Employment outcomes of men treated for prostate cancer

Occupational stress and its association with early retirement and subjective need for occupational rehabilitation in cancer patients

OBJECTIVE

Returning to work often plays an important role for cancer survivors. Occupational stress may hamper a successful return to work, so cancer survivors should be given the opportunity to address occupational stress issues before returning to work. We investigated the amount of occupational stress among cancer patients and whether it is associated with their well-being, their subjective need for occupational rehabilitation and elevations in their risk of early retirement.

METHODS

At the beginning of rehabilitation, we asked cancer patients to respond to occupation-related and health-related questionnaires. We used t-tests, chi-square tests, and logistic regression analyses to address our research questions.

RESULTS

A total of 477 patients participated in the study. Of these, 19% were occupationally stressed, and 26% reported subjective need for occupational rehabilitation. Patients who reported work-related stress had a diminished quality of life, were more likely to report subjective need for occupational rehabilitation (OR = 2.16), and had a higher risk of early retirement (OR = 5.44). Furthermore, cancer patients reported deficits in both active coping abilities and mental stability at work.

CONCLUSIONS

Because occupational stress is associated with a higher risk of early retirement, both patients and physicians should take work-related problems seriously. Screening patients for occupational stress may help physicians identify patients who are at risk of experiencing problematic work re-entries. Furthermore, the results of the study suggest that cancer patients might have problems maintaining confidence in their abilities to solve work-related problems. Therefore, facilitating the development of a perception of self-efficacy might be an important treatment goal.

Awareness and behavior of oncologists and support measures in medical institutions related to ongoing employment of cancer patients in Japan

OBJECTIVE

Improved outcomes of cancer treatment allow patients to undergo treatment while working. However, support from oncologists and medical institutions is essential for patients to continue working. This study aimed to clarify oncologists' awareness and behavior regarding patients who work during treatment, support in medical institutions and their association.

METHODS

A questionnaire was mailed to all 453 diplomates and faculty of the subspecialty board of medical oncology in the Japanese Society of Medical Oncology and all 1016 surgeons certified by the Japanese Board of Cancer Therapy living in the Kanto area. The questionnaire assessed demographics, oncologist awareness and behavior regarding patient employment and support measures at their medical institutions. Logistic regression analysis was used to examine the association of awareness and behavior of oncologists with support measures at their institutions.

RESULTS

A total of 668 individuals participated. The overall response rate was 45.5%. Only 53.6% of respondents advised patients to tell their supervisors about prospects for treatment and ask for understanding. For medical institutions, 28.8% had a nurse-involved counseling program and adjustments in radiation therapy (28.0%) and chemotherapy (41.9%) schedules to accommodate patients' work. There was a significant correlation between awareness and behavior of oncologists and medical institutions' measures to support employed cancer patients.

CONCLUSIONS

There is room for improvement in awareness and behavior of oncologists and support in medical institutions for cancer patients continuing to work. Oncologists could support working patients by exerting influence on their medical institutions. Conversely, proactive development of support measures by medical institutions could alter the awareness and behavior of oncologists.

Burden of HIV disease and comorbidities on the chances of maintaining employment in the era of sustained combined antiretoviral therapies use

OBJECTIVES

Employment status is a major predictor of health status and living conditions, especially among HIV-infected people, a predominantly working-aged population. We aimed to quantify the risk of work cessation following HIV diagnosis in France in 2004-2010 and to measure the respective burden of HIV-related characteristics and of associated comorbidities on this risk.

DESIGN

We used data from a multicenter cohort made of a diversified sample of recently diagnosed HIV-1-infected adults, antiretroviral treatment-naive at baseline in 2004-2008 (ANRS-COPANA cohort). Detailed information on living conditions and clinical and biological characteristics were collected prospectively.

METHODS

The risk of work cessation among the 376 working-aged participants employed at baseline was estimated using the Kaplan-Meier method. Characteristics associated with the risk of work cessation were identified using multivariate Cox models.

RESULTS

The cumulative probability of work cessation reached 14.1% after 2 years and 34.7% after 5 years. Diabetes, hypertension and, to a lesser extent, signs of depression were associated with increased risks of work cessation after accounting for socio-occupational characteristics [adjusted hazard ratios (95% confidence interval): 5.7 (1.7-18.8), 3.1 (1.5-6.4) and 1.6 (0.9-2.9), respectively]. In contrast, HIV disease severity and treatment and experience of HIV-related discrimination were not statistically associated with the risk of work cessation.

CONCLUSION

The risk of work cessation during the course of HIV disease has remained substantial in the most recent period in France. Comorbidities, but not characteristics of HIV disease itself, substantially affect chances of maintaining employment. This provides insights into strategies for limiting the burden of HIV disease for individuals and society.

Early work patterns for gynaecological cancer survivors in the USA

BACKGROUND

Little is known about the balance between work demands and treatment plans for >4.3 million working-age cancer survivors in the USA.

AIMS

To describe changes in work status for gynaecological cancer survivors during the first 6 months following diagnosis and their experience with their employers' programmes and policies.

METHODS

One hundred and ten gynaecological cancer survivors who were working at the time of their cancer diagnosis completed a survey. Case record reviews documented their clinical characteristics and treatment details.

RESULTS

Ninety-five women (86%) had surgery; 81 (74%) received chemotherapy, radiotherapy or both in addition to surgery. Nine per cent of women said that they changed their treatment plan because of their jobs; in contrast, 62% of women said that they changed their work situation to accommodate their treatment plan. Overall, the most common month for women to stop working was Month 1 (41%), to decrease hours was Month 2 (32%) and to increase hours was Month 6 (8%). Twenty-eight per cent of women were aware of employer policies that assisted the return to work process; 70% of women were familiar with the Family and Medical Leave Act (FMLA) and 56% with the Americans with Disabilities Act (ADA). Only 26% completed a formal request for work accommodations. After 6 months, 56 of 83 women (67%) remained working or had returned to work.

CONCLUSIONS

Work patterns varied for these gynaecological cancer survivors over the first 6 months following diagnosis. Opportunities exist to improve communication about work and treatment expectations between cancer survivors, occupational health professionals, employers and treating clinicians.

Work ability of survivors of breast, prostate, and testicular cancer in Nordic countries: a NOCWO study

INTRODUCTION

Cancer can cause adverse effects on survivors' work ability. We compared the self-assessed work ability of breast, testicular, and prostate cancer survivors to that of people without cancer. We also investigated the association of disease-related and socio-demographic factors and job-related resources (organizational climate, social support, and avoidance behavior) with work ability and looked at whether these associations were different for the survivors and reference subjects.

METHODS

Working aged cancer patients diagnosed between 1997 and 2002 were identified from hospital or cancer registries in Denmark, Finland, Iceland, and Norway (Nordic Study on Cancer and Work). A cancer-free reference group was selected from population registries. We collected information on work ability and other factors from 1,490 employed survivors and 2,796 reference subjects via a questionnaire.

