Journal of Cancer Therapy, 2013, 4, 1330-1334
http://dx.doi.org/10.4236/jct.2013.48157 Published Online October 2013 (http://www.scirp.org/journal/jct)
The Role of Work in Breast Cancer Patients
Manuela Pennisi1, Giuseppe Chisari2, Marco Vacante3, Francesco Lucca3, Salvatore Spitaleri3,
Giulia Malaguarnera4*, Giuseppe Grosso4, Filippo Drago4, Vito Catania5, Alfre d o Conso li5,
Mariano Malaguarnera3
1Department of Neurosciences, University of Catania, Catania, Italy; 2Department of Biomedical Sciences, University of Catania,
Catania, Italy; 3Research Center “The Great Senescence”, University of Catania, Catania, Italy; 4International PhD Programme in
Neuropharmacology, University of Catania, Catania, Italy; 5Department of General Surgery, University of Catania, Catania, Italy.
Received June 10th, 2013; revised July 9th, 2013; accepted July 17th, 2013
Copyright © 2013 Manuela Pennisi et al. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
ABSTRACT
Background: Since the survival rates of cancer have increased considerably, the long-term side effects of cancer and
cancer-related treatments may impact survivors’ capability to regain normal lives. The aim of this study was to evaluate
the effects of the breast cancer on the job satisfaction and the quality of life. Methods: We enrolled 130 women di-
vided into four groups: 1) 40 breast cancer survivors (aged 39 - 50); 2) 44 women diagnosed with breast cancer (aged
35 - 49); 3) 46 women in good health status (aged 37 - 48). Job satisfaction was measured with the Warr-Cook-Wall
(WCW) Job satisfaction scale that measures overall job satisfaction and satisfaction with nine aspects of work. Results:
Compared to healthy subjects, breast cancer survivors reported a poorer number of hours of work (p < 0.05) and a sig-
nificant amount of variety in job (p < 0.01), opportunity to use abilities (p < 0.001), income (p < 0.01). Compared to
patients with breast cancer at diagnosis, breast cancer survivors reported a significant amount of variety in job (p <
0.05), opportunity to use abilities (p < 0.05), amount of responsibility (p < 0.05), income (p < 0.05). In our study, the
comparison between breast cancer survivors, breast cancer at diagnosis, and healthy subjects does not differ signifi-
cantly in overall job satisfaction. Conclusions: Understanding the job problems associated with cancer can provide
relevant information regarding potential treatment and psychological support in breast cancer survivors.
Keywords: Breast Cancer; Job Satisfaction; Quality of Life; Cancer Survivors; Work; Absenteeism; Presenteeism
1. Introduction
Breast cancer is the most common malignancy in women
with annual incidence rates ranging from 11.8 per
100,000 in eastern China to 86.3 per 100,000 in North
America [1]. Early screening for breast cancer saves pa-
tient’s breasts and improves their chances and full recov-
ery [2]. Compared with women of similar age without a
history of cancer, a slightly higher proportion of breast
cancer survivors reduced work ability [3] or work per-
formance. The prolonged work absenteeism has a rele-
vant economic impact on the patient and her family.
These outcomes can regrettably lead to a cascade of
problems for the survivor, the workplace and the society
[4]. Even in patients who have node-negative breast can-
cer and are considered to be at low risk, the 10-year re-
currence rate following exclusive local therapy is 15% -
45%, while in patients with node-positive disease, the
rate reaches levels as high as 25% - 90% [5]. Survivors
may have ongoing emotional problems due to fears of
recurrence or death and changes in social relationships
[6]. Various studies demonstrated that exercise and
physical activity can improve many of the symptoms and
health problems experienced by breast cancer survivors
[7,8]. The aim of this study was to evaluate the work-
directed intervention on work productivity, on job satis-
faction and consequently on absenteeism and presentee-
ism.
2. Methods
All eligible subjects to participate in this study were
women, presenting for initial breast tumor evaluation at
Cannizzaro Hospital from January 2008 to December
2010. Questionnaires were used to determine partici-
pants’ demographic (age, education and marital status)
and health information (non-cancer medical history,
cancer disease stage at diagnosis, recurrence, cancer
*Corresponding author.

