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Le GH, Hermansen Å, Dahl E. Return to work after cancer-the impact of working conditions: A Norwegian Register-based Study. J Cancer Surviv 2023:10.1007/s11764-023-01503-0. [PMID: 38114712 DOI: 10.1007/s11764-023-01503-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 11/15/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE The purpose of this study is to compare a cohort of cancer survivors with a cohort of cancer-free employees (1) with respect to employment prospects over a 15-year period and (2) with respect to the differential impact of working conditions on employment over this time period. METHODS The cancer cohort is retrieved from the Cancer Registry of Norway, while data on the non-cancer cohort are retrieved from register data managed by Statistics Norway. Job exposure matrices were used to remedy the lack of working-conditions information in the register data. We use nearest-neighbor matching to match the non-cancer cohort (the control group) to the cancer-survivor cohort (the treatment group). Cox regression analysis was applied to examine the relationships between working conditions, employment, and cancer. The results are reported separately for mechanical-job exposures and psychosocial exposures, as well as by gender. RESULTS Cancer survivors are more likely to experience reduced employment as compared to individuals without a history of cancer. Male cancer survivors in physically demanding occupations have an increased risk of reduced employment after being diagnosed with cancer. This does not apply to female cancer survivors. Regarding the impact of psychosocial exposures on employment, we find no differences over time between cancer survivors and the non-cancer population. CONCLUSIONS Male cancer survivors in physically demanding occupations have an increased risk of reduced employment after being diagnosed with cancer, whereas this is not the case for female cancer survivors. Psychosocial exposures do not impact the relative risk of reduced employment over time. IMPLICATIONS FOR CANCER SURVIVORS We suggest that return to work after cancer should be considered a process rather than only the re-entry step of resuming work. Thus, it is important to provide long-term support for cancer survivors. We recommend providing more attention to working conditions, particularly in occupations that involve a high level of mechanical-job exposures.
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Affiliation(s)
- Giang Huong Le
- Department of Social Work, Child Welfare and Social Policy, OsloMet - Oslo Metropolitan University, Faculty of Social Sciences, Oslo, Norway.
| | - Åsmund Hermansen
- Department of Social Work, Child Welfare and Social Policy, OsloMet - Oslo Metropolitan University, Faculty of Social Sciences, Oslo, Norway
| | - Espen Dahl
- Department of Social Work, Child Welfare and Social Policy, OsloMet - Oslo Metropolitan University, Faculty of Social Sciences, Oslo, Norway
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2
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Møller JJK, la Cour K, Pilegaard MS, Dalton SO, Bidstrup PE, Möller S, Jarlbaek L. Social vulnerability among cancer patients and changes in vulnerability during their trajectories - A longitudinal population-based study. Cancer Epidemiol 2023; 85:102401. [PMID: 37392489 DOI: 10.1016/j.canep.2023.102401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 06/07/2023] [Accepted: 06/15/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND Identification of socially vulnerable cancer patients in the health care system is difficult. Only little is known concerning changes in the patients' social circumstances during the trajectory. Such knowledge is valuable regarding the identification of socially vulnerable patients in the health care system. The objective of this study was to use administrative data to identify population-based characteristics of socially vulnerable cancer patients and investigate how social vulnerability changed during the cancer trajectory. METHODOLOGY A registry-based social vulnerability index (rSVI) was applied to each cancer patient prior to their diagnosis, and used to assess changes in social vulnerability after the diagnosis. RESULTS A total of 32,497 cancer patients were included. Short-term survivors (n = 13,994) died from cancer from one to three years after the diagnosis, and long-term survivors (n = 18,555) survived at least three years after the diagnosis. 2452 (18 %) short-term survivors and 2563 (14 %) long-term survivors were categorized as socially vulnerable at diagnosis, of these 22 % and 33 % changed category to not socially vulnerable during the first two years after the diagnosis, respectively. For patients changing status of social vulnerability, several social and health-related indicators changed, which is in line with the complexity of the multifactorial social vulnerability. Less than 6 % of the patients categorized as not vulnerable at diagnosis, changed to become vulnerable during the following two years. CONCLUSION During the cancer trajectory, social vulnerability may change in both directions. Surprisingly, more patients, who were categorized as socially vulnerable when their cancer was diagnosed, changed status to not socially vulnerable during follow-up. Future research should attempt to increase knowledge on identifying cancer patients, who experience deterioration after the diagnosis.
