Abstract:

Breast cancer is the most common cancer in women, mostly affects women in the working age, between 45-65 years. The therapeutic advances have achieved a very high prevalence (survivors) of about 86%, but are the leading cause of death in women between 35-55 years. It has a great economic impact for health expenses, expenses in incapacity benefits, loss of wages, loss of productivity of the economic system and losses due to absenteeism to companies. Its treatment is in general intense, prolonged, and causes strong emotional distress and poor quality of life damaging the personal, family and social environment. It especially affects negatively the body image and the female self-esteem. This may be a frequent cause of long casualties (prolonged absence of work) and difficult return to work process due both to the effects of the tumor and secondary effects of the treatment, as well as to the appearance of «minor» psychiatric disorders: stress, anxiety, depression and adaptive disorders. The return to work is more difficult when psychological processes appear and sometimes causes more disability than the cancer itself and its sequels. 36% of women with breast cancer suffer from depression and need psychiatric support, and 55% have some type of anxiety disorder or adaptive disorder that requires at least psychological support and anxiolytic prescription in any of the stages of cancer treatment. The psychological factors are directly related to the attitude and this is determinant regarding the return to work. On the other hand, the presence of anxiety and/or depression diminishes the capacity of the woman with cancer to tolerate the treatment and its side effects or to face the problems in the personal environment that a generally so long and sometimes so aggressive process supposes.

Conclusions:

The emergence of psychological processes in breast cancer occurs frequently in the final phase of the process and hinders the return of labor. The appearance of psychological disorders in the initial stage of diagnosis and treatment is not very frequent and against what it might seems, the greater severity of the process or the aggressiveness of the treatments does not parallel imply a greater emotional affection, it is more in these severe processes where anxiety or depression if appear revert or lessen at one year of diagnosis and are more related to structural characteristics of the patient’s personality and other factors in the social and work environment than to the severity of the process. However, it is in the final stage of the treatment, in a percentage close to 35% of the patients with breast cancer, that they develop «minor» psychiatric pathologies causing severe difficulties in the labor return, when they do not condition the no-return or the permanent disability. These mental disorders that occur at the end of the treatment appear more frequently when support is lacking in the social or family environment if the disability (incapacity) is prolonged beyond the year of diagnosis, as well as in cases of uninspiring work, intense physical load or lack of labor support or labor conflict, and as much less influential factors if the patient has a history of previous pathologies or psychological alterations, or older than 55 years. For this reason it is necessary to identify and prevent these psychological processes for a complete socio-health and labor approach and to obtain a greater reincorporation of the surviving patients to work, as well as to improve the patients’ quality of life, and to seek their reintegration into a standardized life. Support should be given to the environment, including support in the work environment to facilitate return to work, including measures for partial and gradual return to work and/or job adaptation. It is also necessary to be aware that the woman who survives breast cancer often needs psychological reconstruction and this also means the therapeutic «rest» of the clinical world that attended her in the phase of active disease and reinforced with a period of adaptation and coping of the vital realities.

Material and method:

the following bibliographic databases were reviewed until May 2017: SciELO, PUBMED, BMC cancer, in relation to breast cancer survivors, onset of mental processes, and return to work, including several systematic reviews. As well as a study of the processes of breast cancer that reached 12 months of temporary incapacity and those assessed as permanent disability in the disability assessment teams of the National Institute of Social Security of Gipuzkoa and Murcia in three annual periods 2006, 2013, and 2015, as well as the Bibliography and reference documents cited in the bibliography.