RESULTS

The adjusted mean value of work ability was slightly lower among the breast and prostate cancer survivors compared to the cancer-free population. Co-morbidity, chemotherapy, low workplace support, and low organizational commitment were associated with reduced work ability. Avoidance behavior from supervisors or colleagues was only related to work ability among the cancer survivors.

CONCLUSIONS AND IMPLICATIONS

More attention should be paid to assisting cancer survivors in work life, particularly those who have chronic diseases or have undergone chemotherapy. Although most factors affecting the work ability of the survivors and reference subjects were the same, survivors' work ability seemed to be particularly sensitive to avoidance behavior. The results suggest that there is a need to improve communication at the workplace and develop supportive leadership practices in order to avoid isolating behavior towards cancer survivors.

Resuming work after cancer: a prospective study of occupational register data

INTRODUCTION

Long-term employment rates have been studied in cancer survivors, but little is known about the return to work of cancer patients. This study investigated return to work (RTW) within 2 years after the diagnosis of different types of cancer.

METHODS

This prospective study investigated the associations of demographics (age, gender, socioeconomic status, and residential region) and occupational factors (occupation, duration of employment, and company size) of employees absent from work due to cancer with the time to partial RTW, defined as working at least 50% of the earnings before sickness absence. Likewise, the associations of demographics and occupational factors with full RTW at equal earnings as before sickness absence were investigated.

RESULTS

The cohort included 5,234 employees who had been absent from work due to cancer between January 2004 and December 2006. The time to partial RTW was shortest among employees with skin cancer (median 55 days) and longest among employees with lung cancer (median 377 days). There were no significant associations between RTW and demographics. With regard to the occupational factors, employees in high occupational classes started working earlier than those in low occupational classes, but the time to full RTW did not differ significantly across occupational classes. Employees working in large companies returned to work earlier than those working in small companies.

CONCLUSION

RTW after different types of cancer depended on occupational factors rather than demographics.

Factors associated with Danish cancer patients' return to work. A report from the population-based study 'The Cancer Patient's World'

PURPOSE

If patients facing difficulties in the process of returning to work after treatment of cancer could be identified, these patients could be assisted in the transition. This might help some patients to stay in work. We therefore assessed demographic and clinical factors associated with returning to work after a cancer diagnosis.

MATERIALS AND METHODS

In this cross-sectional survey, 1490 cancer patients who had been in contact with a hospital department during the past 12 months in three Danish counties responded to a mailed questionnaire. Factors associated with employment and return to work (i.e., working more than 0 h in the past month) respectively, were assessed in multivariate ordinal logistic regression models.

RESULTS

Of the 598 patients below age 65 who were employed at the time of diagnosis, 75% were still employed when answering the questionnaire at a median of 2.8 years after diagnosis and 63% were working. In multivariate analyses, younger and more recently diagnosed patients were more often employed. Patients diagnosed with lung or head and neck cancer were least likely to be employed and having returned to work. Advanced cancer at diagnosis was associated with loss of employment. Advanced cancer and being in active treatment were associated with not having returned to work.

CONCLUSION

A quarter of the patients had lost their employment probably resulting in economic consequences on the individual as well as at the societal level. The highest risk was observed for older patients and those diagnosed with lung or head and neck cancer.

The Working After Cancer Study (WACS): a population-based study of middle-aged workers diagnosed with colorectal cancer and their return to work experiences

Background

The number of middle-aged working individuals being diagnosed with cancer is increasing and so too will disruptions to their employment. The aim of the Working After Cancer Study is to examine the changes to work participation in the 12 months following a diagnosis of primary colorectal cancer. The study will identify barriers to work resumption, describe limitations on workforce participation, and evaluate the influence of these factors on health-related quality of life.

Methods/Design

An observational population-based study has been designed involving 260 adults newly-diagnosed with colorectal cancer between January 2010 and September 2011 and who were in paid employment at the time they were diagnosed. These cancer cases will be compared to a nationally representative comparison group of 520 adults with no history of cancer from the general population. Eligible cases will have a histologically confirmed diagnosis of colorectal cancer and will be identified through the Queensland Cancer Registry. Data on the comparison group will be drawn from the Household, Income and Labour Dynamics in Australia (HILDA) Survey. Data collection for the cancer group will occur at 6 and 12 months after diagnosis, with work questions also asked about the time of diagnosis, while retrospective data on the comparison group will be come from HILDA Waves 2009 and 2010. Using validated instruments administered via telephone and postal surveys, data will be collected on socio-demographic factors, work status and circumstances, and health-related quality of life (HRQoL) for both groups while the cases will have additional data collected on cancer treatment and symptoms, work productivity and cancer-related HRQoL. Primary outcomes include change in work participation at 12 months, time to work re-entry, work limitations and change in HRQoL status.

Discussion

This study will address the reasons for work cessation after cancer, the mechanisms people use to remain working and existing workplace support structures and the implications for individuals, families and workplaces. It may also provide key information for governments on productivity losses.

Study Registration

Australian and New Zealand Clinical Trial Registry No. ACTRN12611000530921

Social welfare and legal constraints associated with work among breast and prostate cancer survivors: experiences from Ireland

INTRODUCTION

Around 40% of cancer survivors are of working age. We investigated employment outcomes among survivors in Ireland where sick leave and sick pay are at the employers' discretion and the law affords no protection against dismissal following extended absence.

METHODS

A questionnaire was mailed to 1,373 survivors, identified from the National Cancer Registry, 6-24 months post-diagnosis. The analysis included breast and prostate cancer respondents who were working at diagnosis. Factors associated with work continuation post-diagnosis and work resumption after cancer-related absence were identified using logistic regression.

RESULTS

The response rate was 54%. Three hundred forty-six respondents were working at diagnosis (breast cancer = 246; prostate cancer = 100). Sixty-two (18%) continued working post-diagnosis. Factors significantly associated with work continuation were: self-employment, prostate cancer, lower pre-diagnosis household income, and not having surgery. Two hundred eighty-four took time off work post-diagnosis; of these, 51 (18%) had left the workforce, 187 (66%) had resumed working, and 46 (16%) planned to resume working. Factors significantly associated with work resumption were: tertiary education, not having chemotherapy, receiving sick pay, and not having a medical card (which provides free access to public health services). Among those who resumed working, the median absence was 30.1 weeks (inter-quartile range = 12.9-51.6). The length of absence varied significantly by socio-demographic, financial, medical, and job- and social welfare-related factors. Median working hours pre- and post-diagnosis differed significantly (pre-diagnosis = 38/week; post-diagnosis = 30/week; p<0.001).

CONCLUSIONS

The high level of workforce departure and associations between self-employment, sick pay and medical cards, and employment outcomes suggest that social welfare and legal provisions are important determinants of the survivors' workforce participation. IMPLICATIONS FOR SURVIVORS: In formulating strategies to optimise survivors' employment outcomes, it is important that policy- and decision-makers are aware of the influence of social welfare and legal provisions.