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Affiliation(s)
- Jens-Jakob Kjer Møller
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Danish Research Centre for Equality in Cancer (COMPAS), Zealand University Hospital, Naestved, Denmark.
| | - Karen la Cour
- Danish Research Centre for Equality in Cancer (COMPAS), Zealand University Hospital, Naestved, Denmark; Research Unit for User Perspectives and Community-Based Interventions, the Research Group for Occupational Science, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Marc Sampedro Pilegaard
- Research Unit for User Perspectives and Community-Based Interventions, the Research Group for Occupational Science, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Susanne Oksbjerg Dalton
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Naestved, Denmark
| | - Pernille Envold Bidstrup
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark; Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Sören Möller
- Research unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Lene Jarlbaek
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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3
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Hernandez D, Schlander M. Income loss after a cancer diagnosis in Germany: An analysis based on the socio-economic panel survey. Cancer Med 2021; 10:3726-3740. [PMID: 33973391 PMCID: PMC8178494 DOI: 10.1002/cam4.3913] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/12/2021] [Accepted: 04/02/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND AND AIMS Cancer treatments often require intensive use of healthcare services and limit patients' ability to work, potentially causing them to become financially vulnerable. The present study is the first attempt to measure, on the German national level, the magnitude of absolute income loss after a cancer diagnosis. METHODS This study analyzes data from the Socio-Economic Panel (SOEP) survey, one of the largest and most comprehensive household surveys in Germany, consisting of approximately 20,000 individuals, who are traced annually. The empirical strategy consists of ordinary least squares (OLS) and multinomial logistic estimators to measure changes in job income, work status, working hours, and pension as a result of reporting a cancer diagnosis for the period between 2009 and 2015. Sample consistency checks were conducted to limit measurement error biases. RESULTS Our results show that job incomes dropped between 26% and 28% within the year a cancer diagnosis was reported. The effect persisted for two years after the diagnosis and was no longer observable after four years. The finding was linked to an increased likelihood of unemployment and a reduction of working hours by 24%. Pension levels, on the other hand, were not affected by a cancer diagnosis. CONCLUSIONS These findings suggest that many cancer patients are exposed to financial hardship in Germany, particularly when the cancer diagnosis occurs during their working age and before requirements to obtain a pension are met. Further research seems warranted to identify particularly vulnerable patient groups.
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Affiliation(s)
- Diego Hernandez
- Division of Health EconomicsGerman Cancer Research Center (DKFZ)HeidelbergGermany
| | - Michael Schlander
- Division of Health EconomicsGerman Cancer Research Center (DKFZ)HeidelbergGermany
- Medical Faculty MannheimHeidelberg UniversityMannheimGermany
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4
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Engan HK, Oldervoll LM, Bertheussen GF, Gaarder MH, Nielsen RA, Paraponaris A, Stene GB, Sandmæl JA, Tandstad T, Torp S. Long-term work outcomes and the efficacy of multidisciplinary rehabilitation programs on labor force participation in cancer patients - a protocol for a longitudinal prospective cohort study. J Public Health Res 2020; 9:1739. [PMID: 33381469 PMCID: PMC7753323 DOI: 10.4081/jphr.2020.1739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 11/18/2020] [Indexed: 11/23/2022] Open
Abstract
Background. Many cancer survivors experience late effects of cancer treatment and therefore struggle to return to work. Norway provides rehabilitation programs to increase labor force participation for cancer survivors after treatment. However, the extent to which such programs affect labor force participation has not been appropriately assessed. This study aims to investigate i) labor force participation, sick leave and disability rates among cancer survivors up to 10 years after being diagnosed with cancer and identify comorbidities contributing to long-term sick leave or disability pensioning; ii) how type of cancer, treatment modalities, employment sectors and financial- and sociodemographic factors may influence labor force participation; iii) how participation in rehabilitation programs among cancer survivor affect the longterm labor force participation, the number of rehospitalizations and incidence of comorbidities. Design and methods. Information from four medical, welfare and occupational registries in Norway will be linked to information from 163,279 cancer cases (15.68 years old) registered in the Norwegian Cancer Registry from 2004 to 2016. The registries provide detailed information on disease characteristics, comorbidities, medical and surgical treatments, occupation, national insurance benefits and demographics over a 10-year period following a diagnosis of cancer. Expected impact of the study for Public Health. The study will provide important information on how treatment, rehabilitation and sociodemographic factors influence labor force participation among cancer survivors. Greater understanding of work-related risk factors and the influence of rehabilitation on work-participation may encourage informed decisions among cancer patients, healthcare and work professionals and service planners.
