 2.61 to 19.55), disease-free (OR 15.27, 95% CI 2.36 to 98.7), employed (OR 9.09, 95%CI 1.12 to 73.5), having no fatigue (OR 2.6, 95% CI 1.05 to 6.48), no pain (OR 3.11, 95% CI 1.16 to 8.35), and no depression (OR 6.58, 95% CI 1.82-23.8) were found to have optimal work ability. Anxiety (OR 4.93, 95% CI 1.76 to 13.76), and sub-optimal work ability (OR 4.22, 95% CI 1.39 to 12.77) were predictors of depression among survivors. Disease status and fatigue were associated with all three dimensions of survivorship in our study.

Conclusion: Understanding survivorship will help improve health outcomes in this population. In our study, work ability, anxiety, depression, and their associated factors were found to be interrelated. Interventions in these areas can go a long way in improving breast cancer survivorship.