Long-term employment effects of surviving cancer

We compare employment and usual hours of work for prime-age cancer survivors from the Penn State Cancer Survivor Survey to a comparison group drawn from the Panel Study of Income Dynamics using cross-sectional and difference-in-differences regression and matching estimators. Because earlier research has emphasized workers diagnosed at older ages, we focus on employment effects for younger workers. We find that as long as two to six years after diagnosis, cancer survivors have lower employment rates and work fewer hours than other similarly aged adults.

The implications of cancer survivorship for spousal employment

BACKGROUND

The purpose of this research was to estimate employment effects for spouses of cancer survivors who were working at the time of the cancer diagnosis.

METHODS

Spouses of cancer survivors were drawn from the Penn State Cancer Survivor Survey. Comparable spouses of individuals without cancer were drawn from the Panel Survey of Income Dynamics. The final sample included 827 spouses of cancer survivors (542 husbands, 285 wives) and 2,766 spouses of individuals without cancer (1,459 husbands, 1,307 wives). Three employment outcomes were studied 2-6 years after diagnosis: whether working, whether working full time (35+ hours per week), and usual hours per week. We used propensity scores to match cases to controls 3:1.

RESULTS

Wives of cancer survivors had a lower probability (-7.5 percentage points) of being employed 2-6 years after diagnosis (p  =  0.036). They were slightly more likely to be working full time, while averaging 1.1 fewer hours per week overall, but these effects were not statistically significant. Cancer's effect on husbands was not significant for any of the employment outcomes. However, if survivor wives and husbands were working at follow-up, they had more than twice the odds of working full-time (wives OR = 2.18, p  =  0.0004; husbands OR = 2.65, p  =  0.012) and worked more hours per week than other spouses (wives 1.9, p  =  0.041; husbands 1.5, p  =  0.04).

CONCLUSIONS

The implications to cancer survivors and their spouses of these results is that the employment of survivor spouses, especially of wives, is somewhat reshaped by cancer in the medium to long run. However, there is little or no effect on aggregate hours worked by spouses who were employed at diagnosis.

Changes in employment status and experience of discrimination among cancer patients: findings from a nationwide survey in Korea

BACKGROUND

As the number of working cancer patients increases, workplace discrimination and its relationship to changes in employment status among cancer patients is becoming an increasingly important social concern. The aim of this study is to provide a comprehensive overview of the relationship between changes in employment status and discrimination following a diagnosis of cancer.

METHODS

A total of 748 cancer patients, aged 18 years and older, who were employed before receiving a diagnosis of cancer, were enrolled in this study. Patients were recruited from ten cancer centers in Korea. Sociodemographic data, work-related data, and clinical information, as well as information on changes in employment status and incidences of discrimination, were collected from all patients.

RESULTS

A change in employment status was reported by 73.4% of the sample, with unemployment being the most common change (46.4%). Forty-two (5.6%) patients reported that they had experienced discrimination in the workplace. Reports of discrimination were only weakly correlated with changes in employment status, but were significantly correlated with forced unemployment. Additional analyses revealed that being female, being from a lower socioeconomic status group and having a disability were risk-factors for unemployment, while being male, being from a higher socioeconomic status group and having a disability were risk-factors for workplace discrimination or forced unemployment.

CONCLUSIONS

More attention should be paid to vulnerable who are diagnosed with cancer. An individualized and culture-based approach should be taken to minimize undesirable changes in employment status and to reduce discrimination among patients receiving a diagnosis of cancer.

Applying propensity score methods in medical research: pitfalls and prospects

The authors review experimental and nonexperimental causal inference methods, focusing on assumptions for the validity of instrumental variables and propensity score (PS) methods. They provide guidance in four areas for the analysis and reporting of PS methods in medical research and selectively evaluate mainstream medical journal articles from 2000 to 2005 in the four areas, namely, examination of balance, overlapping support description, use of estimated PS for evaluation of treatment effect, and sensitivity analyses. In spite of the many pitfalls, when appropriately evaluated and applied, PS methods can be powerful tools in assessing average treatment effects in observational studies. Appropriate PS applications can create experimental conditions using observational data when randomized controlled trials are not feasible and, thus, lead researchers to an efficient estimator of the average treatment effect.

The burden of out-of-pocket and indirect costs of prostate cancer

BACKGROUND

Out-of-pocket and indirect (OPI) costs play an important role in prostate cancer (PCa) outcomes research. We sought to analyze OPI costs of newly diagnosed PCa patients receiving either radical prostatectomy (RP) or external beam radiation therapy (EBRT).

METHODS

Prospective cohort design was used to recruit 512 newly diagnosed PCa patients from urology clinics of an urban academic hospital and a Veterans Administration medical center. Participants provided demographic information and completed self-reported generic and prostate-specific Health Related Quality of Life (HRQoL) and indirect-cost surveys at baseline and at 3, 6, 12, and 24 months follow-up. Linear mixed models were applied to study the association between OPI costs, treatment and HRQoL outcomes. Propensity scores adjusted for potential confounders and Bonferroni correction was used to account for multiple testing.

RESULTS

Total mean OPI costs varied between RP group and EBRT group at 3-month ($5576 vs. $2010), 6-month ($1776 vs. $2133), 12-month ($757 vs. $774), and at 24-month follow-up ($458 vs. $871). Linear mixed models indicated that RP was associated with lower medication costs (OR = 0.61, CI = 0.48-0.89) and total OPI costs (OR = 0.71, CI = 0.64-0.92). Total OPI costs were inversely related to most of the generic HRQoL items. Similarly, prostate-specific HRQoL items of urinary function (OR = 0.72; adjusted-CI = 0.58-0.84), bowel function (OR = 0.96; adjusted-CI = 0.78-0.98), sexual function (OR = 0.85; adjusted-CI = 0.72-0.92), urinary bother (OR = 0.79; adjusted-CI = 0.67-0.83), and sexual bother (OR = 0.88; adjusted-CI = 0.76-0.93) were inversely related to OPI costs.

CONCLUSIONS

OPI costs of PCa care are substantial and vary across time and treatment.

Work task disability in employed breast and prostate cancer patients

INTRODUCTION

Nearly 60% of cancer survivors are of working age, making inquiries into work-related disabilities particularly relevant. This paper describes work-related physical and cognitive disability estimates 12 and 18 months after diagnosis and treatment in a sample of employed breast and prostate cancer patients.

METHODS

We recruited employed, newly diagnosed patients (n=447 breast, n=267 prostate) from the Metropolitan Detroit Cancer Surveillance System for telephone interviews 12 and 18 months after diagnosis. We defined disability by work task activity limitation. Disability estimates and employment were compared using Pearson chi-square tests. Duration of hours worked was compared by disability status using t-tests.

RESULTS

Approximately 60% of women reported physical disability at 12 months which decreased to 36% at 18 months. Cognitive disability was reported by 34% and 22% of women at 12 and 18 months, respectively. Fewer men reported physical disability, only 29% at 12 months, decreasing to 17% at 18 months. Cognitive disability was reported by 12% and 7% of men at 12 and 18 months, respectively. More individuals with disability left the workforce at each timeframe than those without disability.

CONCLUSIONS

A significant proportion of breast and prostate cancer patients experienced work-related disabilities 1 year or more following treatment. Physical disability was more problematic than cognitive disability.

