The impact of cancer diagnosis on employment status in a working population
Автор: Palizgir A., Khodakarim N., Mohammadi S., Rezaei F., Hosseininejad M.
Журнал: Сибирский онкологический журнал @siboncoj
Рубрика: Эпидемиологические исследования
Статья в выпуске: 4 т.23, 2024 года.
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The aim of this study was to investigate the status of return to work and the influencing factors in patients with common cancers referring to three medical centers during the years 2020 to 2022. Material and Methods. In the present study (a retrospective cohort), all patients who visited three medical centers during the years 2020-2022 and were diagnosed with common cancers (non-Hodgkin’s lymphoma, Hodgkin’s lymphoma, gastrointestinal cancers and sarcoma), were included in the study. Work ability index (WAI) was assessed based on selected questions from the WAI questionnaire. Hospital Anxiety and Depression Scale (HADS) was used to assess depression and anxiety, and Multidimensional Fatigue Inventory (MFI-20) was used to assess the level of fatigue. Then, the data obtained from individuals who returned to work were compared with those who did not return.
Cancer, quality of life, return to work
Короткий адрес: https://sciup.org/140307085
IDR: 140307085 | DOI: 10.21294/1814-4861-2024-23-4-19-31
Текст научной статьи The impact of cancer diagnosis on employment status in a working population
Occupational Illness and injuries can create employment difficulties for individuals to the extent that they may not be able to return to their previous jobs. The span of this problem partly relates to the extent of the damage, the type of disease, and the individual's occupation [1, 2]. With the development of societies, new technologies, and equipment in medical science, conditions can be created where individuals can return to work after a period of treatment [3, 4].
Cancer is one of the primary diseases that disrupt the normal lives of individuals, forcing many patients to temporarily leave their jobs during treatment [3, 5]. In severe cases, they may be forced to permanently quit their jobs [6]. Individuals who are unable to return to their workplace impose a burden on their families and society. Losing a job due to illness, regardless of the financial costs, also carries negative psychological consequences for patients, reducing not only their hope for life and motivation but also causing anxiety in their families [7, 8].
In recent years, the number of cancer survivors has increased due to advances in diagnosis and treatment. Returning to society after treatment is a crucial goal for cancer patients following initial therapies, which can help more patients return to work and resume their normal lives [9]. Returning to work after cancer treatment is a complex phenomenon influenced by factors beyond the disease itself [6, 10]. Cancer survivors who were employed at the time of diagnosis may face economic pressure if they lose their jobs, especially if alternative sources of income are not available or if they lose access to job-related health insurance.
Some studies indicate that 26–53 % of cancer survivors lose or leave their jobs during or after treatment [9]. The physical and mental burden of cancer and its treatment, along with side effects such as fatigue, pain and anxiety, can lead to disruptions in patients’ ability to work. These patients need help to overcome personal (physical and psychological) and occupational issues to return to work [3]. Employment rates among cancer survivors reported in various studies range from 41 % to 84 % [1]. The results obtained in different studies are not consistent due to the diversity of cancer types. In recent years, several factors related to return to work after cancer treatment have been identified and more evidence has emerged regarding the importance of demographic, occupational and disease-related factors. In our country, few studies have been conducted on the rate of return to work of cancer patients and the factors affecting it. Therefore, in this study, we examined the return-to-work status of patients with common cancers and the factors related to their employment after completing the treatment period.
The aim of this study was to investigate the status of return to work and the influencing factors in patients with common cancers referring to three medical centers during the years 2020 to 2022.
Material and Methods
This observational study was conducted as a retrospective cohort. In this study, 750 individuals who were admitted for the first time with a cancer diagnosis in three medical centres of Iran University of Medical Sciences during the years 2020-2022 and were among common cancers (non-Hodgkin’s lymphoma, Hodgkin’s lymphoma, gastrointestinal cancers such as oesophageal, gastric, colon, and various sarcomas), were examined. 540 individuals (337 deceased, 79 non-responders to telephone calls, 64 homemakers, 31 unemployed, 16 wrong phone numbers, 10 with less than six months since diagnosis, and 3 without a phone number) were excluded from the study. 210 individuals met the criteria, of which 135 individuals completed the questionnaire (response rate 64.2 %).