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Affiliation(s)
| | - Line M Oldervoll
- LHL Clinics Trondheim, Norway.,Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Gro F Bertheussen
- Clinic for Physical Medicine and Rehabilitation, St. Olav's University Hospital, Norway.,Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Martine H Gaarder
- The Cancer Clinic, St. Olav's University Hospital, Trondheim, Norway
| | - Roy A Nielsen
- Fafo Institute for Labour and Social Research, Norway
| | - Alain Paraponaris
- Aix Marseille University, CNRS, EHESS, Centrale Marseille, AMSE, Aix-Marseille School of Economics, France.,Southeastern Health Observatory (ORS PACA), Faculté de Médecine, Marseille, France
| | - Guro B Stene
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Torgrim Tandstad
- The Cancer Clinic, St. Olav's University Hospital, Trondheim, Norway.,Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Steffen Torp
- Department of Health, Social and Welfare Studies, University of South-Eastern Norway, Tønsberg, Norway
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5
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Xiao D, Guizard AV, Daubisse-Marliac L, Woronoff AS, Trétarre B, Delafosse P, Molinié F, Cowppli-Bony A, Lapôtre-Ledoux B, Bara S, Marrer E, Velten M, Laroche L, Heutte N, Grosclaude P, Joly F. Evaluation of long-term living conditions in patients treated for localised prostate cancer. Eur J Cancer Care (Engl) 2020; 30:e13333. [PMID: 32969128 DOI: 10.1111/ecc.13333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 06/07/2020] [Accepted: 08/07/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the evolution of living conditions (LC) in long-term survivors of localised prostate cancer 10 years after treatment compared with those of a same-age control group from the general population. METHODS Two hundred and eighty-seven patients diagnosed with prostate cancer in 2001 were selected in 11 French cancer registries. They were matched with controls randomly selected for age and residency. Both patients and controls completed a self-administered LC questionnaire concerning their familial, social and professional life, and general and specific quality of life (QoL) and anxiety and depression questionnaires. RESULTS Compared with controls, patients reported more sexual modifications (p < .0001), but without any difference in marital status. Patients' circle of friends was more stable than that of the controls (91% vs. 63%; p < .0001) and patients reported fewer friendship modifications than controls (p < .0006). Their professional and physical activities were also preserved. They reported more anxiolytic intake (p = .002) but did not consult their general practitioner more often. Type of specialist consulted differed in the two groups. CONCLUSION Patients treated for localised prostate cancer had the same living conditions as men of the same age. Their social life was satisfying on the whole, albeit they reported more sexual difficulties than their counterparts.
