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Complete response to therapy: why do primary central nervous system lymphoma patients not return to work?

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Abstract

Purpose

Although primary central nervous system lymphomas (PCNSL) represent extremely aggressive brain tumours, high-dose methotrexate in combination with other chemotherapeutic agents has resulted in long-term disease control in a substantial fraction of patients. Advances in treatment efficacy with longer survival resulted in a focus on additional outcome measures such as quality of life (QoL) and neurocognition. Despite recent evidence of return to work as an important aspect of patients' QoL, little is known about occupational reintegration in PCNSL long-term survivors. This study aimed to detect specific characteristics of patients who successfully resumed work after complete response to therapy.

Methods

Patients with ongoing complete response to therapy completed a test battery capturing neurocognition, social integration, QoL and psychological burden. Of 25 patients who had been in regular employment before diagnosis only eight returned to work after treatment (32%).

Results

Patients who resumed work rated important aspects of their QoL and social integration as higher and suffered less from symptoms affecting QoL than patients who did not resume work. Also, the subjective confidence in their ability to work was higher in patients who resumed work, but independent predictors of return to work were not found in logistic regression analyses.

Conclusion

Occupational (re)integration is of clinical relevance in PCNSL patients after complete response to therapy. Due to the small size of our cohort the present results should be considered an exploratory first step. Return to work might be a crucial aspect of QoL and (re)integration into society after cure of PCNSL.

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Data availability

All data generated or analysed during this study are included in this published article and its supplementary information files.

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Funding

This study was not funded.

Author information

Author notes

  1. Greta Wiemann, Milena Pertz, Uwe Schlegel and Patrizia Thoma contributed equally to this work.

Authors and Affiliations

  1. Department of Neurology, University Hospital Knappschaftskrankenhaus, Ruhr-University Bochum, In der Schornau 23-25, 44892, Bochum, Germany

    Greta Wiemann, Milena Pertz, Thomas Kowalski, Sabine Seidel & Uwe Schlegel

  2. Neuropsychological Therapy Centre (NTC)/Clinical Neuropsychology, Faculty of Psychology, Ruhr-University Bochum, Universitätsstraße 150, 44780, Bochum, Germany

    Patrizia Thoma

Authors
  1. Greta Wiemann
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  2. Milena Pertz
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  3. Thomas Kowalski
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  4. Sabine Seidel
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  5. Uwe Schlegel
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  6. Patrizia Thoma
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by GW and MP. Patient recruitment was supported by TK and SS. The first draft of the manuscript was written by GW and MP and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Milena Pertz.

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Conflict of interest

US received speech honoraria from medac, GSK, Novartis and advisory board honoraria from Roche and Novocure.

Consent to participate

Written informed consent was obtained from all individual participants included in the study.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee (local ethics board of the medical faculty, Ruhr-University Bochum, reference number 17-6238-BR) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Wiemann, G., Pertz, M., Kowalski, T. et al. Complete response to therapy: why do primary central nervous system lymphoma patients not return to work?. J Neurooncol 149, 171–179 (2020). https://doi.org/10.1007/s11060-020-03587-5

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  • DOI: https://doi.org/10.1007/s11060-020-03587-5

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