The Role of Work in Breast Cancer Patients 1331
treatment and other medical information) (Table 1). The
inclusion criteria were at least 30 years of age, employed
full or part time. The exclusion criteria were as follows:
patients who have alarming symptoms and signs, includ-
ing weight loss, anaemia, headache; asthma or chronic
obstructive pulmonary disease; chronic hepatitis or liver
cirrhosis; angina, myocardial infarction or heart failure;
malignancy; neurosis or psychosis; dementia. Partici-
pants were initially recruited to participate in a study
examining work and ability and health related quality of
life. After obtaining informed, written consent, demo-
graphic, laboratory and clinic-pathological data were
obtained from medical record review and patient inter-
view and incorporated into a clinical database. Job satis-
faction was measured with the Warr-Cook-Wall (WCW)
Job satisfaction scale developed by Warr [9]. The WCW
instrument measures overall job satisfaction and satisfac-
tion with nine aspects of work (amount of variety in job,
opportunity to use abilities, freedom of working method,
amount of responsibility, physical working condition,
hours of work, income, recognition for work, and col-
leagues and fellow workers) with each item rated on a
7-point Likert scale (1 = extreme dissatisfaction to 7 =
extreme satisfaction). A higher overall mean score indi-
cates higher job satisfaction. Absenteeism and presentee-
ism were evaluated in all subjects. Absenteeism was ex-
Table 1. Demographic char ac teristics of subjects include d in the study.
Characteristics Breast Cancer Survivors (Group 1) Breast Cancer at diagnosis (Group 2) Healthy subjects (Group 3)
Patients (n) 40 44 46
Age (years) 44.7 ± 5.2 41.8 ± 6.7 42.9 ± 5.4
HR (bpm) 74 ± 5 77 ± 6 76 ± 4
SBP (mmHg) 132 ± 12 136 ± 8 135 ± 6
DBP (mmHg) 80 ± 8 78 ± 9 79 ± 8
BMI (Kg/m2) 25.8 ± 2.4 26.2 ± 2.0 25.7 ± 2.6
Education
<High School 12 (30%) 14 (31%) 12 (26%)
High School 18 (45%) 18 (40%) 14 (30%)
>High School 10 (25%) 12 (27%) 20 (43%)
Marital status
Married 24 (60%) 27 (61%) 28 (60%)
Single 6 (15%) 4 (9%) 6 (13%)
Divorced/Separated 4 (10%) 6 (14%) 4 (8%)
Widow/Widower 6 (15%) 7 (15%) 8 (17%)
Employment
Working full time 30 (75%) 31 (70%) 30 (65%)
Working part time 10 (25%) 13 (29%) 16 (35%)
Smoking
No 15 (37%) 12 (27%) 12 (26%)
Current 20 (50%) 22 (50%) 18 (39%)
Ex 5 (12%) 10 (23%) 16 (35%)
Alcohol
No 22 (55%) 25 (56%) 26 (56%)
Current 4 (10%) 6 (14%) 4 (8%)
Ex 14 (35%) 13 (29%) 16 (35%)

The Role of Work in Breast Cancer Patients 1332
pressed as both the total work time lost (the sum of total
hours absent for breast cancer symptoms) and the per-
centage of work time lost during employed time for the
past seven days. Presenteeism was expressed as both
total limited work time and the percentage of limited
productivity whilst at work [10].
Statistical Analysis
Results are expressed as means +/− standard deviations.
Comparisons of quantitative data were made using the
Student’s t-test or Mann-Whitney test. Qualitative data
were analyzed using the chi-square test. A P value of
<0.05 was considered as indicating a statistically signifi-
cant difference. All data management and statistical cal-
culations were performed using SPSS 15.0 statistical
package (Chicago, IL).
3. Results
Demographic characteristics of subjects included in the
study are reported in Table 1. There were not significant
differences between groups at baseline with respect to
sex, age, education, marital status, type of employment
(full or part time), smoking and alcohol consumption.
Subjects working full time were 75% in Group 1, 70% in
Group 2 and 65% in Group 3; subjects working part time
were in the three groups respectively 25%, 29% and
35%.
Compared to healthy subjects, breast cancer survivors
reported a poorer numbers of hours of work (p < 0.05)
and a significant amount of variety in job (p < 0.01), op-
portunity to use abilities (p < 0.001), income (p < 0.01).
Compared to patients with breast cancer at diagnosis,
breast cancer survivors reported a significant amount of
variety in job (p < 0.05), opportunity to use abilities (p <
0.05), amount of responsibility (p < 0.05), income (p <
0.05) (Table 2). Both the mean absenteeism and mean
presenteeism were similar in all groups. In breast cancer
survivors the overall job satisfaction was significantly
increased in married and employed working full time. In
patients with breast cancer at diagnosis the overall job
satisfaction was significantly decreased in both married
and working part-time subjects.
4. Discussion
The improvement of social environmental condition,
medical care, screening and diagnostic parameters caused
an increase of survival in breast cancer patients [11].
Since the survival rates of cancer have increased consid-
erably, the long-term side effects of cancer and cancer-
related treatments may impact survivors’ capability to
regain normal lives. This implies that some forms of can-
cer are becoming chronic diseases entailing both poorer
overall quality of life compared to the general population
and disabling long-term residual symptoms, such as fa-
tigue, depression, pain and functional limitation [12].
