The Breast Cancer and the Workforce Communication App: A randomized controlled trial of an English/Spanish intervention to promote long-term job retention

乳腺癌和劳动力沟通应用程序：一项针对促进长期工作保留的英语/西班牙语干预措施的随机对照试验

• 批准号: 10443450
• 负责人: Victoria S Blinder
• 金额: $ 53.11万
• 依托单位: SLOAN-KETTERING INST CAN RESEARCH
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-02-01 至 2025-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10443450
• 关键词: Adjuvant; Adjuvant Therapy; Affect; Aftercare; Bankruptcy; Breast Cancer Patient; Breast Cancer Treatment; Breast Cancer survivor; Breast Cancer therapy; Cancer Patient; Cancer Survivor; Cellular Phone; Characteristics; Charge; Chemotherapy-Oncologic Procedure; Common Terminology Criteria for Adverse Events; Communication; Communities; Data; Diagnosis; Employment; Ethnic Origin; Face; Financial Hardship; Funding; Goals; High Prevalence; Hour; Immigrant; Income; Intervention; Intervention Studies; Interview; Job loss; Knowledge; Language; Light; Link; Longitudinal Studies; Low income; Malignant Neoplasms; Measures; Minority; Minority Women; Mobile Health Application; Occupations; Oncology; Outcome; Pamphlets; Parents; Participant; Pathway interactions; Patient Outcomes Assessments; Patient Self-Report; Patients; Postoperative Period; Provider; Race; Randomized; Randomized, Controlled Trials; Reporting; Risk; Role; Savings; Schedule; Security; Sick Leave; Structure; Survivors; Symptoms; System; Target Populations; Time; Wages; Woman; Work; Working Women; Workplace; breast cancer diagnosis; chemotherapy; cohort; design; effectiveness evaluation; effectiveness testing; efficacy testing; empowerment; flexibility; follow-up; improved; malignant breast neoplasm; mobile application; mobile computing; mortality; mortality risk; novel; parent grant; provider communication; skills; standard of care; stressor; survivorship; tool; treatment adherence; treatment duration; trial comparing

ABSTRACT Job loss is one of the most impactful, yet understudied, stressors associated with a breast cancer diagnosis. Long-term financial consequences can include difficulty paying bills, accumulation of debt, and bankruptcy. Importantly, bankruptcy in cancer survivors has been linked to increased mortality. Women with access to work accommodations, such as schedule flexibility, are more likely to work during chemotherapy and to retain their jobs in the long term. Similarly, women with adequate sick leave may choose to take time off while maintaining job security. However, low-income minorities are less likely to have such accommodations, leading to higher rates of job loss and financial distress. For these patients, finding a way to continue to work during treatment is critical. In the Breast Cancer and the Workforce study, which focuses on immigrant and minority women, only 57% of pre-diagnosis employed low-income women retained their jobs after treatment completion, compared to 93% of higher-income women. Low-income women were less than half as likely as higher-income women to have accommodating employers and only one-fourth as likely to retain their jobs. However, patients whose confidence in asking for work accommodations improved over time were more than five times as likely to retain their jobs than those whose confidence did not improve. Based on these data, we developed the Breast Cancer and the Workforce Communication App. The goal of the parent study is to evaluate the effectiveness of this app in promoting job retention among women undergoing adjuvant (curative) breast cancer chemotherapy. For the proposed extension, we will build on the funded study by extending the follow-up of participants to 3 years, providing a long-term view of work in the post-treatment survivorship period. Additionally, we will evaluate the effect of our app on overall financial hardship in the long term, providing critical knowledge that will enhance our understanding of the relationship between work and financial hardship and of the role that interventions focused on work (such as ours) may have in attenuating financial hardship. The proposed extension has two main components that will allow us to study long-term work outcomes and better understand the effect of decreased wages and job loss on long-term financial hardship. In Aim 1, we will extend post- treatment follow-up to 3 years to 1) gain a longer-term perspective of work outcomes in breast cancer survivors, 2) evaluate changes in access to accommodations over time, and 3) evaluate work outcomes based on receipt of extended post-operative chemotherapy (which has become the standard of care for some patients in the time since the parent study was funded). In Aim 2, we will measure the relationship between work and financial hardship by correlating patient-reported changes in employment (work status, work hours, and earnings) to subjective and objective indicators of financial hardship. Additionally, we will conduct semi- structured interviews with a subset of study participants to identify pathways leading to financial hardship and to better understand the relationship between work and financial hardship.

抽象的 失业是与乳腺癌诊断相关的最有影响力，但经过研究的压力之一。 长期财务后果可能包括难以支付账单，债务积累和破产。 重要的是，癌症幸存者的破产与死亡率的增加有关。有工作机会的妇女 住宿（例如日程安排灵活性）在化学疗法期间更有可能工作并保留其 从长远来看工作。同样，有足够病假的妇女可以选择在维持的同时休假 工作安全。但是，低收入少数族裔不太可能拥有这样的住宿，导致更高 失业率和财务困扰。对于这些患者，找到一种在治疗期间继续工作的方法是 批判的。在乳腺癌和劳动力研究中，专注于移民和少数族裔妇女 57％的诊断前使用低收入妇女在治疗完成后保留了工作 93％的高收入妇女。低收入妇女的可能性不如高收入女性的一半 拥有可容纳雇主，只有四分之一的可能保留工作。但是，患者的患者 对随着时间的推移提高工作住宿的信心，保留的可能性是五倍以上 他们的工作要比那些没有信心没有提高的工作。基于这些数据，我们开发了乳房 癌症和劳动力通信应用程序。父母研究的目的是评估 该应用程序促进接受辅助（治愈性）乳腺癌化学疗法的妇女的工作保留。 对于拟议的扩展，我们将通过将参与者的随访扩大到3 多年，在治疗后的生存期提供长期的工作。此外，我们会的 从长远来看，评估我们应用程序对整体财务困难的影响，提供关键知识 将增强我们对工作与经济困难之间关系以及对角色之间关系的理解 专注于工作的干预措施（例如我们的工作）可能会减轻经济困难。提议 扩展具有两个主要组成部分，使我们能够研究长期的工作成果并更好地了解 工资下降和失业对长期财务困难的影响。在AIM 1中，我们将扩展到后 - 3年至1）乳腺癌的锻炼结果的治疗后续后续 幸存者，2）评估随着时间的推移访问访问权限的变化，3）评估基于工作结果 收到扩展的术后化疗（这已成为某些人的护理标准） 父母研究以来的患者）。在AIM 2中，我们将衡量 工作和经济困难通过将患者报告的就业变化（工作状态，工作时间， 和收益），以实现经济困难的主观和客观指标。此外，我们将进行半 与一部分研究参与者进行结构化访谈，以确定导致经济困难和的途径 更好地了解工作与经济困难之间的关系。