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尚未得到充分研究的压力源之一。 长期的财务后果可能包括支付账单困难、债务积累和破产。 重要的是，癌症幸存者的破产与死亡率增加有关。有工作机会的妇女 住宿安排，例如日程安排的灵活性，更有可能在化疗期间发挥作用并保留其 从长远来看，就业机会。同样，有足够病假的女性可以选择休假，同时维持 工作保障。然而，低收入少数群体不太可能获得此类住宿，从而导致更高的收入 失业和财务困境的比率。对于这些患者来说，找到一种在治疗期间继续工作的方法是 批判的。在关注移民和少数族裔女性的乳腺癌和劳动力研究中，仅 相比之下，57% 的诊断前就业低收入女性在治疗完成后保留了工作 93% 的高收入女性。低收入女性的可能性不到高收入女性的一半 拥有包容的雇主，只有四分之一的人有可能保住工作。然而，患者 随着时间的推移，要求工作便利的信心得到提高，保留的可能性是其五倍多 他们的工作比那些信心没有改善的人要好。根据这些数据，我们开发了乳房 癌症和劳动力沟通应用程序。家长研究的目的是评估 该应用程序可促进接受辅助（治疗性）乳腺癌化疗的女性保留工作。 对于拟议的扩展，我们将在资助研究的基础上，将参与者的随访时间延长至 3 名 年，提供了治疗后生存期工作的长期观点。此外，我们将 从长远来看，评估我们的应用程序对整体财务困难的影响，提供关键知识 将加深我们对工作与经济困难之间的关系以及经济困难所扮演的角色的理解 以工作为重点的干预措施（例如我们的干预措施）可能有助于减轻经济困难。拟议的 扩展有两个主要组成部分，使我们能够研究长期工作成果并更好地理解 工资下降和失业对长期财务困难的影响。在目标 1 中，我们将延长后期 治疗随访长达 3 年，以 1) 获得乳腺癌工作成果的长期视角 幸存者，2) 评估随着时间的推移住宿条件的变化，以及 3) 评估工作成果 接受延长术后化疗（这已成为某些患者的护理标准） 自母研究资助以来的时间段内的患者）。在目标 2 中，我们将衡量之间的关系 通过关联患者报告的就业变化（工作状态、工作时间、 和收入）到财务困难的主观和客观指标。此外，我们还将进行半 对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 更好地理解工作和经济困难之间的关系。