Returning to work after cancer: quantitative studies and prototypical narratives

OBJECTIVE

A combination of quantitative data and illustrative narratives may allow cancer survivorship researchers to disseminate their research findings more broadly. We identified recent, methodologically rigorous quantitative studies on return to work after cancer, summarized the themes from these studies, and illustrated those themes with narratives of individual cancer survivors.

METHODS

We reviewed English-language studies of return to work for adult cancer survivors through June 2008, and identified 13 general themes from papers that met methodological criteria (population-based sampling, prospective and longitudinal assessment, detailed assessment of work, evaluation of economic impact, assessment of moderators of work return, and large sample size). We drew survivorship narratives from a prior qualitative research study to illustrate these themes.

RESULTS

Nine quantitative studies met four or more of our six methodological criteria. These studies suggested that most cancer survivors could return to work without residual disabilities. Cancer site, clinical prognosis, treatment modalities, socioeconomic status, and attributes of the job itself influenced the likelihood of work return. Three narratives-a typical survivor who returned to work after treatment, an individual unable to return to work, and an inspiring survivor who returned to work despite substantial barriers-illustrated many of the themes from the quantitative literature while providing additional contextual details.

CONCLUSION

Illustrative narratives can complement the findings of cancer survivorship research if researchers are rigorous and transparent in the selection, analysis, and retelling of those stories.

The role of socioeconomic status in adjustment after ductal carcinoma in situ

BACKGROUND

A large body of literature suggests that socioeconomic status (SES) is positively associated with mental and physical health. However, little research has examined the impact of SES on psychological adjustment after a major stressor. The current study examined whether SES (education and financial status) was associated with distress (anxiety and depression) in women diagnosed with ductal carcinoma in situ (DCIS). This study also explored whether social support explained the association between SES and distress and whether social support buffered the impact of low SES on distress.

METHODS

A total of 487 women with newly diagnosed DCIS were enrolled in the study. Participants completed questions about sociodemographic, psychosocial, and clinical characteristics at the time of enrollment and 9 months after their diagnosis.

RESULTS

Financial status was inversely associated with anxiety and depression at the 9-month follow-up. Financial status also predicted change in anxiety and depression. Women with high financial status reported a decline in anxiety and depression during the study period, whereas women with medium or low financial status reported an increase in anxiety and depression. In addition, the probability of exceeding the screening threshold suggestive of clinical depression increased with decreasing financial status. Education was not associated with anxiety or depression. The presence of social support did not explain the association between financial status and change in distress. Social support did not buffer the effect of low SES on anxiety and depression.

CONCLUSIONS

Women with medium or low SES were vulnerable to escalating anxiety and depression after a DCIS diagnosis.

Financial status, employment, and insurance among older cancer survivors

BACKGROUND

Few data are available about the socioeconomic impact of cancer for long-term cancer survivors.

OBJECTIVES

To investigate socioeconomic outcomes among older cancer survivors compared to non-cancer patients.

DATA SOURCE

2002 Health and Retirement Study.

STUDY DESIGN

We studied 964 cancer survivors of > 4 years and 14,333 control patients who had never had cancer from a population-based sample of Americans ages >or= 55 years responding to the 2002 Health and Retirement Study.

MEASURES

We compared household income, housing assets, net worth, insurance, employment, and future work expectations.

ANALYSES

Propensity score methods were used to control for baseline differences between cancer survivors and controls.

RESULTS

Female cancer survivors did not differ from non-cancer patients in terms of income, housing assets, net worth, or likelihood of current employment (all P > 0.20); but more were self-employed (25.0% vs. 17.7%; P = 0.03), and fewer were confident that if they lost their job they would find an equally good job in the next few months (38.4% vs. 45.9%; P = 0.03). Among men, cancer survivors and noncancer patients had similar income and housing assets (both P >or= 0.10) but differed somewhat in net worth (P = 0.04). Male cancer survivors were less likely than other men to be currently employed (25.2% vs. 29.7%) and more likely to be retired (66.9% vs. 62.2%), although the P value did not reach statistical significance (P = 0.06). Men were also less optimistic about finding an equally good job in the next few months if they lost their current job (33.5% vs. 46.9%), although this result was not significant (P = 0.11).

CONCLUSIONS

Despite generally similar socioeconomic outcomes for cancer survivors and noncancer patients ages >or=55 years, a better understanding of employment experience and pessimism regarding work prospects may help to shape policies to benefit cancer survivors.

Effect of cancer diagnosis on patient employment status: a nationwide longitudinal study in Korea

BACKGROUND

Cancer diagnosis may adversely affect employment status. Our aim was to investigate whether cancer diagnosis effects employment status by comparing employment status changes in cancer patients with to that of cancer-free workers over a 5-6-year period.

METHODS

All 25-55-year-old, non-self-employed, Korean workers who were diagnosed with cancer for the first time in 2001 were identified as first baseline study subjects (n=4991). Of these, those who lost their jobs within 1 year of cancer diagnosis were selected as second baseline subjects (n=1334). Sex- and age-matched cancer-free individuals from the general population were used as a reference group. We compared the time until job loss from the first baseline and the time until re-employment from the second baseline between these two groups during the 5-6-year follow-up period while adjusting for sex, age group, job-type, and equivalent household income using the National Health Insurance administrative database.

RESULTS

Cancer patients were more likely to lose their jobs after cancer diagnosis and were less likely to be re-employed than cancer-free individuals in almost all sex and age groups. Most major cancer sites were also associated with decreased employment status, with the exception of thyroid cancer.

CONCLUSION

Cancer diagnosis adversely affects employment status in Korea, and the effects are widespread in almost all sex and age groups. Significant efforts are needed to improve the employment status of cancer patients in Korea, as well as in developing or newly developed countries that have similar social security systems.

Limitations on work and attendance rates after employees with cancer returned to work at a single manufacturing company in Japan

OBJECTIVES

The purpose of this study was to evaluate the work limitations and attendance rates after employees diagnosed with cancer returned to work from sick leave, and to identify the related factors for the limitations and attendance rates at a single manufacturing company in Japan.

METHODS

This study retrospectively analyzed 129 men and 4 women, employed in a single manufacturing industry, who returned to work after sick leave due to newly diagnosis of cancer. Limitations on work after the return to work were enforced in the workplace based on an industrial physician's evaluation. All the employees who needed measures for work were examined by the industrial physicians every 1-6 months until the termination of such work limitations.

RESULTS

Limitations on work after the return to work were enforced for 79 (59%) employees (36 employees with alteration of work, 31 with prohibition of shift work and 55 with prohibition of overtime work). A higher degree of work limitations was significantly correlated with work-related factors before sick leave (i.e. shift work, production line) as well as disease/treatment-related factors (i.e. chemotherapy, recurrence/metastasis), while the attendance rates after the return to work were not correlated with adverse work-related factors before sick leave.

CONCLUSION

The enforcement of work limitations for employees with cancer was relatively common and was based on both disease/treatment- and work-related factors, and this phenomenon may play an important role in the return to work as well as the successful continuation of work after cancer survivors return to work.

