Presenteeism in working-age breast cancer survivors 1-5 years after surgery: relative contributions of treatment-related symptoms and modifiable factors.

[BACKGROUND] Presenteeism among working-age breast cancer survivors drives job loss and economic burden, but the extent to which it is attributable to treatment-related symptoms remains unclear. We examined determinants of presenteeism severity 1-5 years after surgery and preferences for support.

[METHODS] In this cross-sectional study, presenteeism was assessed with the Work Productivity and Activity Impairment questionnaire in 203 employed survivors (< 65 years) 1-5 years post-surgery. Presenteeism was modeled using hierarchical multiple linear regression with four blocks: (1) patient characteristics/treatment exposures; (2) work-related factors; (3) psychological symptoms and health literacy; and (4) physical function and cancer treatment-related symptoms. A modifiable-only sensitivity model with prespecified clinical cutoffs was also estimated.

[RESULTS] Presenteeism was present in 55.7% and severe in 27.1%. Model fit improved stepwise, with the largest incremental variance at Step 4. In the final model, higher presenteeism was independently associated with aromatase inhibitor-induced musculoskeletal symptoms, postmastectomy pain syndrome, greater cancer-related fatigue, reduced shoulder range of motion, and non-desk-based work (all p < 0.05). Over 70% preferred physiotherapy or pharmacotherapy.

[CONCLUSION] Presenteeism in working-age survivors of breast cancer was strongly associated with modifiable treatment-related symptoms. Based on our findings, multidisciplinary, patient-centered interventions are recommended to support job retention and reintegration.