The mean age of the participants at the time of diagnosis and treatment completion was 50.2 ± 10.4 and 53.0 ± 10.8 years, respectively. There were 114 (84.4 %) male patients and 21 (15.7 %) female patients. The majority of individuals (82.2 %) were married. Most individuals were diagnosed with gastric cancer (66 individuals: 48.9 %).
The files of these individuals were reviewed for the required variables, including personal factors such as age, gender, marital status, education level, smoking status, and disease-related factors such as date of diagnosis, cancer type, treatment type (surgery, chemotherapy, radiotherapy), cancer stage, treatment duration, time since completion of treatment, disease recurrence, and pre-existing comorbidities that could affect return to work (including neurological, cardiovascular, respiratory, gastrointestinal, renal, hepatobiliary, endocrine, musculoskeletal, genitourinary, hematologic, dermatologic, and psychiatric disorders). Results were recorded.
Additionally, a checklist containing variables related to work absence days or unemployment, the first day of full-time work, job title at the time of hospitalization and after returning to work, monthly income in the previous and current jobs, spouse’s employment status, insurance support, employer support, co-worker support, job satisfaction, employment status, working hours in the previous and current jobs, obstacles to returning to work (including disease and treatment-related symptoms such as fatigue, weight loss, anxiety and stress, cognitive problems, pain, physical appearance changes, or job termination), number of family members, treatment side effects (leukopenia, nausea and vomiting, anemia, tingling, numbness in hands and feet, etc.), medications (anxiolytics, antidepressants), receipt of rehabilitation and psychiatric counselling, availability of sick leave in the current job, was prepared. Then, these items were asked from the patients via telephone contact using the phone number recorded in the medical records.
The work ability index (WAI) was assessed based on selected questions from the WAI questionnaire, which has been shown in previous studies to be a suitable substitute for this questionnaire, including current work ability (0 to 10) and work ability regarding the physical and mental demands of the job (2 to 10) [11]. The Hospital Anxiety and Depression Scale (HADS) was used to assess the depression and anxiety [12]. HADS contains 14 items, 7 items are related to anxiety subscale and 7 items are related to depression. A higher score indicates more severe emotional distress. In this study, a score of 8 or higher in each subscale indicates the presence of anxiety or depression [13]. The Multidimensional Fatigue Inventory (MFI-20) questionnaire was used to assess the level of fatigue. The MFI questionnaire includes 20 items and 5 subscales of general, physical and mental fatigue, decreased activity and decreased motivation. The total score for each domain ranges from 4 to 20, and the total fatigue score, which is determined by summing the scores of the domains, can range from 20 to 100. A higher score indicates more severe fatigue [14]. Quality of life was assessed on a scale of 1 to 100 (1 being the lowest and 100 being the highest quality of life) [15].
Then, all demographic, occupational, and disease related variables mentioned above were compared between individuals who returned to work and those who did not. The results for quantitative variables were expressed as mean and standard deviation, and for qualitative variables, frequency and percentage were reported. Quantitative data were compared using the t-test, and qualitative data were analyzed using the Chisquare test. Non-normally distributed variables were expressed as median with 25th and 75th percentiles, and were compared between the two groups applying the Mann-Whitney U test. Statistical analysis was performed using SPSS software version 22, considering a significance level of less than 0.05.
Participation in this study was voluntary. The patients were not charged for entering the study. Informed consent was obtained from all individual participants included in the study. All patient data remained confidential. This study was approved by the Ethics Committee with the ethics code IR.IUMS. FMD.REC.1400.137.
