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Lost workdays in uterine cervical cancer survivors compared to the general population: impact of treatment and relapse

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Abstract

Purpose

The aim of the present study was to examine the risk of lost workdays due to sick leave and disability pension by treatment modality and relapse in a population-based cohort of cervical cancer survivors versus matched comparators.

Methods

We identified 1971 cervical cancer patients aged ≤60 years (median 42) at diagnosis in Sweden 2003–2009 and 9254 population comparators. Information on sociodemographic and clinical characteristics, sick leave, and disability pension was retrieved from nationwide prospective registers. Differences in the annual mean number of lost workdays were calculated by linear regression, and hazard ratios (HRs) of disability pension were calculated by Cox regression analysis, with follow-up through September 2013.

Results

Cervical cancer patients had more lost workdays annually than comparators up to 8 years following diagnosis. Relapse-free patients had more lost workdays than comparators up to 4 years. Risk of disability pension during follow-up was increased among the relapse-free patients treated with hysterectomy (HR 1.8 [95 % confidence interval (CI) 1.1–2.8]), hysterectomy plus chemotherapy and/or radiotherapy (HR 2.5 [95 % CI 1.2–5.4]), or chemotherapy and/or radiotherapy alone (HR 3.0 [95 % CI 1.3–6.8]), compared with the population. Women treated with fertility-sparing surgery did not have more lost workdays than the population beyond the first year and were not at increased risk of disability pension.

Conclusion

We observed a long-standing increased risk of lost workdays among cervical cancer patients, overall, as well as among relapse-free patients.

Implications for Cancer Survivors

Extensive but not limited treatment was associated with increased risk of lost workdays, possibly reflecting an association between treatment side effects and work ability.

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Acknowledgments

The authors would like to thank Ellen T. Chang, Health Sciences Practice, Exponent, Inc., Menlo Park, California, and Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California, USA, for the English language revision.

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Authors and Affiliations

  1. Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden

    Åsa H. Everhov

  2. Unit of Clinical Epidemiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden

    Sara Ekberg, Ingrid Glimelius & Karin E. Smedby

  3. Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden

    Angelica Lindén Hirschberg & Angelique Flöter Rådestad

  4. Department of Oncology, Sahlgrenska Academy, Gothenburg, Sweden

    Karin Bergmark

  5. Department of Immunology, Genetics and Pathology, Unit of Oncology, Uppsala University, Uppsala, Sweden

    Ingrid Glimelius

  6. Department of Surgery, South Hospital, SE 118 61, Stockholm, Sweden

    Åsa H. Everhov

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  1. Åsa H. Everhov
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  2. Sara Ekberg
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Correspondence to Åsa H. Everhov.

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Supplementary Table S1

ICD codes for diagnoses and treatments. (DOC 31 kb)

Supplementary Table S2

Mean differences in days on sick-leave or disability pension (lost workdays) per year of follow-up among cervical cancer patients versus matched population comparators. (DOC 87 kb)

Supplementary Table S3

Associations of socio-demographic factors and treatment with risk (hazard ratio, HR) of disability pension among cervical cancer patients only. (DOCX 28 kb)

Supplementary Fig. 1

Sick leave and disability pension (lost workdays) per year from 2 years before diagnosis/match date to the 10th year of follow-up among A) all cervical cancer patients (including relapse) and B) population comparators. Numbers within bars represent percentages of individuals with 0, 1–49, 50–364 and ≥365 lost workdays during each year. The 75th and 90th percentile lines refer to the annual number of lost workdays shown on the secondary y-axis (to the right). (DOCX 281 kb)

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Everhov, Å.H., Ekberg, S., Hirschberg, A.L. et al. Lost workdays in uterine cervical cancer survivors compared to the general population: impact of treatment and relapse. J Cancer Surviv 10, 514–523 (2016). https://doi.org/10.1007/s11764-015-0496-1

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  • DOI: https://doi.org/10.1007/s11764-015-0496-1

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