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Prospective predictors of return to work in the 5 years after hematopoietic cell transplantation

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Abstract

Introduction

Work return is an indicator of recovery and functional status for cancer survivors. We investigated whether demographic, medical and functional factors predicted full-time work return following hematopoietic cell transplantation (HCT).

Methods

Adults (N = 197), most with hematologic malignancy, completed assessments before their HCT and at intervals over 5 years. Assessments included treatment and demographic factors, and date of return to full-time work. We created binary variables, indicative of major impairment, from the Short Form 36 Health Survey (SF-36) mental (MCS) and physical (PCS) function component scores, dichotomized at 1 SD below population norms (≤40 vs. >40). PCS and MCS were imputed for 16% of the sample. Predictors of work return were analyzed using Cox proportional hazards regression.

Results

Of the 130 patients working full-time at pre-HCT, 88 (68%) were alive and relapse-free at 5 years. Of these, 53 (60%) had returned to full-time and 28 (32%) to part-time work. For the primary analyses at 6 month post-HCT, 14 patients had already died or relapsed and 10 had returned to work. Among the remaining 106 patients, those with PCS >40 returned to work faster (Hazard Ratio (HR) 2.38, 95% Confidence Interval (CI) 1.26–4.49). Female survivors were less likely to return to work than males (HR 0.54, 95% CI 0.29–0.99).

Conclusion

Return to work is a lengthy process for many survivors. Predictors of slower return include physical dysfunction and female gender.

Implications for cancer survivors

Realistic preparation for time off work is essential to long-term health and finances of cancer survivors.

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References

  1. de Boer AG, Taskila T, Ojajarvi A, van Dijk FJ, Verbeek JH. Cancer survivors and unemployment: a meta-analysis and meta-regression. JAMA. 2009;301(7):753–62.

    Article  PubMed  Google Scholar 

  2. Bradley CJ, Bednarek HL. Employment patterns of long-term cancer survivors. Psycho-Oncology. 2002;11(3):188–98.

    Article  PubMed  Google Scholar 

  3. Short PF, Vasey JJ, Tunceli K. Employment pathways in a large cohort of adult cancer survivors. Cancer. 2005;103(6):1292–301.

    Article  PubMed  Google Scholar 

  4. Spelten ER, Sprangers MA, Verbeek JH. Factors reported to influence the return to work of cancer survivors: a literature review. Psycho-Oncology. 2002;11(2):124–31.

    Article  PubMed  Google Scholar 

  5. Syrjala KL, Langer SL, Abrams JR, Storer B, Sanders JE, Flowers ME, et al. Recovery and long-term function after hematopoietic cell transplantation for leukemia or lymphoma. JAMA. 2004;291(19):2335–43.

    Article  CAS  PubMed  Google Scholar 

  6. Hensel M, Egerer G, Schneeweiss A, Goldschmidt H, Ho AD. Quality of life and rehabilitation in social and professional life after autologous stem cell transplantation. Ann Oncol. 2002;13(2):209–17.

    Article  CAS  PubMed  Google Scholar 

  7. Lee SJ, Fairclough D, Parsons SK, Soiffer RJ, Fisher DC, Schlossman RL, et al. Recovery after stem-cell transplantation for hematologic diseases. J Clin Oncol. 2001;19(1):242–52.

    CAS  PubMed  Google Scholar 

  8. Duell T, van Lint MT, Ljungman P, Tichelli A, Socie G, Apperley JF, et al. Health and functional status of long-term survivors of bone marrow transplantation. EBMT Working Party on Late Effects and EULEP Study Group on Late Effects. European Group for Blood and Marrow Transplantation. Ann Intern Med. 1997;126(3):184–92.

    CAS  PubMed  Google Scholar 

  9. Deeg HJ, Leisenring W, Storb R, Nims J, Flowers ME, Witherspoon RP, et al. Long-term outcome after marrow transplantation for severe aplastic anemia. Blood. 1998;91(10):3637–45.

