Abstract
Purpose
To determine the prevalence of and factors associated with the reduction or complete cessation of employment following treatment in head and neck cancer survivors.
Methods
This cross-sectional study was conducted among head and neck cancer survivors visiting outpatient clinics at the Princess Margaret Cancer Centre over a period of 18 months. Participants at any point along their survivorship course completed a survey that included demographic information, the Radiation Therapy Oncology Group (RTOG) Work Status Questionnaire, the Functional Assessment of Cancer Therapy–Head and Neck (FACT-HN), the M.D. Anderson Symptom Inventory–Head and Neck (MDASI-HN), the Cancer Survivors’ Unmet Needs Measure (CaSUN), and the EuroQol EQ-5D-5L utility scale.
Results
Among 130 participants, 64 were employed at diagnosis. At the time of study, 31 (48%) had reduced their work, among whom, 21 (32.8%) had not returned to work at all following treatment. Pre-treatment employment status, cancer-related symptoms, quality of life, and health utility were associated with employment outcomes.
Conclusion
A high proportion of head and neck cancer survivors reduced their work capacity and many did not return following cancer treatment. Further research is needed to understand the barriers to work return in these survivors and to explore strategies to encourage resumption of employment and employment satisfaction.
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References
Ringash J (2015) Survivorship and quality of life in head and neck Cancer. J Clin Oncol 33(29):3322–3327
Papadakos JM, McQuestion M, Gokhale A (2017) Informational Needs of Head and Neck Cancer Patients. J Cancer Educ. https://doi.org/10.1007/s13187-017-1176-9
Giuliani M, McQuestion M, Jones M, Papadakos J, Le Lisa W, Alkazaz N, Cheng T, Waldron J, Catton P, Ringash J (2016) Prevalence and nature of survivorship needs in patients with head and neck cancer. Head Neck 38(7):1097–1103
Capozzi LC, Lau H, Reimer RA, McNeely M, Giese-Davis J, Culos-Reed SN (2012) Exercise and nutrition for head and neck cancer patients: a patient oriented, clinic-supported randomized controlled trial. BMC Cancer 12:446
Dewa CS et al (2016) Advice about work-related issues to peers and employers from head and neck Cancer survivors. PLoS ONE [electronic Resource] 11(4):e0152944
Buckwalter AE, Karnell LH, Smith RB, Christensen AJ, Funk GF (2007) Patient-reported factors associated with discontinuing employment following head and neck Cancer treatment. Arch. Otolaryngol. Head Neck Surg 133(5):464–470
Ringash J (2014) Facing head and neck cancer deaths head on: lessons for survival. J Cancer Educ 120(10):1446–1449
Forte T, Niu J, Lockwood G, Bryant H (2012) Incidence trends in head and neck cancers and human papillomavirus (HPV)-associated oropharyngeal cancer in Canada, 1992–2009. Cancer Causes Control 23(8):1343–1348
Rossa L, Petersen MA, Johnsena AT, Lundstroema LH, Carlsenb K, Groenvolda M (2012) Factors associated with Danish cancer patients’ return to work. A report from the population-based study ‘the Cancer Patient's world’. Cancer Epidemiol 36(2):222–229
Short PFV, Joseph J (2005) Employment pathways in a large cohort of adult cancer survivors. Cancer 103(6):1292–1301
Verdonck-de Leeuw IM, van Bleek WJ, René Leemans C, de Bree R (2010) Employment and return to work in head and neck cancer survivors. Oral Oncol 46(1):56–60
Spelten ER et al (2017) Factors reported to influence the return to work of cancer survivors: a literature review. Psycho-Oncologia 11(2):124–131
Islam T, Dahlui M, Majid HA, Nahar AM, Taib NA, Mohd, Su TT (2014) Factors associated with return to work of breast cancer survivors: a systematic review. BMC Public Health 14(3):S8
Liu HE (2008) Changes of satisfaction with appearance and working status for head and neck tumour patients. J Clin Nurs 17(14):1930–1938
Cooper AF, Hankins M, Rixon L, Eaton E, Grunfeld EA (2013) Distinct work-related, clinical and psychological factors predict return to work following treatment in four different cancer types. Psycho-Oncol 22(3):659–667
Isaksson J, Wilms T, Laurell G, Fransson P, Ehrsson YT (2016) Meaning of work and the process of returning after head and neck cancer. Supportive Care Cancer 24(1):205–213
Taylor JC, Terrell JE, Ronis DL, Fowler KE, Bishop C, Lambert MT, Myers LL, Duffy SA, Bradford CR, Chepeha DB, Hogikyan ND, Prince ME, Teknos TN, Wolf GT, University of Michigan Head and Neck Cancer Team (2004) Disability in patients with head and neck Cancer. Arch Otolaryngol Head Neck Surg 130(6):764–769
Baxi SS, Salz T, Xiao H, Atoria CL, Ho A, Smith-Marrone S, Sherman EJ, Lee NY, Elkin EB, Pfister DG (2016) Employment and return to work following chemoradiation in patient with HPV-related oropharyngeal cancer. Cancers Head Neck 1(1):4