Transitions in work participation after a diagnosis of colorectal cancer

BACKGROUND

How cancer adversely affects an individual's work role is an understudied survivorship issue. There are no Australian studies quantifying work participation after cancer or the potential barriers to work continuance. Using a large, population-based cohort of working adults with colorectal cancer, we assessed changes in work participation separately for men (n=621) and women (n=354).

METHODS

Telephone survey methods collected data on colorectal cancer survivors identified through the Queensland Cancer Registry. Status at baseline and one-year post-diagnosis were described, and logistic regression models assessed correlates of work cessation.

RESULTS

Among working adults who were diagnosed with colorectal cancer, 33% of men and 40% of women were not working at one-year post-diagnosis. Radiation therapy among men (OR=2.55, 95%CI: 1.35-4.83) and chemotherapy among women (OR=2.49, 95% Cl: 1.23-5.04) were associated with a higher prevalence of work cessation. Having private health insurance was linked with resuming work for both men and women.

CONCLUSION

A large proportion of working men and women leave the workforce by 12 months following a diagnosis of colorectal cancer. Factors correlated with work cessation after colorectal cancer appear different for men and women.

IMPLICATIONS

A better understanding of how cancer affects working adults and contributes to unwanted work cessation is required to identify individuals who may benefit from occupational rehabilitation programs.

Impact of breast cancer diagnosis and treatment on work-related life and factors affecting them

We investigated the impacts of breast cancer diagnosis and treatment on employment status and the ability to perform occupational and housekeeping tasks. We performed a cross-sectional study to compare Korean breast cancer survivors (n = 1,594) who had been working before cancer diagnosis with a group of 20 to 60-year-old women from the general Korean population (n = 415). Employment decreased from 47.6% to 33.2% after cancer treatment. It was significantly smaller relative to the general population (52.1%) [adjusted odds ratio (aOR) = 1.68; 95% confidence interval (CI): 1.35-2.11). There was an inverse association between employment and low levels of education, low household income, multiple comorbidities, disease stage, and mastectomy. In addition, women who lived with a spouse were more likely to quit working after treatment compared to women who had no spouse. Fatigue and exhaustion were the most frequent difficulties encountered during occupational work (by 46.8% of cancer survivors) and housework (64.6%). Our findings suggest that breast cancer has a greater impact on employment among Korean women than among women in previously studied Western populations. Our data suggest that socio-cultural factors, as well as certain clinical characteristics, influence the decisions of Korean women to return or to not return to work after surviving breast cancer.

Cancer's impact on employment and earnings--a population-based study from Norway

INTRODUCTION

Increased attention is being paid to the long-term health and well-being of people living with a history of cancer. Of particular concern is cancer's effect on productivity and work ability, which in turn is important for persons' financial situation, life satisfaction, and social relationships. We explored the extent to which Norwegian cancer survivors stay affiliated to working life compared to the cancer-free population, and quantified cancer-associated earning declines.

METHODS AND RESULTS

Logistic regression models were estimated to explore the impact of cancer on employment using register data covering the entire Norwegian population in 2001, 567,000 men and 549,300 women 40-59 years old, of whom 34,000 were diagnosed with cancer. These analyses revealed that a cancer diagnosis was strongly associated with not being employed. Log-linear regression models were used to estimate the effect of cancer on labor earnings in 2001 for those employed. Cancer was associated with a 12% decline in earnings overall. Leukemia, lymphomas, lung, brain, bone, colorectal, and head-and-neck cancer resulted in the largest reductions in employment and earnings. Earning declines were strongly associated with educational level. In addition, linear regression models were used to estimate differentials in earnings before and after cancer. These results accorded well with those from cross-sectional models.

CONCLUSION AND IMPLICATIONS FOR CANCER SURVIVORS

Cancer survivors are less likely to be employed than the cancer-free population, and undertake modifications in their employment, e.g. reduce work-hours or hold lower-wage jobs, which result in reduced earnings. A social class gradient is present and must be addressed to accommodate appropriate intervention from welfare societies.

The impact of physical and psychosocial factors on work characteristics after cancer

Most previously employed cancer survivors continue to work after treatment, but the impact of cancer symptoms or psychosocial concerns on their work has seldom been assessed. We conducted a community-based survey of cancer survivors from the Colorado Central Cancer Registry to assess the changes in their work and the demographic, clinical, and psychosocial characteristics associated with work changes over the 2 years following diagnosis. Of 100 survivors, 92 returned to work, but 57% of those reduced their work by more than 4 h/week, and 56% noted a change in some aspect of their occupational role. Physical symptoms, particularly lack of energy or nausea/vomiting, and psychological symptoms, particularly feeling bored or useless or feeling depressed, were significantly associated with a reduction in work hours or a change in occupational role. Since changes in work are common and are associated with both physical and psychosocial symptoms, strategies are needed to reduce symptom burden and barriers to work and to improve work capacity for working-age cancer survivors.

Work disability associated with cancer survivorship and other chronic conditions

The long-term effects of cancer and its treatment on employment and productivity are a major concern for the 40% of cancer survivors in the U.S. who are working age. This study's objectives were (1) to quantify the increase in work disability attributable to cancer in a cohort of adult survivors who were an average of 46 months post-diagnosis and (2) to compare disability rates in cancer survivors to individuals with other chronic conditions. Data from the Penn State Cancer Survivor Study (PSCSS) and the Health and Retirement Study (HRS) were compared. The PSCSS sample included 647 survivors age 55-65, diagnosed at four medical centers in Pennsylvania and Maryland. There were 5988 similarly aged subjects without cancer in the HRS. Adjusted odds ratios for work disability were estimated for cancer survivorship, heart disease, stroke, diabetes, lung disease, and arthritis/rheumatism with multivariate logistic regression. Even for cancer-free survivors, the adjusted disability rate was significantly higher in comparison to adults with no chronic conditions (female OR = 1.94; male OR = 1.89). There were few significant differences between disability rates for cancer and other conditions. The elevated disability rate is another argument for viewing cancer survivorship as a chronic condition potentially requiring a broad range of psychosocial services.

Work ability and return-to-work in cancer patients

The extent to which self-assessed work ability collected during treatment can predict return-to-work in cancer patients is unknown. In this prospective study, we consecutively included employed cancer patients who underwent treatment with curative intent at 6 months following the first day of sick leave. Work ability data (scores 0–10), clinical and sociodemographic data were collected at 6 months, while return-to-work was measured at 6, 12 and 18 months. Most of the 195 patients had been diagnosed with breast cancer (26%), cancer of the female genitals (22%) or genitourological cancer (22%). Mean current work ability scores improved significantly over time from 4.6 at 6 months to 6.3 and 6.7 at 12 and 18 months, respectively. Patients with haematological cancers and those who received chemotherapy showed the lowest work ability scores, while patients with cancer of urogenital tract or with gastrointestinal cancer had the highest scores. Work ability at 6 months strongly predicted return-to-work at 18 months, after correction for the influence of age and treatment (hazard ratio=1.37, CI 1.27–1.48). We conclude that self-assessed work ability is an important factor in the return-to-work process of cancer patients independent of age and clinical factors.