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Affiliation(s)
- Dingyu Xiao
- General Cancer Registry of Calvados, François Baclesse Cancer Center, Caen, France
| | - Anne-Valérie Guizard
- General Cancer Registry of Calvados, François Baclesse Cancer Center, Caen, France.,UMR 1086 « Cancers et Préventions », Inserm - University of Basse-Normandie, Caen, France
| | - Laetitia Daubisse-Marliac
- Claudius Regaud Institute, IUCT-O, Tarn Cancer Registry, Toulouse, France.,UMR1027, University of Toulouse, UPS, Inserm, Toulouse, France.,FRANCIM Network of French Cancer Registries, Toulouse, France
| | - Anne-Sophie Woronoff
- FRANCIM Network of French Cancer Registries, Toulouse, France.,General Cancer Registry of Doubs, Besançon, France
| | - Brigitte Trétarre
- FRANCIM Network of French Cancer Registries, Toulouse, France.,General Cancer Registry of Hérault, Montpellier, France
| | - Patricia Delafosse
- FRANCIM Network of French Cancer Registries, Toulouse, France.,General Cancer Registry of Isère, Grenoble, France
| | - Florence Molinié
- FRANCIM Network of French Cancer Registries, Toulouse, France.,General Cancer Registry of Loire-Atlantique-Vendée, Nantes, France
| | - Anne Cowppli-Bony
- FRANCIM Network of French Cancer Registries, Toulouse, France.,General Cancer Registry of Vendée, Nantes, France
| | - Bénédicte Lapôtre-Ledoux
- FRANCIM Network of French Cancer Registries, Toulouse, France.,General Cancer Registry of Somme, Amiens, France
| | - Simona Bara
- FRANCIM Network of French Cancer Registries, Toulouse, France.,General Cancer Registry of Manche, Cherbourg, France
| | - Emilie Marrer
- FRANCIM Network of French Cancer Registries, Toulouse, France.,General Cancer Registry of Haut-Rhin, Mulhouse, France
| | - Michel Velten
- FRANCIM Network of French Cancer Registries, Toulouse, France.,General Cancer Registry of Bas-Rhin, Strasbourg, France
| | - Lucie Laroche
- General Cancer Registry of Calvados, François Baclesse Cancer Center, Caen, France
| | - Natacha Heutte
- CETAPS EA 3832, Normandie University, UNIROUEN, Mont Saint Aignan, France.,Quality of Life in Oncology National Platform, France
| | - Pascale Grosclaude
- Claudius Regaud Institute, IUCT-O, Tarn Cancer Registry, Toulouse, France.,UMR1027, University of Toulouse, UPS, Inserm, Toulouse, France.,FRANCIM Network of French Cancer Registries, Toulouse, France
| | - Florence Joly
- UMR 1086 « Cancers et Préventions », Inserm - University of Basse-Normandie, Caen, France.,Department of Medical Oncology, François Baclesse Cancer Center, Caen, France.,CHU Côte de Nacre, University of Basse-Normandie, Caen, France
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6
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Stapelfeldt CM, Duijts SFA, Horsboel TA, Momsen AMH, Andersen NT, Larsen FB, Friis K, Nielsen CV. Educational attainment and work disability in cancer survivors: Do diagnosis and comorbidity affect this association? Eur J Cancer Care (Engl) 2020; 29:e13228. [PMID: 31999396 DOI: 10.1111/ecc.13228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 12/13/2019] [Accepted: 01/07/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To study whether educational attainment had less impact on work disability in cancer survivors than in individuals without cancer. To study whether comorbidity had a higher impact on work disability in low-educated cancer survivors than in high-educated and whether this impact differed when compared with individuals without cancer. METHODS Linkage of population-based public health survey data and the Danish Cancer Registry formed two groups: cancer survivors (n = 3,514) and cancer-free individuals (n = 171,262). In logistic regression models, the risk of experiencing an 8-week sick leave spell and the granting of disability pension within a 3-year follow-up period was studied in three educational levels and whether these associations were modified by history of cancer and comorbidity. Odds ratios (OR) with 95% confidence intervals (CI) are reported. RESULTS Non-stratified adjusted risk of experiencing an 8-week sick leave spell (OR: 1.41, 95% CI (1.33-1.49)) or being granted a disability pension (OR: 1.61, 95% CI (1.31-1.97)) was significantly higher in low-educated than in high-educated respondents. Cancer or comorbidity did not significantly interact with education on the risk of work disability. CONCLUSIONS A moderate impact of low education on future work disability was found for all respondents, neither history of cancer nor comorbidity modified this association.
