Employment After a Breast Cancer Diagnosis: A Qualitative Study of Ethnically Diverse Urban Women

Employment status is related to treatment recovery and quality of life in breast cancer survivors, yet little is known about
return to work in immigrant and minority survivors. We conducted an exploratory qualitative study using ethnically cohesive
focus groups of urban breast cancer survivors who were African-American, African-Caribbean, Chinese, Filipina, Latina, or
non-Latina white. We audio- and video-recorded, transcribed, and thematically coded the focus group discussions and we analyzed
the coded transcripts within and across ethnic groups. Seven major themes emerged related to the participants’ work experiences
after diagnosis: normalcy, acceptance, identity, appearance, privacy, lack of flexibility at work, and employer support. Maintaining
a sense of normalcy was cited as a benefit of working by survivors in each group. Acceptance of the cancer diagnosis was most
common in the Chinese group and in participants who had a family history of breast cancer; those who described this attitude
were likely to continue working throughout the treatment period. Appearance was important among all but the Chinese group
and was related to privacy, which many thought was necessary to derive the benefit of normalcy at work. Employer support included
schedule flexibility, medical confidentiality, and help maintaining a normal work environment, which was particularly important
to our study sample. Overall, we found few differences between the different ethnic groups in our study. These results have
important implications for the provision of support services to and clinical management of employed women with breast cancer,
as well as for further large-scale research in disparities and employment outcomes.