Work Productivity Among Younger Breast Cancer Survivors: The Impact of Behavioral Interventions for Depression.

OBJECTIVES: The Pathways to Wellness randomized controlled trial found that two behavioral interventions, mindfulness awareness practices and survivorship education, reduced depressive symptoms in younger breast cancer survivors (BCS) compared to wait-list control. This secondary analysis examines whether the interventions led to reduced loss of work productivity among younger BCS and whether such reductions were mediated by reductions in depressive symptoms.

METHODS: The Work Productivity and Activity Impairment scale was used to measure work productivity loss at four assessment time points. Correlates of productivity loss at enrollment were examined using multivariable linear regression. Differences in change over time in productivity loss between each intervention group and control were assessed using linear mixed models. Reduced depressive symptoms was tested as a mediator of reduced productivity loss.

RESULTS: Of 247 trial participants, 199 were employed and included in the analyses. At enrollment, higher productivity loss was associated with chemotherapy receipt (p = .003), younger age (p = .021), more severe cognitive problems (p = .002), higher musculoskeletal pain severity (p = .002), more depressive symptoms (p = .016) and higher fatigue severity (p = .033). The mindfulness intervention led to significantly less productivity loss compared to control at all three post-intervention assessment points (all p < .05), with about 54% of the effect mediated by reduction in depressive symptoms. Survivorship education was not associated with reduced loss of productivity.

CONCLUSIONS: These findings suggest that addressing depressive symptoms through behavioral interventions such as mindfulness may mitigate impacts on work productivity in younger BCS.