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Affiliation(s)
- Christina M Stapelfeldt
- Section of Clinical Social Medicine and Rehabilitation, Department of Public Health, Aarhus University, Aarhus C, Denmark.,DEFACTUM Social & Health Services and Labour Market, Aarhus C, Denmark
| | - Saskia F A Duijts
- Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Trine A Horsboel
- Survivorship and Inequality in Cancer, Danish Cancer Society, Copenhagen, Denmark
| | | | - Niels T Andersen
- Section of Biostatistics, Department of Public Health, Aarhus University, Aarhus C, Denmark
| | - Finn B Larsen
- DEFACTUM Social & Health Services and Labour Market, Aarhus N, Denmark
| | - Karina Friis
- DEFACTUM Social & Health Services and Labour Market, Aarhus N, Denmark
| | - Claus V Nielsen
- Section of Clinical Social Medicine and Rehabilitation, Department of Public Health, Aarhus University, Aarhus C, Denmark.,DEFACTUM Social & Health Services and Labour Market, Aarhus C, Denmark.,Regional Hospital West Jutland, Herning, Denmark
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7
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Alleaume C, Bendiane MK, Peretti-Watel P, Bouhnik AD. Inequality in income change among cancer survivors five years after diagnosis: Evidence from a French national survey. PLoS One 2019; 14:e0222832. [PMID: 31581224 PMCID: PMC6776327 DOI: 10.1371/journal.pone.0222832] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 09/08/2019] [Indexed: 11/30/2022] Open
Abstract
Worldwide, around 18 million people receive a cancer diagnosis each year, most of whom survive long enough to face additional cancer-related costs. In France, most costs directly related to cancer are covered by the National Health Insurance Fund, and cancer patients can receive treatments without paying advance fees. In this context, the costs faced by cancer survivors are mostly social costs. Drawing on fundamental cause theory, this study aimed to explore the socially-differentiated evolution of cancer survivor's income five years after diagnosis. Our study draws on the findings of VICAN5, a French national survey that was conducted in 2015/2016 in a representative sample of 4,174 cancer survivors to obtain information on living conditions five years after diagnosis, and that was restricted to 12 tumour sites accounting for 88% of global cancer incidence in France. We used the multiple imputation method and the Heckman selection model to identify the factors associated with a decrease in household income per consumption unit (HICU), while accounting for missing data. Among survivors still working five years after diagnosis, 17.6% reported lower income at survey than at diagnosis. After adjustment for socio-demographic and medical characteristics, the decrease in HICU was more frequent in women, singles, low educated survivors, and survivors with reduced working time. Finally, subjective measures of income variation and economic well-being were a useful complement to objective measures since 31.6% of cancer survivors still working five years after diagnosis reported a perceived decrease in household income. In conclusion, inequalities in economic well-being persist long after diagnosis in France, and this despite the fact that most cancer-related costs are covered by the French National Health Insurance Fund. Consequently, more attention should be paid to cancer patients with low socio-economic status to help reduce inequalities in post-diagnosis living conditions.
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Affiliation(s)
- Caroline Alleaume
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
| | - Marc-Karim Bendiane
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
| | - Patrick Peretti-Watel
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France
| | - Anne-Déborah Bouhnik
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
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8
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Pálmarsdóttir R, Kiesbye Øvlisen A, Severinsen MT, Glimelius I, Smedby KE, El-Galaly T. Socioeconomic impact of Hodgkin lymphoma in adult patients: a systematic literature review. Leuk Lymphoma 2019; 60:3116-3131. [PMID: 31167589 DOI: 10.1080/10428194.2019.1613538] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Hodgkin lymphoma is a highly curable disease with a peak incidence in young adulthood at times where education, family, and social relations are established. We performed a systematic literature review to assess the impact of Hodgkin lymphoma on the socioeconomic status of adolescent and adult survivors (including educational achievements, occupational aspects, marriage, and parenthood). In total, 39 articles were included. Overall, 26-36% of survivors perceived Hodgkin lymphoma as negatively affecting their socioeconomic status. Studies consistently found educational achievements in line with general population. Employment rates for survivors were comparable to the general population, but lower than before Hodgkin lymphoma diagnosis, with a post-diagnosis increase in disability pension and early retirement. Employed survivors encountered problems related to physical restrictions and recruitment. Marriage and parenthood were not substantially affected. In conclusion, current studies suggest acceptable socioeconomic outcomes following a Hodgkin lymphoma diagnosis but the use of standardized reporting methods hampers comparability across studies.