Long-term effects of cancer survivorship on the employment of older workers

OBJECTIVE

To estimate the long-term effects of cancer survivorship on the employment of older workers.

DATA SOURCES

Primary data for 504 subjects who were 55-65 in 2002 and were working when diagnosed with cancer in 1997-1999, and secondary data for a comparison group of 3,903 similarly aged workers in the Health and Retirement Study (HRS) in 2002.

STUDY DESIGN

Three employment outcomes (working, working full time, usual hours per week) were compared between the two groups. Both Probit/Tobit regressions and propensity score matching were used to adjust for potentially confounding differences between groups. Sociodemographic characteristics, baseline employment characteristics, and the presence of other health conditions were included as covariates.

DATA COLLECTION METHODS

Four telephone interviews were conducted annually with cancer survivors identified from tumor registries at four large hospitals in Pennsylvania and Maryland. Many of the questions were taken from the HRS to facilitate comparisons.

PRINCIPAL FINDINGS

Cancer survivors of both genders worked an average of 3-5 hours less per week than HRS controls. For females, we found significant effects of survivorship on the probability of working, the probability of working full-time, and hours. For males, survivorship affected the probability of full-time employment and hours without significantly reducing the probability of working. For both genders, these effects were primarily attributable to new cancers. There were no significant effects on the employment of cancer-free survivors.

CONCLUSIONS

Survivors with recurrences or second primary tumors may particularly benefit from employment support services and workplace accommodation. Reassuringly, any long-term effects on the employment of cancer-free survivors are fairly small.

Cancer survivors' views of work 3 years post diagnosis: a UK perspective

The impact of cancer on people's working lives is an increasingly important concern but knowledge on this issue is very limited in the UK. Forty-one people of working age were purposively selected from the North Western Cancer Intelligence Service and interviewed by telephone to describe their experiences to returning to work following diagnosis and treatment. The data was subject to qualitative thematic analysis using NVIVO software. The results indicated the importance of returning to work from diagnosis and through treatment which was then followed by a re-assessment of work-life balance when people recovered from primary treatment and were back in employment. The principle motivations for returning to work were a quest for normality and financial pressures. One barrier to returning to work was the lack of medical advice from cancer specialists and general practitioners regarding the appropriate time to get back to work. A good relationship with their employer/manager was a major influence on returning to work and appeared to be related to duration of service rather than occupational status. These findings demonstrate the importance of paid work to people diagnosed with cancer and highlight the need to improve the support from medical professionals, especially oncology nurses.

Factors affecting cancer survivors' employment and work ability

PURPOSE

Due to the improved prognosis of many forms of cancer, an increasing number of cancer survivors are both willing and able to return to work after their treatment. This has increased interest in studying work and cancer-related issues. The purpose of this paper is to give an overview of research on the impact of cancer on employment and work ability, on the effect of psychosocial factors on survivors' well-being, and to indicate research needs for the future.

RESULTS

Studies have shown that the majority of cancer survivors are able to continue working. There is, however, a group of cancer survivors who suffer from impaired health as a result of their illness, and this impairment sometimes leads to a decreased ability to work, or even disability. Employment and impaired work ability has most commonly been found to be associated with cancer type, type of treatment, health status, education and physical workload. The few studies that have focused on the effects of psychosocial factors in work life suggest that social support from occupational health services, and workplace accommodations for illness affect cancer survivors' return to work.

CONCLUSIONS

More research is needed on the impact of social factors at work, which seem to play an important role in cancer survivors' ability to continue working.

Employment status and work-related difficulties in stomach cancer survivors compared with the general population

Little was known about work situation and work-related difficulties, including housework after stomach cancer diagnosis. We aimed to compare employment status and work-related difficulties between stomach cancer survivors and the general population. We enrolled 408 stomach cancer survivors from two hospitals 28 months after diagnosis and 994 representative volunteers from the general population from 15 geographic districts. Working was defined as being employed (including self-employed) and nonworking as being retired or a homemaker. Nonworking was significantly higher among stomach cancer survivors (46.6%) than in the general population (36.5%). Compared with the general population, the survivors had more fatigue in performing both housework (adjusted odds ratio (aOR)=2.08; 95% confidence interval (95% CI)=1.01-4.29) and gainful work (aOR=4.02; 2.55-6.33). More cancer survivors had reduced working hours (aOR=1.42; 95% CI=4.60-28.35) and reduced work-related ability (aOR=6.11; 95% CI=3.64-10.27) than did the general population. The association of nonworking with older age and being female was significantly more positive for survivors than for the general population. Among survivors, poorer Eastern Cooperation Oncology Group Performance Status and receiving total gastrectomy were positively associated with nonworking. Stomach cancer survivors experienced more difficulties in both housework and gainful employment than did the general population. Our findings on stomach cancer survivors' work-related difficulties and the predictors of nonworking will help physicians guide patients towards more realistic postsurgical employment plans.

A study of work changes due to cancer in tumor-free primary-treated cancer patients. A NOCWO study

GOALS OF WORK

The goal of this study is to explore the characteristics of tumor-free cancer survivors (CSs) who after their primary treatment were still working but made work changes due to cancer and compare them to survivors who did not.

PATIENTS AND METHODS

The sample consisted of 431 CSs (219 females with breast cancer, 212 males with testicular (N = 150) or prostate cancer (N = 62)) diagnosed 2-6 years prior to the study. All CSs had good prognosis and had returned to work after primary treatment. All CSs filled in a mailed questionnaire covering demography, morbidity, life style, mental distress, fatigue, quality of life and job strain.

RESULTS

Seventy-two CSs (17%) had made work changes due to cancer during the observation period, and 359 (83%) had not. Among CSs who made work changes, significantly more were females; they showed significantly poorer physical and mental work ability, worked fewer hours per week, reported more comorbidity, and had lower physical and mental quality of life and more neuroticism, compared to the nonchange group. Work changes were moderately correlated with current work ability.

CONCLUSIONS

The majority of CSs did not report any work changes due to cancer during the 2-6-year observation period, which is an encouraging finding. A minority had done work changes, and this group consisted mainly of women and was also characterized by poorer physical and mental quality of life and poorer mental work ability due to cancer. The issue of work changes and work ability should be considered in the follow-up of cancer survivors.

Costs of cancer care in the USA: a descriptive review

Although many studies assessing the cost of cancer care have been conducted in the US, to date, these studies and the underlying methods used to estimate costs have not been reviewed systematically. We conducted a descriptive review of the published literature on the cost of cancer care in the US, and identified 60 papers published between 1995 and 2006 pertinent to our study. We found heterogeneity across the studies in terms of the settings, populations studied, measurement of costs, and study methods. We also identified limitations in the generalizability of findings, the misclassification of patient groups and costs, and concerns with study methods. Among studies that reported costs of cancer care in multiple phases of care and for multiple tumor sites, costs were generally highest in the initial year following diagnosis and the last year of life, and lower in the continuing phase (i.e. the period between the initial and last year of life phases), following a 'u-shaped' curve. Within phase of care, costs for lung and colorectal cancer care were generally higher than those for breast and prostate cancer care, however, the long-term or lifetime costs for each type of cancer were more similar, reflecting the differences in survival and costs in each phase between the different disease types.