This condition determines a high impact on the quality of
life, including, physical and mental health, on work and
return to work. A large body of psychosocial cancer re-
search has noted the importance of distressing factors,
individual coping attempts, psychosocial burden and re-
sources in understanding both health-related quality of
life and psychological adjustment to cancer. The objec-
tive of our study was to evaluate the elements that have
the main impact on overall job satisfaction separated
from breast cancer survivors, breast cancer, and healthy
workers. Advances in diagnosis and treatment of breast
cancer have created a large population of survivors
Table 2. Job satisfaction scores in breast cancer survivors.
Breast Cancer Survivors
(Group 1; n = 40)
Breast Cancer at diagnosis
(Group 2; n = 44) Healthy subjects (Group 3; n = 46)
Amount of variety in job 5.45 ± 1.21 4.87 ± 1.44** 4.76 ± 1.61B
Opportunity to use abilities 5.87 ± 1.04 5.21 ± 1.08** 5.04 ± 1.02C
Freedom of working method 5.21 ± 1.44 5.44 ± 1.09* 5.10 ± 1.10A
Amount of responsibility 5.75 ± 1.67 5.10 ± 1.22** 5.21 ± 1.36A
Physical working condition 4.82 ± 1.87 5.00 ± 1.46* 5.12 ± 1.22A
Hours of work 4.67 ± 1.44 4.96 ± 1.38* 5.28 ± 1.20B
Income 4.44 ± 1.65 5.24 ± 1.31** 5.31 ± 1.41B
Recognition for work 5.04 ± 1.20 5.10 ± 1.28* 5.25 ± 1.32A
Colleagues and fellow workers 5.61 ± 1.08 5.44 ± 1.12* 5.36 ± 1.18A
Overall job satisfaction 5.41 ± 1.04 5.20 ± 1.18* 5.28 ± 1.25A
Comparison between group 1 and group 2: *p = NS; **p < 0.05; ***p < 0.001. Comparison between group 1 and group 3: Ap = NS; Bp < 0.05; Cp < 0.001.

The Role of Work in Breast Cancer Patients 1333
requiring long-term follow-up care [1,2]. The risk of dis-
ease recurrence peaks during the first 5 years after pri-
mary therapy, but may continue for up to 30 years after
that. Work plays an important role in the psychological
treatment for many patients. As a result, breast cancer is
increasingly viewed as a chronic illness [9-11]. Our cul-
ture continues to perpetuate the healthy subject view that
an individual with cancer is somehow now defective.
Work intervention has been found to have significant
positive effects on functional capacity and physical func-
tioning, fatigue, body image, psychological adjustment,
sleep problems and overall health and quality of life [12-
16]. In our study, the comparison between breast cancer
survivors, breast cancer at diagnosis, and healthy subjects
does not differ significantly in overall job satisfaction.
Job satisfaction was often stated as a strong motivator for
social status and for social contacts. Changes in the life
of the person with cancer (e.g. being away from work or
not being able to do the usual roles at home) may affect
the person’s self-esteem [2]. Yet employers continue to
perceive cancer survivors as poor risks for advancement
and cancer survivors are at high risk for job loss. A limi-
tation of this study was the small number of included
subjects. Understanding job problems associated with
cancer can provide relevant information regarding poten-
tial treatment and psychological support in breast cancer
survivors. More systematic investigation is needed vary-
ing the dimensions of activity explored in this study.
5. Acknowledgements
GM was supported by the International PhD programme
in Neuropharmacology, University of Catania. The au-
thors declare that they have no competing interests.
REFERENCES
[1] D. M. Parkin, F. Bray, J. Ferlay and P. Pisani, “Global
Cancer Statistics, 2002,” CA: A Cancer Journal for Cli-
nicians, Vol. 55, No. 2, 2005, pp. 74-108.
http://dx.doi.org/10.3322/canjclin.55.2.74
[2] L. L. Humphrey, M. Helfand, B. K. Chan and S. H.
Woolf, “Breast Cancer Screening: A Summary of the Evi-
dence for the US Preventive Services Task Force,” An-
nals of Internal Medicine, Vol. 137, No. 5, 2002, pp. 347-
360.
http://dx.doi.org/10.7326/0003-4819-137-5_Part_1-20020
9030-00012
[3] C. J. Bradley, D. Neumark, H. L. Bednarek and M.
Schenk, “Short-Term Effects of Breast Cancer on Labor
Market Attachment: Results from a Longitudinal Study,”
Journal of Health Economics, Vol. 24, No. 1, 2005, pp.