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Affiliation(s)
| | - Andreas Kiesbye Øvlisen
- Department of Hematology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Marianne Tang Severinsen
- Department of Hematology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Ingrid Glimelius
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Solna, Sweden.,Department of Immunology, Genetics and Pathology, Clinical and Experimental Oncology, Uppsala University and Uppsala Akademiska Hospital, Uppsala, Sweden
| | - Karin E Smedby
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Solna, Sweden.,Hematology Center, Karolinska University Hospital, Solna, Sweden
| | - Tarec El-Galaly
- Department of Hematology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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9
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Jensen LS, Overgaard C, Bøggild H, Garne JP, Lund T, Overvad K, Fonager K. The long-term financial consequences of breast cancer: a Danish registry-based cohort study. BMC Public Health 2017; 17:853. [PMID: 29084512 PMCID: PMC5661907 DOI: 10.1186/s12889-017-4839-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 10/06/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND A breast cancer diagnosis affects an individual's affiliation to labour market, but the long-term consequences of breast cancer on income in a Danish setting have not been examined. The present study investigated whether breast cancer affected future income among Danish women that participated in the work force. We also examined the roles of sociodemographic factors and prior psychiatric medical treatment. METHODS This registry-based cohort study was based on information retrieved from linked Danish nationwide registries. We compared the incomes of 13,101 women (aged 30-59 years) diagnosed with breast cancer (exposed) to those of 60,819 women without breast cancer (unexposed). Changes in income were examined during a 10-year follow-up; for each follow-up year, we calculated the mean annual income and the relative change compared to the income earned one year prior to diagnosis. Expected changes in Danish female income, according to calendar year and age, were estimated based on information from Statistics Denmark. For exposed and unexposed groups, the observed income changes were dichotomized to those above and those below the expected change in income in the Danish female population. We examined the impact of breast cancer on income each year of follow-up with logistic regression models. Analyses were stratified according to educational level, marital status, and prior psychiatric medical treatment. RESULTS Breast cancer had a temporary negative effect on income. The effect was largest during the first three years after diagnosis; thereafter, the gap narrowed between exposed and unexposed cohorts. The odds ratio for an increase in income in the cancer cohort compared to the cancer-free cohort was 0.81 (95% CI 0.77-0.84) after three years. After seven years, no significant difference was observed between cohorts. Stratified analyses demonstrated that the negative effect of breast cancer on income lasted longest among women with high educational levels. Being single or having received psychiatric medical treatment increased the chance to experience an increase in income among women with breast cancer. CONCLUSION A breast cancer diagnosis led to negative effects on income, which ameliorated over the following seven years. Sociodemographic factors and prior psychiatric medical treatment might influence long-term consequences of breast cancer on income.