Disease severity, self-reported experience of workplace discrimination and employment loss during the course of chronic HIV disease: differences according to gender and education

OBJECTIVES

Evidence for the existence of a harmful effect of chronic disease on employment status has been provided. Although this effect of chronic illness on employment has been reported to be higher among the groups with the lowest position on the labour market, the mechanisms of such inequalities are poorly understood. The present study aimed at investigating social inequalities in the chances of maintaining employment during the course of HIV infection and at examining the correlates of such inequalities.

METHODS

The authors used data from a national representative sample of people living with HIV in France (ANRS-EN12-VESPA survey). Retrospective information on social trajectory and disease characteristics from the time of HIV diagnosis was available. The risk of employment loss associated with indicators of disease severity and HIV-related workplace discrimination was computed over time since HIV diagnosis according to sociodemographic and occupational factors, using Cox proportional hazards models.

RESULTS

Among the 478 working-age participants diagnosed as being HIV-infected in the era of multitherapies and employed at the time of HIV diagnosis, 149 experienced employment loss. After adjusting for sociodemographic and occupational factors, disease severity and self-reported HIV-related discrimination at work were significantly associated with the risk of employment loss in a socially-differentiated manner: advancement in HIV disease was associated with an increased risk of employment loss among women (HR 4.45, 95% CI 2.10 to 9.43) but not among men; self-reported experience of HIV-related discrimination at work was associated with an increased risk of employment loss among individuals with a primary/secondary educational level (HR 8.85, 95% CI 3.68 to 21.30) but not among those more educated.

CONCLUSIONS

Chronic HIV disease affects the chances of maintaining employment in a socially-differentiated manner, resulting in increasing inequalities regarding workforce participation. Disease severity and workplace HIV-related discrimination, particularly affecting the employment status of the most socioeconomically disadvantaged, may play a major role.

Distress among Prostate Cancer Patients and Spouses is Associated with Hormone Treatment and Participation in Decision-Making

Background

The aim of this study was to chart cancer experience and distress shared between prostate cancer (PC) patients and their spouses, focusing on effects of hormone treatment and treatment decision-making.

Patients and methods

This observational prospective study involved 203 PC patients and 194 spouses surveyed within 5 years from being diagnosed with PC. Fifty percent of the patients had received hormone treatment.

Results

Younger (<65 years) patients and spouses were significantly more distressed than the older. Patients receiving hormone treatment tended to be more distressed than those not treated (sum of scores, 5.6 vs 4.3, p = 0.017), and the same trend was seen in their spouses (p = 0.08). The spouse experienced difficulties in concentration and decision-making (Chi-squared test, p = 0.012) and somatic symptoms (p = 0.049) more often if the patient suffered the same problems. Use of alcohol/drugs was significantly more common among younger (<65 years) spouses (27.8% vs 7.2%, p < 0.001) and in those with higher level of education (26.1% vs 12.2%, p = 0.015).

Conclusions

Significant associations were observed in distress variables between prostate cancer patients and spouses, especially among younger patients and when hormone treatment was used. Distress among patients was associated with participation in treatment-decision making, and among spouses with age and educational level.

Meaning in life mediates the relationship between social and physical functioning and distress in cancer survivors

OBJECTIVES

Impairments in physical and social functioning are often associated with distress for the cancer survivor. Impaired functioning may also lead individuals to question previously held beliefs about meaning in life. Meaning in life was hypothesized to mediate the relationship between functioning and distress.

DESIGN AND METHODS

Two studies were conducted. In the cross-sectional study (I), cancer survivors (N=420) were accrued via the Internet and completed measures of social and physical functioning, meaning and distress. In the longitudinal study (II), breast cancer survivors (N=167) completed measures of functioning at 18 months, meaning at 24 months and distress at 30 months post-diagnosis.

RESULTS

In Study I, meaning in life was a significant, partial mediator for both of the effects of physical and social functioning impairments on heightened distress. In Study II, significant indirect effects of functioning impairments on distress through meaning were replicated even when functioning and distress were measured 1 year apart. The relationship of social functioning and distress was fully mediated by meaning in life, whereas the relationship of physical functioning and distress was partially mediated by meaning.

CONCLUSIONS

The negative social and physical sequelae of cancer are associated with heightened distress, and this association appears to be accounted for, in part, by patients' loss of meaning in their lives.

Distress reduction from a psychological intervention contributes to improved health for cancer patients

PURPOSE

Psychological interventions are efficacious in reducing emotional distress for cancer patients. However, it is not clear whether psychological improvements are, in turn, related to improved health. A clinical trial tests whether a psychological intervention for cancer patients can do so, and also tests two routes to achieve better health: (a) reducing patients' Emotional Distress, and/or (b) enhancing their functional immunity.

METHODS

Post-surgery, 227 breast cancer patients were randomized to intervention or assessment only Study Arms. Conducted in small groups, intervention sessions were offered weekly for 4 months and followed by monthly sessions for 8 months. Measures included psychological (distress), biological (immune), and health outcomes (performance status and evaluations of patient's symptomatology, including toxicity from cancer treatment, lab values) collected at baseline, 4 months, and 12 months.

RESULTS

A path model revealed that intervention participation directly improved health (p<.05) at 12 months. These effects remained when statistically controlling for baseline levels of distress, immunity, and health as well as sociodemographic, disease, and cancer treatment variables. Regarding the mechanisms for achieving better health, support was found for an indirect effect of distress reduction. That is, by specifically lowering intervention patients' distress at 4 months, their health was improved at 12 months (p<.05). Although the intervention simultaneously improved patients' T-cell blastogenesis in response to phytohemagglutinin (PHA), the latter increases were unrelated to improved health.

CONCLUSION

A convergence of biobehavioral effects and health improvements were observed. Behavioral change, rather than immunity change, was influential in achieving lower levels of symptomatology and higher functional status. Distress reduction is highlighted as an important mechanism by which health can be improved.

Successful return to work for cancer survivors

This study investigated factors associated with successful return to work for cancer survivors in accordance with the Americans with Disabilities Act. A focus group was held with seven female cancer survivors. Participants discussed return-to-work issues following a cancer diagnosis. Factors such as coworker support and job flexibility improved their experiences, whereas coworker and supervisor ignorance about cancer and lack of support made returning to work more stressful. Participants discussed personal, environmental, and cancer-related factors that influenced their experiences with returning to work following a cancer diagnosis. Knowledge of factors that support employees helps occupational health nurses ease their transition, and may improve quality of life for employees. Physicians and health care provider teams may play a critical role in the employees' positive evaluation of their recovery process. This pilot study serves as a basis for a larger, population-based study.

