Published: Value in Health, 2017
Objectives
While the clinical impact of HER2+ breast cancer (HER2+BC) is well described, data on the societal impact are lacking. This study compared work productivity in three HER2+ patient groups: early (E)BC during adjuvant treatment, EBC post-treatment, and metastatic (M)BC.
Methods
A cross-sectional, observational study of 299 consenting female patients recruited from 14 secondary care centres. Group1 (n=89): receiving targeted HER2 therapy±chemotherapy for EBC; Group2 (n=108): in follow-up post-targeted treatment for EBC; Group3 (n=102): MBC on treatment. Patients completed questionnaires including the Work Productivity and Activity Impairment (WPAI) measure and EQ-5D-5L; clinical staff collected patient and disease characteristics from medical records. Associations and inter-group differences were assessed using correlational analysis and univariate analysis of variance (ANOVA). [NCT03099200].
Results
Fewer Group3 patients were employed (n=28) compared to Group1 (n=45) and Group2 (n=55) (p<0.003), with more reporting an inability to work (Group3: n=27, Group1: n=7, Group2: n=5) (p<0.003). Of employed patients, Group2 reported lower mean (SD) levels of work absenteeism (9% [24%]) and overall work impairment (26% [31%]), compared to Group1 (38% [44%]; p<0.001 and 49% [40%]; p=0.015, respectively), and marginally lower mean (SD) levels of absenteeism than Group3 (31% [44%]; p=0.068). Across all patients (including unemployed), mean (SD) activity impairment in Group1 (34% [28%]) and Group2 (28% [26%]) was lower than in Group3 (48% [31%]; p<0.005). Across groups, higher work and activity impairments were associated with lower EQ-5D-5L health utility: r=-.3950; p<0.001, and r=-0.6670; p<0.001, respectively.
Conclusions
The relatively low levels of absenteeism and work impairment reported by employed patients suggest that those who were able to work remained productive. However, a higher proportion of MBC patients were unable to work, and reported significantly higher levels of overall activity impairment compared to those with EBC. Impairment was related to health utility, reflecting the overall impact of advanced disease.
