Work Ability, Anxiety, and Depression among Long-Term Breast Cancer Survivors of Northern Kerala, India - Historical Cohort Study

Sep 21, 2026

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Increasing breast cancer incidence and improved survival have led to more women living beyond treatment, yet long-term survivorship includes persistent physical effects and psychosocial challenges. This historical cohort study examines work ability, anxiety, and depression among long-term female breast cancer survivors in Northern Kerala, India, using retrospective hospital-based cancer registry data from 2016 (n=534) and a follow-up survey in 2022 (n=209). Mean work ability and associated factors are analyzed via multivariate regression.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages8

Reading Time20 min

AccessFree to download

Abstract

Introduction

Materials and Methods

Study Design and Data Source

Participants and Follow-up

RESEARCH ARTICLE Editorial Process: Submission:06/27/2023 Acceptance:01/18/2024 Work Ability, Anxiety, and Depression among Long-Term Breast Cancer Survivors of Northern Kerala, India;AHistorical Cohort Study Neethu Ambali Parambil1,2, Srinivasan Kannan1 * Abstract Background: Increasing number of breast cancer cases, and improved survival due to advancements in early detection, and treatment resulted in an increase in women living beyond a cancer diagnosis. Survivors have to face long-term physical effects as well as psychosocial issues post-treatment. This study aims to study survivourship in terms of work ability, anxiety and depression. Methods: Retrospective cohort study on female breast cancer survivors from Hospital Based Cancer Registry (HBCR) of a Tertiary Cancer Centre (TCC). Data from 2016 (n=534) were collected from the medical records, and a follow-up survey (n=209) was conducted in 2022 to study their survivorship issues. Results: In 2022, the mean age of the cohort (n=209) was 55.45 ± 9.36. The mean work ability score was 40.7±5.73 (95% CI 39.92 to 41.48) . In the multivariate binary logistic regression model, those who were married (OR 7.15, 95%CI 2.61 to 19.55), disease-free (OR 15.27, 95% CI 2.36 to 98.7), employed (OR 9.09, 95%CI 1.12 to 73.5), having no fatigue (OR 2.6, 95% CI 1.05 to 6.48), no pain (OR 3.11, 95% CI 1.16 to 8.35), and no depression (OR 6.58, 95% CI 1.82-23.8) were found to have optimal work ability. Anxiety (OR 4.93, 95% CI 1.76 to 13.76), and sub-optimal work ability (OR 4.22, 95% CI 1.39 to 12.77) were predictors of depression among survivors. Disease status and fatigue were associated with all three dimensions of survivorship in our study. Conclusion: Understanding survivorship will help improve health outcomes in this population. In our study, work ability, anxiety, depression, and their associated factors were found to be interrelated. Interventions in these areas can go a long way in improving breast cancer survivorship. Keywords: Breast cancer-work ability-Kerala-survivor Asian Pac J Cancer Prev, 25 (1), 115-122 Introduction Breast cancer is leading globally in 2020 with more than two million cases [1]. Advanced treatment and early detection have improved five-year survival, leading to an increasing number of individuals living beyond breast cancer treatment [2] . While treatment is one side of the coin, the other side is the post-treatment consequences experienced by the survivor [3] . The term ‘survivorship’refers to the experience of living with, through and beyond, a cancer diagnosis and the person is known as a ‘survivor’ [4]. The term ‘survivor’ was first used by Dr Mullan in his article “Seasons of Survival; Reflections of a Physician with cancer”, where he told the world that cancer survivors have common experiences which are specific to them, that are different from the general population [5]. In Asia, breast cancer is diagnosed at much younger ages than in Western countries [6], the registry data from South India also confirming the same [7] . Cases are diagnosed in the early stages in Kerala as opposed to other parts of India [8, 9] . Early diagnosis results in better survival. This, in turn, has resulted in an increasing number of young survivors living beyond treatment in that region. While the physician is more cautious about the immediate side effects of cancer treatment and signs of recurrence, the survivor is more concerned about the hindrances to dayto-day activities caused by post treatment lymphedema, fatigue, pain, hot flashes, and so on [10] . Survivorship research is gaining importance in the presently, as the difficulties and challenges faced by these women can no more be ignored [11] . Breast cancer treatment has a multimodality approach, which has medical as well as psychosocial long-term and late effects [3] . The survivor also have issues related to their social roles, return to work, body image concerns, and sexual functions [12] .

FAQs

What was the purpose of this study?

To examine survivorship outcomes related to work ability, anxiety, and depression among long-term breast cancer survivors in Northern Kerala, India.

How were participants selected and what data were used?

Female breast cancer patients registered in a tertiary cancer center’s hospital-based cancer registry in 2016 were included (n=534), with follow-up survey data collected in 2022 (n=209) from medical records and survey responses.

Which factors were associated with optimal work ability?

The study reported associations between optimal work ability and variables including being married, disease-free status, employment, and absence of fatigue and pain, as well as absence of depression.

Sep 21, 2026

Uploaded by Anda