Results
Descriptive analysis of demographic and occupational variables is presented in Table 1. According to the information in Table 2, 120 (89 %) of individuals experienced treatment side effects. 87 (64 %) of individuals had at least one concomitant comorbidity. 27 (20 %) of participants experienced disease recurrence. Only 12 (8.9 %) individuals received psychiatric counselling, with 50 % reporting depression and 50 % reporting stress. None of the study participants received psychiatric medications. Other disease-related information is shown in Table 2.
In Table 3, descriptive analysis of quantitative variables including fatigue, anxiety, depression, and work ability is provided. According to the MFI questionnaire, the mean total fatigue score among the study participants was 62.2 ± 15.3, indicating high levels of fatigue. Additionally, the mean anxiety and depression scores were above 8, indicating emotional distress among the study participants.
The job titles of the study participants before diagnosis and after completing treatment are given in Table 4. The most job title before cancer diagnosis was manual work, while none of the participants were in this job after completing the treatment. Due to the small sample size in each subgroup, it was not possible to perform further analysis on the job title.
After completing the treatment, 36 (26.7 %) of the patients returned to work. The majority of these individuals (n=24, 66.6 %) reported a decrease in physical ability to work. 12 (33.3 %) individuals reported early fatigue, 3 (8.3 %) individuals reported reduced opportunity for promotion, and 3 (8.3 %) individuals reported a reduction in wages. Sixty-six (73.3 %) patients did not return to work, with the most common reason being physical inability to work in 60 individuals (66.6 %). The employment status of those who returned to work and the reasons for not returning to work are shown in Table 5.
About 58 % of individuals who returned to work could not use sick leave. The average weekly working hours among individuals who returned to work were approximately 8 hours less than the average working hours before diagnosis.
Regarding the type of cancer, the highest rate of return to work was observed in individuals with nonHodgkin’s lymphoma (60 %), and the lowest rate
Table 1/Òàблицà 1
|
Variables/Показатели |
Number of patients/ Число больных |
|
|
Gender/Пол |
Male/Мужской Female/Женский |
114 (84.4 %) 21 (15.7 %) |
|
Marital status/Семейный статус |
Married/Женат, замужем Single/Не женат, не замужем |
111 (82.2 %) 24 (17.8 %) |
|
Smoking status/Курение |
Yes/Да No/Нет |
48 (35.6 %) 87 (64.4 %) |
|
Low/Низкий |
87 (62.2 %) |
|
|
Education level/Уровень образования |
Moderate/Средний |
36 (26.7 %) |
|
High/Высокий |
15 (11.1 %) |
|
|
Public servant/Государственный служащий |
12 (8.9 %) |
|
|
Еmployment at the time of diagnosis/ |
Employee/Наемный работник |
27 (20 %) |
|
Занятость на момент постановки диагноза |
Self employed/Самозанятый |
36 (26.7 %) |
|
Daily worker/Временный работник |
60 (44.4 %) |
|
|
Income level in previous job/ Уровень дохода на предыдущей работе |
Low/Низкий Moderate/Средний High/Высокий |
81 (60 %) 45 (33.3 %) 9 (6.7 %) |
|
Income level in current job/ Уровень дохода на настоящей работе |
Low/Низкий Moderate/Средний High/Высокий |
13 (36.2 %) 11 (30.5 %) 12 (33.3 %) |
|
Spouse's employment status/ |
Yes/Да |
21 (18.9 %) |
|
Статус занятости супруга |
No/Нет |
90 (81.1 %) |
|
Sick leave feasibility in the current/ |
Yes/Да |
15 (41.6 %) |
|
Возможность взять больничный на настоящей работе |
No/Нет |
21 (58.3 %) |
Note: created by the authors.
Примечание: таблица составлена авторами.
|
Descriptive analysis of the disease-related variables Анализ показателей, связанных с заболеванием |
Table 2/Таблица 2 |
|
Variables/Показатели |
Number of patients/ Число больных |
Notes: * – a person may have reported more than one item; created by the authors.
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