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Purpose <p>Depressive symptoms (DS) are common in patients with breast cancer (BC). Our aim was to assess the association between return-to-work (RTW) trajectories and DS in long-term BC survivors (BCS) (≥ 5&#xa0;years after diagnosis) in France.</p> Methods <p>The French population-based CONSTANCES cohort was linked to the national retirement insurance (CNAV) and national health insurance system (SNDS) databases. RTW trajectories were identified and categorized using the sequence analysis method&#xa0;and clustering. DS were assessed with the 20-item Center for Epidemiological Studies-Depression (CES-D) scale. The association between RTW trajectories and DS was analyzed with adjusted logistic regressions and statistical analyses were stratified according to the time from BC diagnosis to CES-D completion (i.e. &lt; 5 or ≥ 5&#xa0;years after BC diagnosis).</p> Results <p>DS (CES-D score &gt; 20) was observed in 22.7% in the &lt; 5&#xa0;years CES-D group and 20.2% in the ≥ 5&#xa0;years CES-D group. Three RTW trajectory patterns were identified: sustainable RTW (<i>n</i> = 203), unemployment and work transitions (<i>n</i> = 138), and disability worker status (<i>n</i> = 83). Compared with the sustainable RTW group, DS risk was higher in the disability worker status group (&lt; 5&#xa0;years post-diagnosis: OR [95% CI]: 3.22 [1.46;7.17] and ≥ 5&#xa0;years post-diagnosis: 3.88 [1.13; 14.1]) and in the unemployment and work transitions group (&lt; 5&#xa0;years post-diagnosis: OR [95% CI]: 1.68 [0.81; 3.49], not significant). In this group, risk decreased after 5&#xa0;years (OR [95% CI]: 0.19 [0.03; 0.88]).</p> Conclusion <p>Returning to work or pursuing new professional opportunities after BC may reduce the risk of long-term DS.</p> Implications for Cancer Survivors <p>DS may persist for an extended period after BC diagnosis. Engaging in sustainable RTW and exploring new professional opportunities contribute to supporting long-term psychological well-being and reduce the risk of persistent depressive symptoms in BCS.</p>

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Association between return-to-work trajectories and depressive symptoms in long-term breast cancer survivors: results from the French CONSTANCES cohort

  • 期刊论文

  • 发表日期：

    2025年11月19日

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  • Clémence Rapicault,
  • Bertrand Porro,
  • Julie Gourmelen,
  • Céline Ribet,
  • Anne-Lise Rolland,
  • Yves Roquelaure,
  • Mélanie Bertin

摘要

Purpose

Depressive symptoms (DS) are common in patients with breast cancer (BC). Our aim was to assess the association between return-to-work (RTW) trajectories and DS in long-term BC survivors (BCS) (≥ 5 years after diagnosis) in France.

Methods

The French population-based CONSTANCES cohort was linked to the national retirement insurance (CNAV) and national health insurance system (SNDS) databases. RTW trajectories were identified and categorized using the sequence analysis method and clustering. DS were assessed with the 20-item Center for Epidemiological Studies-Depression (CES-D) scale. The association between RTW trajectories and DS was analyzed with adjusted logistic regressions and statistical analyses were stratified according to the time from BC diagnosis to CES-D completion (i.e. < 5 or ≥ 5 years after BC diagnosis).

Results

DS (CES-D score > 20) was observed in 22.7% in the < 5 years CES-D group and 20.2% in the ≥ 5 years CES-D group. Three RTW trajectory patterns were identified: sustainable RTW (n = 203), unemployment and work transitions (n = 138), and disability worker status (n = 83). Compared with the sustainable RTW group, DS risk was higher in the disability worker status group (< 5 years post-diagnosis: OR [95% CI]: 3.22 [1.46;7.17] and ≥ 5 years post-diagnosis: 3.88 [1.13; 14.1]) and in the unemployment and work transitions group (< 5 years post-diagnosis: OR [95% CI]: 1.68 [0.81; 3.49], not significant). In this group, risk decreased after 5 years (OR [95% CI]: 0.19 [0.03; 0.88]).

Conclusion

Returning to work or pursuing new professional opportunities after BC may reduce the risk of long-term DS.

Implications for Cancer Survivors

DS may persist for an extended period after BC diagnosis. Engaging in sustainable RTW and exploring new professional opportunities contribute to supporting long-term psychological well-being and reduce the risk of persistent depressive symptoms in BCS.