Employment and cancer: findings from a longitudinal study of breast and prostate cancer survivors

We discuss how cancer affected the employment of almost 800 employed patients who participated in a longitudinal study. The greatest reduction in patients' labor supply (defined as employment and weekly hours worked) was observed 6 months following diagnosis. At 12 and 18 months following diagnosis, many patients returned to work. Based on these and other findings related to patients' employment situations, we suggest 4 areas for future research: 1) collection of employment information in cancer studies; 2) research into racial and ethnic minority patients and employment outcomes; 3) interventions to reduce the effects of cancer and its treatment on employment; and 4) investigations into the influence of employment-contingent health insurance on cancer treatment and recovery.

Prostate Cancer

PURPOSE

We quantified the burden of prostate cancer in the United States by identifying trends in incidence, disease presentation, survival rates and use of health care resources, and by estimating the economic impact of the disease.

MATERIALS AND METHODS

The analytic methods used to generate these results were described previously.

RESULTS

Age adjusted prostate cancer incidence rates peaked in 1992 at 237/100,000 men, decreased in 1995 and then increased at approximately 1.7% yearly through 2000, when the rate was 180/100,000. Marked stage migration and an improvement in 5-year overall survival were also noted. Age adjusted inpatient hospitalizations for prostate cancer decreased in the 1990s from 729/100,000 population in 1992 to 309/100,000 in 2001. Considerable ethnic and regional variation was noted. During the same period age adjusted radical prostatectomy rates varied from 128/100,000 men in 1994 to 108/100,000 in 2000. Surgery rates decreased in older men, while they increased in younger men. Outpatient physician office visits also varied in the 1990s with ethnic and regional variation again noted. Finally, the total medical expenditure for prostate cancer treatment was $1.3 billion in 2000, which represents a 30% increase over the total expenditure for 1994.

CONCLUSIONS

The burden of prostate cancer in the United States is considerable and it appears to have markedly increased in the prostate specific antigen era. Further research is needed to determine if we are using our limited health care resources appropriately for the diagnosis and treatment of this common malignancy.

Comparative study of work ability between cancer survivors and their referents

Even though cancer survivors are often able to continue working after they have been diagnosed, they may have health impairments resulting in reduced work ability. We studied the current work ability of 591 employed people with an early-stage of breast cancer, lymphoma, testicular or prostate cancer, and 757 referents. We also investigated whether the survivors perceived that cancer had impaired their work ability, and which disease-related, socio-demographic and social factors at work had an impact on their work ability. The work ability of the cancer survivors did not differ from that of their referents. Among the survivors, 26% reported that their physical work ability, and 19% that their mental work ability had deteriorated due to cancer. The survivors who had other diseases or had had chemotherapy, most often reported impaired work ability, whereas survivors with a strong commitment to their work organisation, or a good social climate at work, reported impairment less frequently.

Absenteeism from work: the experience of employed breast and prostate cancer patients in the months following diagnosis

BACKGROUND

A better understanding of how cancer treatments affect patient's employment may help patients and physicians make more informed choices between treatment alternatives. This study examined the number of days employed patients undergoing treatment for either breast or prostate cancer were absent from their jobs.

METHOD

Using the Detroit Surveillance, Epidemiology, End-Results registry, all potentially eligible women diagnosed with breast cancer and men diagnosed with prostate cancer were selected. Subjects who were employed full-time were included in this analysis.

RESULTS

Women treated for breast cancer missed an average of 44.5 days from work; the median days missed was 22. The median days missed by women treated with surgery and chemotherapy was 40. Men diagnosed with prostate cancer missed an average of 27 days (median days = 20) from work. The median days missed for men treated surgically without hormone or radiation therapy was 25. In multivariable analyses, taking a leave of absence and greater elapsed time from diagnosis to interview were associated with the greatest number of days absent from work for all patients. Men treated with hormone and/or radiation therapy or who were not treated missed fewer days from work relative to men undergoing surgery.

CONCLUSION

Research and interventions are needed to minimize work loss for cancer patients. Vocational rehabilitation programs may minimize the impact of treatment on work. Information on how treatments may infringe the ability for patients to earn a living may influence treatment decisions.

Screening childhood cancer survivors with the brief symptom inventory-18: classification agreement with the symptom checklist-90-revised

The Brief Symptom Inventory-18 (BSI-18) is an 18-item symptom checklist used as a brief distress screening in cancer and other medical patients. This study evaluated the validity of the BSI-18 in a sample of 221 adult survivors of childhood cancers ages 18-55 (median = 26). Validity of the BSI-18 was compared to the Symptom Checklist-90-Revised (SCL-90-R). Results indicated the BSI-18 scales had acceptable internal consistency (alpha >0.80) and were highly correlated with the corresponding SCL-90-R subscales (correlations from 0.88 to 0.94). When subjects were classified as case positive (significantly distressed) using the BSI-18 manual case-rule, classification agreement with the SCL-90-R was poor as evidenced by low sensitivity (41.78%). An alternative BSI-18 case-rule previously developed for cancer patients using the General Severity Index (GSI; GSI t-score >or=57) demonstrated better sensitivity (83.54%). ROC analysis indicated the BSI-18 had strong diagnostic utility relative to the SCL-90-R (AUC = 0.98) and several possible GSI cut-off scores were evaluated. The optimal cut-of score was a t-score >or=50 which had a sensitivity of 97.47% and a specificity of 85.21%. Results support use of the BSI-18 with adult survivors of childhood cancer but indicate an alternative case-rule must be used.

Factors distinguishing employed from unemployed people in the Positive Health Study

OBJECTIVE

To identify predictors of unemployment among Australian people living with HIV/AIDS.

DESIGN

A longitudinal cohort of Australian men living with HIV/AIDS.

METHODS

Participants were separated into two groups, currently working versus currently unemployed. The two groups were compared on a range of factors related to physical health, mental health and sociodemographic variables. Each family of variables was reduced to a set of best predictors, and multivariate log binomial regression was used to identify the predictors of unemployment.

RESULTS

Unemployment was more likely among those who experienced HIV/AIDS-related illness, scored higher on the Kessler scale of psychological distress and were older. There was a lower likelihood of unemployment among those who had better self-rated health, had been living with HIV/AIDS for a shorter period and who had a tertiary education.

CONCLUSION

These findings indicate that unemployment among people living with HIV/AIDS is best understood within a combined social and medical context. Interventions that acknowledge the differences in age and education that contribute to unemployment would improve employment prospects among people living with HIV/AIDS.

Best practice in primary care pathology: review 4

This fourth best practice review examines four series of common primary care questions in laboratory medicine are examined in this review: (1) safety monitoring for three common drugs; (2) use of prostate-specific antigen; (3) investigation of vaginal discharge; and (4) investigation of subfertility. The review is presented in question-answer format, referenced for each question series. The recommendations represent a precis of the guidance found using a standardised literature search of national and international guidance notes, consensus statements, health policy documents and evidence-based medicine reviews, supplemented by Medline Embase searches to identify relevant primary research documents. They are not standards but form a guide to be set in the clinical context. Most of them are consensus based rather than evidence based. They will be updated periodically to take account of new information.