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Affiliation(s)
- Laura Schärfe Jensen
- Department of Social Medicine, Aalborg University Hospital, Havrevangen 1, 2. Sal, 9000 Aalborg, Denmark
| | - Charlotte Overgaard
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Henrik Bøggild
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Department of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Jens Peter Garne
- Department of Breast surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Thomas Lund
- Department of Public Health and Quality Improvement, Central Denmark Region, Aarhus, Denmark
| | - Kim Overvad
- Department of Public Health – Section for Epidemiology, Aarhus University, Aarhus, Denmark
| | - Kirsten Fonager
- Department of Social Medicine, Aalborg University Hospital, Havrevangen 1, 2. Sal, 9000 Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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10
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Egestad H, Nieder C. Undesirable financial effects of head and neck cancer radiotherapy during the initial treatment period. Int J Circumpolar Health 2015; 74:26686. [PMID: 25623815 PMCID: PMC4306757 DOI: 10.3402/ijch.v74.26686] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 12/15/2014] [Accepted: 12/16/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Healthcare cost and reforms are at the forefront of international debates. One of the current discussion themes in oncology is whether and how patients' life changes due to costs of cancer care. In Norway, the main part of the treatment costs is supported by general taxpayer revenues. OBJECTIVES The objective of this study was to clarify whether head and neck cancer patients (n=67) in northern Norway experienced financial health-related quality of life (HRQOL) deterioration due to costs associated with treatment. DESIGN HRQOL was examined by the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 in the beginning and in the end of radiation treatment in patients treated at the University Hospital in Northern Norway. Changes in financial HRQOL were calculated and compared by paired sample T-tests. Multiple regression analyses were used to examine correlations among gender, marital status, age and treatment with or without additional chemotherapy and changes in the HRQOL domain of financial difficulties. RESULTS The majority of score results at both time points were in the lower range (mean 15-25), indicating limited financial difficulties. We observed no statistically significant differences by gender, marital status and age. Increasing financial difficulties during treatment were reported by male patients and those younger than 65, that is, patients who were younger than retirement age. The largest effect was seen in singles. However, differences were not statistically significant. CONCLUSIONS During the initial phase of the disease trajectory, no significant increase in financial difficulties was found. This is in line with the aims of the Norwegian public healthcare model. However, long-term longitudinal studies should be performed, especially with regard to the trends we observed in single, male and younger patients.
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Affiliation(s)
- Helen Egestad
- Faculty of Health Sciences, Department of Health and Care Sciences, UiT, The Arctic University of Norway, Tromsø, Norway;
| | - Carsten Nieder
- Faculty of Health Sciences, Department of Health and Care Sciences, UiT, The Arctic University of Norway, Tromsø, Norway; Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway
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The global impact of non-communicable diseases on households and impoverishment: a systematic review. Eur J Epidemiol 2014; 30:163-88. [PMID: 25527371 DOI: 10.1007/s10654-014-9983-3] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 12/12/2014] [Indexed: 10/24/2022]
Abstract
The global economic impact of non-communicable diseases (NCDs) on household expenditures and poverty indicators remains less well understood. To conduct a systematic review and meta-analysis of the literature evaluating the global economic impact of six NCDs [including coronary heart disease, stroke, type 2 diabetes mellitus (DM), cancer (lung, colon, cervical and breast), chronic obstructive pulmonary disease (COPD) and chronic kidney disease (CKD)] on households and impoverishment. Medline, Embase and Google Scholar databases were searched from inception to November 6th 2014. To identify additional publications, reference lists of retrieved studies were searched. Randomized controlled trials, systematic reviews, cohorts, case-control, cross-sectional, modeling and ecological studies carried out in adults and assessing the economic consequences of NCDs on households and impoverishment. No language restrictions. All abstract and full text selection was done by two independent reviewers. Data were extracted by two independent reviewers and checked by a third independent reviewer. Studies were included evaluating the impact of at least one of the selected NCDs and on at least one of the following measures: expenditure on medication, transport, co-morbidities, out-of-pocket (OOP) payments or other indirect costs; impoverishment, poverty line and catastrophic spending; household or individual financial cost. From 3,241 references, 64 studies met the inclusion criteria, 75% of which originated from the Americas and Western Pacific WHO region. Breast cancer and DM were the most studied NCDs (42 in total); CKD and COPD were the least represented (five and three studies respectively). OOP payments and financial catastrophe, mostly defined as OOP exceeding a certain proportion of household income, were the most studied outcomes. OOP expenditure as a proportion of family income, ranged between 2 and 158% across the different NCDs and countries. Financial catastrophe due to the selected NCDs was seen in all countries and at all income levels, and occurred in 6-84% of the households depending on the chosen catastrophe threshold. In 16 low- and middle-income countries (LMIC), 6-11% of the total population would be impoverished at a 1.25 US dollar/day poverty line if they would have to purchase lowest price generic diabetes medication. NCDs impose a large and growing global impact on households and impoverishment, in all continents and levels of income. The true extent, however, remains difficult to determine due to the heterogeneity across existing studies in terms of populations studied, outcomes reported and measures employed. The impact that NCDs exert on households and impoverishment is likely to be underestimated since important economic domains, such as coping strategies and the inclusion of marginalized and vulnerable people who do not seek health care due to financial reasons, are overlooked in literature. Given the scarcity of information on specific regions, further research to estimate impact of NCDs on households and impoverishment in LMIC, especially the Middle Eastern, African and Latin American regions is required.