Handschel J, Gellrich NC, Bremerich A, Krüskemper G (2013) Return to work and quality of life after therapy and rehabilitation in oral cancer. In Vivo 27(3):401–407
Koch R, Wittekindt C, Altendorf-Hofmann A, Singer S, Guntinas-Lichius O (2014) Employment pathways and work-related issues in head and neck cancer survivors. Head Neck 37(4):585–593
Canadian Partnership Against Cancer. Programs and Resources to Facilitate Return to Work for People with Cancer or Other Chronic Diseases: Environmental Scan. Cancer Journey Advisory Group, April 2012
Stergiou-Kita M, Grigorovich A, Tseung V, Milosevic E, Hebert D, Phan S, Jones J (2014) Qualitative meta-synthesis of survivors' work experiences and the development of strategies to facilitate return to work. J Cancer Surviv 8(4):657–670
National Cancer Institute (2017) D.o.C.C.P.S. In: Definitions - Office of Cancer Survivorship
List MA, D'Antonio LL, Cella DF, Siston A, Mumby P, Haraf D, Vokes E (1996) The performance status scale for head and neck cancer patients and the functional assessment of cancer therapy-head and neck scale: a study of utility and validity. Cancer 77(11):2294–2301
Rosenthal DI, Mendoza TR, Chambers MS, Asper JA, Gning I, Kies MS, Weber RS, Lewin JS, Garden AS, Ang KK, S. Wang X, Cleeland CS (2007) Measuring head and neck cancer symptom burden: the development and validation of the M. D. Anderson symptom inventory, head and neck module. Head Neck 29(10):923–931
Herdman M, Gudex C, Lloyd A, Janssen MF, Kind P, Parkin D, Bonsel G, Badia X (2011) Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res 20(10):1727–1736
Hodgkinson K et al (2006) The development and evaluation of a measure to assess cancer survivors’ unmet supportive care needs: the CaSUN (Cancer Survivors' unmet needs measure). Psycho-Oncologia 16(9):796–804
Radiation Therapy Oncology Group. Demographic Work Status Questionnaire. Available from: https://www.rtog.org/LinkClick.aspx?fileticket=lbxiSb0V2LA%3D&tabid=40
Vartanian JG, Carvalho AL, Toyota J, Kowalski ISG, Kowalski LP (2006) Socioeconomic effects of and risk factors for disability in long-term survivors of head and neck Cancer. Arch Otolaryngol Head Neck Surg 132(1):32–35
Wellspring Returning to Work Program Available from: https://wellspring.ca/downtown-toronto/programs/all-programs/returning-to-work/
Terrell JE, Nanavati K, Esclamado RM, Bradford CR, Wolf GT (1999) Health impact of head and neck cancer. Otolaryngol Head Neck Surg 120(6):852–859
Morrison T, Thomas R, Guitard P (2015) Physicians’ perspectives on cancer survivors’ work integration issues. Can Fam Physician:e36–e42
Law M, Cooper B, Strong S, Stewart D, Rigby P, Letts L (1996) The Person-Environment-Occupation Model: A transactive approach to occupational performance. Can J Occup Ther 63:9–23
Acknowledgements
The MDASI-HN, FACT-HN, EQ-5D, and CaSUN were used with permission. This work was supported by the Princess Margaret Foundation Discovery fund.
Funding
This study was funded by the Princess Margaret Cancer Center Discovery Grant.
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Conflict of interest
No financial relationship exists with the organization that sponsored this research.
We have full control of all primary data and agree to allow the journal to review the data if requested.
Meredith Giuliani declares that she has no conflict of interest.
Janet Papadakos declares that she has no conflict of interest.
Michaela Broadhurst declares that she has no conflict of interest.
Jennifer Jones declares that she has no conflict of interest.
Maurene McQuestion declares that she has no conflict of interest.
Lisa W Le declares that she has no conflict of interest.
Lydia Beck declares that she has no conflict of interest.
John Waldron declares that he has no conflict of interest.
Jolie Ringash declares that he has no conflict of interest.
Ethical approval
Research involving human participants and/or animals: all procedures performed in studies involving human participants were in accordance with the ethical standards of the Princess Margaret Cancer Center institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Results focusing on unmet needs from the overall cohort have been previously published (Giuliani, M. McQuestion, M. Jones, J. Papadakos, J. Le, LW. Alkazaz, N. Cheng, T. Waldron, J. Catton, P. Ringash, J. Prevalence and nature of survivorship needs in patients with head and neck cancer. Head Neck. 2016;38(7): 1097-1103.
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Informed consent was obtained from all individual participants included in the study.
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Giuliani, M., Papadakos, J., Broadhurst, M. et al. The prevalence and determinants of return to work in head and neck cancer survivors. Support Care Cancer 27, 539–546 (2019). https://doi.org/10.1007/s00520-018-4343-6
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DOI: https://doi.org/10.1007/s00520-018-4343-6