137-160. http://dx.doi.org/10.1016/j.jhealeco.2004.07.003
[4] C. Messner and D. Patterson, “The Challenge of Cancer
in the Workplace,” Cancer Practice, Vol. 9, No. 1, 2001,
pp. 50-51.
http://dx.doi.org/10.1046/j.1523-5394.2001.91009.x
[5] I. A. Olivotto, C. D. Bajdik, P. M. Ravdin, C. H. Speers,
A. J. Coldman, B. D. Norris, G. J. Davis, S. K. Chia and
K. A. Gelmon, “Population-Based Validation of the Prog-
nostic Model ADJUVANT! for Early Breast Cancer,”
Journal of Clinical Oncology, Vol. 23, No. 12, 2005, pp.
2716-2725. http://dx.doi.org/10.1200/JCO.2005.06.178
[6] N. K. Aaronson, “Methodologic Issues in Assessing the
Quality of Life of Cancer Patients,” Cancer, Vol. 67,
Suppl. 3, 1991, pp. 844-850.
http://dx.doi.org/10.1002/1097-0142(19910201)67:3+<84
4::AID-CNCR2820671416>3.0.CO;2-B
[7] V. Mock, K. H. Dow, C. J. Meares, P. M. Grimm, J. A.
Dienemann, M. E. Haisfield-Wolfe, W. Quitasol, S. Mi-
tchell, A. Chakravarthy and I. Gage, “Effects of Exercise
on Fatigue, Physical Functioning, and Emotional Distress
during Radiation Therapy for Breast Cancer,” Oncology
Nursing Forum, Vol. 24, No. 6, 1997, pp. 991-1000.
[8] A. J. Daley, H. Crank, N. Mutrie, J. M. Saxton and R.
Coleman, “Determinants of Adherence to Exercise in
Women Treated for Breast Cancer,” European Journal of
Oncology Nursing, Vol. 11, No. 5, 2007, pp. 392-399.
http://dx.doi.org/10.1016/j.ejon.2007.03.001
[9] P. Warr, J. Cook and T. Wall, “Scales for the Measure-
ment of Some Work Attitudes and Aspects of Psycho-
logical Well-Being,” Journal of Occupational P s yc ho lo gy ,
Vol. 52, No. 2, 1979, pp. 129-148.
http://dx.doi.org/10.1111/j.2044-8325.1979.tb00448.x
[10] M. C. Reilly, K. L. Gooch, R. L. Wong, H. Kupper and D.
van der Heijde, “Validity, Reliability and Responsiveness
of the Work Productivity and Activity Impairment Ques-
tionnaire in Ankylosing Spondylitis,” Rheumatology (Ox-
ford), Vol. 49, No. 4, 2010, pp. 812-819.
[11] M. Vacante, V. D’Agata, M. Motta, G. Malaguarnera, A.
Biondi, F. Basile, M. Malaguarnera, C. Gagliano, F. Drago
and S. Salamone, “Centenarians and Supercentenarians:
A Black Swan. Emerging Social, Medical and Surgical
Problems,” BMC Surgery, Vol. 12, Suppl. 1, 2012, p. S36.
http://dx.doi.org/10.1186/1471-2482-12-S1-S36
[12] P. Frazzetto, M. Vacante, M. Malaguarnera, E. Vinci, F.
Catalano, E. Cataudella, F. Drago, G. Malaguarnera, F.
Basile and A. Biondi, “Depression in Older Breast Cancer
Survivors,” BMC Surgery, Vol. 12, Suppl. 1, 2012, p. S14.
http://dx.doi.org/10.1186/1471-2482-12-S1-S14
[13] V. S. Helgeson, “Recent Advances in Psychosocial Onco-
logy,” Journal of Consulting and Clinical Psychology,
Vol. 73, No. 2, 2005, pp. 268-271.
http://dx.doi.org/10.1037/0022-006X.73.2.268
[14] V. S. Helgeson and P. L. Tomich, “Surviving Cancer: A
Comparison of 5-Year Disease-Free Breast Cancer Sur-
vivors with Healthy Women,” Psycho-Oncology, Vol. 14,
No. 4, 2005, pp. 307-317.
http://dx.doi.org/10.1002/pon.848
[15] S. Moulder and G. N. Hortobagyi, “Advances in the
Treatment of Breast Cancer,” Clinical Pharmacology &
Therapeutics, Vol. 83, 2008, pp. 26-36.
http://dx.doi.org/10.1038/sj.clpt.6100449
[16] F. C. Dimeo, F. Thomas, C. Raabe-Menssen, F. Pröpper
and M. Mathias, “Effect of Aerobic Exercise and Relaxa-

The Role of Work in Breast Cancer Patients 1334
tion Training on Fatigue and Physical Performance of
Cancer Patients after Surgery. A Randomised Controlled
Trial,” Supportive Care in Cancer, Vol. 12, No. 11, 2004,
pp. 774-779.
http://dx.doi.org/10.1007/s00520-004-0676-4