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12
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A controlled cohort study of long-term income in colorectal cancer patients. Support Care Cancer 2014; 22:2821-30. [DOI: 10.1007/s00520-014-2258-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 04/16/2014] [Indexed: 11/27/2022]
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Abstract
With the favorable trend regarding survival of cancer in the Western world, there is an increasing focus among patients, clinicians, researchers, and politicians regarding cancer survivors' health and well-being. Their number is rapidly growing and more than 3 % of the adult populations in Western countries have survived cancer for 5 years or more. Cancer survivors are at increased risk for a variety of late effects after treatment, some life-threatening such as secondary cancer and cardiac diseases, others might negatively impact on their daily functioning and quality of life. The latter might include fatigue, anxiety disorders and difficulties returning to work while depression does not seem to be more common among survivors than in the general population. Still, the majority of survivors regain their health and social functioning. The field of cancer survivorship research has been rapidly growing. Models for follow-up care of cancer survivors have been proposed, but how to best integrate the knowledge of the field into clinical practice with adequate follow-up of cancer survivors at risk for developing late effects is still an unsolved question.
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Affiliation(s)
- Cecilie E Kiserud
- National Resource Center for late effects after Cancer Treatment, Oslo University Hospital, Radiumhospitalet, 4953 Nydalen, 0424, Oslo, Norway,
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Šaltytė Benth J, Dahl FA, Lurås H, Dahl AA. A controlled study of income development for breast cancer survivors in Norway. J Cancer Surviv 2013; 8:239-47. [PMID: 24352869 DOI: 10.1007/s11764-013-0324-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 10/23/2013] [Indexed: 10/25/2022]
Abstract
AIMS This study seeks to assess the impact of breast cancer on survivors' annual income at 1 to 13 years of follow-up. METHODS A Norwegian registry-based dataset with a 13-year follow-up period was used. The dataset contained case-control pairs, where each pair consisted of one breast cancer case and a cancer-free control, matched for age, marital status, and municipality of residence. A mixed linear model was used to analyse the average income development for cases and controls adjusting for available demographic variables not used in the matching procedure, such as education level, immigration history, and number of children. Individual income was only considered relevant for cancer survivors, thus case-control pairs were censored upon death. Income development by stage of tumour at time of diagnosis was also assessed. RESULTS The income of breast cancer survivors had reduced immediately following diagnosis. At 1 year after diagnosis, income development between cases and controls became significantly different (p = 0.006). Differences increased slightly but remained significant throughout the follow-up period. At 13 years after diagnosis, the estimated cumulative income loss for survivors was 39.403 € (p < 0.001). The income development of stage I breast cancer patients was similar to their controls. For higher stage breast cancer patients, the income differences were more pronounced but not always statistically significant. CONCLUSIONS Breast cancer has a significant negative effect on the individual incomes of survivors, even at 13 years after diagnosis. Effects increased for individuals with more advanced cancer stages. IMPLICATIONS FOR CANCER SURVIVORS In Norway, breast cancer survivors experience lower income than their cancer-free controls. This may indicate a need for financial compensations in order to maintain the standard of living for this group of patients.
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