    CAS  PubMed  Google Scholar 

  10. Edman L, Larsen J, Hagglund H, Gardulf A. Health-related quality of life, symptom distress and sense of coherence in adult survivors of allogeneic stem-cell transplantation. Eur J Cancer Care (Engl). 2001;10(2):124–30.

    Article  CAS  Google Scholar 

  11. Molassiotis A, Boughton BJ, Burgoyne T, van den Akker OB. Comparison of the overall quality of life in 50 long-term survivors of autologous and allogeneic bone marrow transplantation. J Adv Nurs. 1995;22(3):509–16.

    Article  CAS  PubMed  Google Scholar 

  12. Heinonen H, Volin L, Uutela A, Zevon M, Barrick C, Ruutu T. Quality of life and factors related to perceived satisfaction with quality of life after allogeneic bone marrow transplantation. Ann Hematol. 2001;80(3):137–43.

    Article  CAS  PubMed  Google Scholar 

  13. Socie G, Mary JY, Esperou H, Robert DV, Aractingi S, Ribaud P, et al. Health and functional status of adult recipients 1 year after allogeneic haematopoietic stem cell transplantation. Br J Haematol. 2001;113(1):194–201.

    Article  CAS  PubMed  Google Scholar 

  14. Syrjala KL, Langer SL, Abrams JR, Storer BE, Martin PJ. Late effects of hematopoietic cell transplantation among 10-year adult survivors compared with case-matched controls. J Clin Oncol. 2005;23(27):6596–606.

    Article  PubMed  Google Scholar 

  15. Steiner JF, Cavender TA, Main DS, Bradley CJ. Assessing the impact of cancer on work outcomes: what are the research needs? Cancer. 2004;101(8):1703–11.

    Article  PubMed  Google Scholar 

  16. Short PF, Vargo MM. Responding to employment concerns of cancer survivors. J Clin Oncol. 2006;24(32):5138–41.

    Article  PubMed  Google Scholar 

  17. Syrjala KL, Chapko MK, Vitaliano PP, Cummings C, Sullivan KM. Recovery after allogeneic marrow transplantation: prospective study of predictors of long-term physical and psychosocial functioning. Bone Marrow Transplant. 1993;11(4):319–27.

    CAS  PubMed  Google Scholar 

  18. Broers S, Kaptein AA, Le Cessie S, Fibbe W, Hengeveld MW. Psychological functioning and quality of life following bone marrow transplantation: a 3-year follow-up study. J Psychosom Res. 2000;48(1):11–21.

    Article  CAS  PubMed  Google Scholar 

  19. Blume KG, Forman S, Appelbaum FR, editors. Thomas' hematopoietic cell transplantation. 3rd ed. Malden: Blackwell; 2004.

    Google Scholar 

  20. Flowers ME, Lee S, Vogelsang G. An update on how to treat chronic GVHD. Blood. 2003;102(6):2312.

    Article  CAS  PubMed  Google Scholar 

  21. Lee SJ, Vogelsang G, Flowers ME. Chronic graft-versus-host disease. Biol Blood Marrow Transplant. 2003;9(4):215–33.

    Article  CAS  PubMed  Google Scholar 

  22. Vogelsang GB. How I treat chronic graft-versus-host disease. Blood. 2001;97(5):1196–201.

    Article  CAS  PubMed  Google Scholar 

  23. Wingard JR, Curbow B, Baker F, Piantadosi S. Health, functional status, and employment of adult survivors of bone marrow transplantation. Ann Intern Med. 1991;114(2):113–8.

    CAS  PubMed  Google Scholar 

  24. Mosher CE, Redd WH, Rini CM, Burkhalter JE, DuHamel KN. Physical, psychological, and social sequelae following hematopoietic stem cell transplantation: a review of the literature. Psycho-Oncology. 2009;18(2):113–27.

    Article  PubMed  Google Scholar 

  25. Russell JA, Larratt L, Brown C, Turner AR, Chaudhry A, Booth K, et al. Allogeneic blood stem cell and bone marrow transplantation for acute myelogenous leukemia and myelodysplasia: influence of stem cell source on outcome. Bone Marrow Transplant. 1999;24(11):1177–83.

