Background: At time of BC diagnosis, a large proportion of patients (pts) work. However, long term effects of BC and BC treatment are likely to impact employment status in follow up. Methods: The ECOG ACRIN protocol E5103 was a phase III trial that randomized BC pts to receive adjuvant doxorubicin, cyclophosphamide, and paclitaxel with either bevacizumab or placebo. Telephone based surveys were administered to all pts enrolled between 01/Jan/10 and 08/Jun/10 as part of a Decision-Making/QOL component. Symptom burden was evaluated using the Memorial symptom assessment scale’s (MSAS) global distress index (GDI), psychological and physical scores. Employment status was defined as 1) full time, 2) unemployed, disabled, medical leave 3) other (part time, homemaker, retired and other/unk). Results presented here are part of the 18 months (m) post enrollment follow up. Results: Of 519 pts who had not withdrawn at a time point prior to 18 m, pt reported outcomes (PRO) were available from 460 (88.6%). At enrollment (at least 1 m from primary surgery), 38% of pts were working full time and 19% were unemployed, disabled or on medical leave. At 18 m, 42% of pts were working full time, but 13% were unemployed, disabled or on medical leave. Pts who were unemployed, disabled or on medical leave reported significantly worse symptom burden -Table. Conclusions: Among pts enrolled in a randomized controlled trial and treated with contemporary adjuvant BC chemotherapy, persistent symptomatology was associated with negative employment outcome. Future strategies are needed to support BC survivors at risk of difficulties in job reintegration. Clinical trial information: NCT00433511

*PRO of how pt feels in past 7 days; score range 0-4; higher: worse QOL.

**Wilcoxon rank sum test: full time vs unemployed, disabled, medical leave.