Assessment of employability in patients with breast cancer with a completely unfavorable clinical-labor prognosis

Objective. To develop objective criteria applicable in the practice of medical and social expertise when assessing the employability of patients suffering from breast cancer with absolutely life-threatening clinical and labor prognosis.

Materials and methods. In order to realize our aims we conducted a retrospective study of 37 female patients of employable age with malignant neoplasms of the breast, who at examination (primary or repeated) in medical and rehabilitation expert commissions (MREC) were assigned the first disability group due to absolutely unfavorable clinical and labor prognosis in respect of life in the nearest future. Inclusion criteria were morphologically confirmed breast cancer, absolutely unfavorable clinical and clinical and labor prognosis. Exclusion criteria were synchronous and metachronous cancer, presence of significant concomitant pathology.

Results. The results of the study showed that it is reasonable to use quantitative values of the Karnovsky index and ECOG scale as the simplest and the most universal criteria for evaluation of the general somatic status of a patient when examining patients with breast cancer with absolutely unfavorable prognosis at MREC. During the study, the quantitative values of the given indicators correlating with the degree of severity of disability to labor activity are determined: at the values of the Karnovsky index 60 points and more, the ECOG status 2-3, a reliable correlation (τ = 0,51, p < 0,001) with severely limited ability to work (АС 4) is revealed. As a result of the study, it was demonstrated that disabled individuals of the first group can be recognized as able-bodied with limitations only with higher values of these scales, taking into account harmful and dangerous production factors, as well as class of working conditions.

Conclusion. We found that when assessing the degree of severity of limitations to the ability to work in the disabled people of the first group with absolutely unfavorable clinical and labor prognosis, it is reasonable to be guided by the generally accepted scales of assessment of the general condition of a cancer patient (Karnovsky index, ECOG scale), taking into account the existing harmful and/or dangerous production factors, as well as the working conditions class. 

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