Implementing indicators and trajectories of return to work after breast cancer diagnosis: a mixed-methods study using the French National Healthcare Insurance Database and stakeholder consultation

Purpose Return to work (RTW) is important for quality of life after breast cancer but its analysis at the population-level remains limited in France. This study aimed to implement Electronic Healthcare Data (EHD)-based indicators and trajectories to measure RTW after breast cancer diagnosis, and to examine stakeholders’ perspectives regarding these indicators. Methods We followed a mixed-methods approach that consisted of (i) implementing RTW indicators and identifying clusters of trajectories using state sequence analysis with data from a representative sample of the French National Health Data System and (ii) exploring, through qualitative focus group and interviews, stakeholders’ perceptions on the interpretation, limitations and utility of these indicators. Results We extracted data from 317 women aged 25-55 years with a first diagnosis of early-stage breast cancer. The median number of sickness absence periods was 2 for a total of 434 days during the 3-year follow-up, and the median time to sustainable RTW was 240 days. Three clusters of RTW trajectories were identified: “early RTW” (49.5% of the population), “RTW after partial resumption” (37.5%) and “continuous compensation” (12.9%). Feedback from stakeholders highlighted the multi-factorial nature of RTW and underscored the added value of EHD for studying RTW, despite certain limitations. Conclusions We demonstrated the feasibility of calculating RTW indicators and identifying trajectories using the French National Health Data System. These indicators can serve as outcome measures in RTW promotion and provide a basis for designing targeted interventions for breast cancer survivors. Micro abstract This study explores Return to work (RTW) after breast cancer in France using Electronic Healthcare Data (EHD) to develop RTW indicators and trajectories in a sample of 317 women. Employing a mixed-methods approach, it identifies three distinct RTW pathways and gathers stakeholder insights on the indicators' utility and limitations. The findings highlight the feasibility of EHD-based RTW analysis and its potential to inform targeted interventions.