    Article  CAS  PubMed  Google Scholar 

  26. Lee SJ, Loberiza FR, Rizzo JD, Soiffer RJ, Antin JH, Weeks JC. Optimistic expectations and survival after hematopoietic stem cell transplantation. Biol Blood Marrow Transplant. 2003;9(6):389–96.

    Article  PubMed  Google Scholar 

  27. Parimon T, Au DH, Martin PJ, Chien JW. A risk score for mortality after allogeneic hematopoietic cell transplantation. Ann Intern Med. 2006;144(6):407–14.

    PubMed  Google Scholar 

  28. Jager HR, Williams EJ, Savage DG, Rule SA, Hajnal JV, Sikora K, et al. Assessment of brain changes with registered MR before and after bone marrow transplantation for chronic myeloid leukemia. AJNR Am J Neuroradiol. 1996;17(7):1275–82.

    CAS  PubMed  Google Scholar 

  29. Socie G, Clift RA, Blaise D, Devergie A, Ringden O, Martin PJ, et al. Busulfan plus cyclophosphamide compared with total-body irradiation plus cyclophosphamide before marrow transplantation for myeloid leukemia: long-term follow-up of 4 randomized studies. Blood. 2001;98(13):3569–74.

    Article  CAS  PubMed  Google Scholar 

  30. Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30(6):473–83.

    Article  PubMed  Google Scholar 

  31. Ware JE Jr, Kosinski M, Bayliss MS, McHorney CA, Rogers WH, Raczek A. Comparison of methods for the scoring and statistical analysis of SF-36 health profile and summary measures: summary of results from the Medical Outcomes Study. Med Care. 1995;33(4 Suppl):AS264–79.

    PubMed  Google Scholar 

  32. Ware JE Jr, Kosinski M, Keller SD. SF-36 physical and mental health summary scales: A user's manual. Boston: The Health Institute; 1994.

    Google Scholar 

  33. Rubin DB. Multiple imputation for non-response in surveys. New York: John Wiley and Sons, Inc.; 1987.

    Book  Google Scholar 

  34. van Buuren S, Boshuizen HC, Knook DL. Multiple imputation of missing blood pressure covariates in survival analysis. Stat Med. 1999;18(6):681–94.

    Article  PubMed  Google Scholar 

  35. Wood AM, White IR, Royston P. How should variable selection be performed with multiply imputed data? Stat Med. 2008;27(17):3227–46.

    Article  PubMed  Google Scholar 

  36. Pintilie M. Dealing with competing risks: testing covariates and calculating sample size. Stat Med. 2002;21(22):3317–24.

    Article  PubMed  Google Scholar 

  37. Hosmer DW, Lemeshow S. Applied survival analysis. New York: John Wiley and Sons, Inc.; 1999.

    Google Scholar 

  38. Institute of Medicine. From Cancer Patient to Cancer Survivor: Lost in Transition 2005.

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Acknowledgments

Supported by grants from the National Cancer Institute (CA 63030, CA78990, CA112631). We thank Thomas Wickizer for his helpful comments on an earlier draft.

Conflict of interest

We report no conflicts of interest.

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Authors and Affiliations

  1. Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N. D5-220, Seattle, WA, 98109, USA

    Anne C. Kirchhoff, Wendy Leisenring & Karen L. Syrjala

  2. Department of Health Services, University of Washington School of Public Health and Community Medicine, Seattle, WA, USA

    Anne C. Kirchhoff

  3. Department of Biostatistics, University of Washington School of Public Health, Seattle, WA, USA

    Wendy Leisenring

  4. Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA

    Karen L. Syrjala

Authors
  1. Anne C. Kirchhoff
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Correspondence to Karen L. Syrjala.

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Kirchhoff, A.C., Leisenring, W. & Syrjala, K.L. Prospective predictors of return to work in the 5 years after hematopoietic cell transplantation. J Cancer Surviv 4, 33–44 (2010). https://doi.org/10.1007/s11764-009-0105-2

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  • DOI: https://doi.org/10.1007/s11764-009-0105-2

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