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Sick leave and disability pension in Hodgkin lymphoma survivors by stage, treatment, and follow-up time—a population-based comparative study

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An Erratum to this article was published on 01 July 2015

Abstract

Purpose

This study seeks to investigate the long-term public health burden of Hodgkin lymphoma (HL) in terms of work loss following contemporary treatment protocols and associations with established treatment complications and lymphoma relapse.

Methods

We identified 1,989 Swedish HL patients (1,082 with clinical information) aged 18–60 (median 33) years at diagnosis 1992–2009, and matched 1:4 to population comparators. Sick leave, disability pension (work loss), and comorbidity were retrieved through September 2013. Relative risks (RR) with 95 % confidence intervals (CI) were calculated using Poisson regression, and mean lost work days were estimated yearly during follow-up.

Results

The risk of annual work loss was elevated in HL survivors versus comparators up to the 15th year post-diagnosis (RR5th year 1.64, 95 % CI 1.46–1.84; RR10th year 1.33, 95 % CI 1.15–1.34; and RR15th year 1.30, 95 % CI 1.04–1.62). The risk remained elevated up to the 10th year after adjustment for secondary malignancies and cardiovascular disease (RR10th year 1.31, 95 % CI 1.13–1.52). Advanced-stage patients had more lost days than comparators (mean number5th year 66 versus 33, mean difference 34, 95 % CI 20–48) as did patients receiving 6–8 chemotherapy courses (62 versus 33, mean difference5th year 30, 95 % CI 17–43). Among patients in the first complete remission, a difference was still observed for advanced-stage (51 versus 33, mean difference5th year 19, 95 % CI 5–34) but not early-stage disease.

Conclusions

Advanced-stage HL survivors treated with full-dose chemotherapy were at increased risk of work loss, not only explained by relapse, secondary malignancies, or cardiovascular disease.

Implications for Cancer Survivors

The results call for increased awareness and evaluation of reasons for long-term work disability following intensive chemotherapy among young HL survivors.

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Acknowledgments

This work was supported by the Swedish Cancer Society CAN 2012/774, and the Stockholm County Council 20120169. Karin E Smedby and Martin Neovius were supported by the National Strategic Research Program in Epidemiology in Sweden. Ingrid Glimelius was supported by the Swedish Society of Medicine and the Swedish Society for Medical Research.

Informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000.

Conflicts of interest

Ingrid Glimelius, Sara Ekberg, Johan Linderoth, Mats Jerkeman Ellen T Chang, Martin Neovius, and Karin Ekstrom-Smedby declare that they have no conflicts of interest.

Author information

Authors and Affiliations

  1. Section of Oncology, Department of Immunology, Genetics and Pathology, University of Uppsala, Uppsala, Sweden

    I. Glimelius

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

    I. Glimelius, S. Ekberg, M. Neovius & K. E. Smedby

  3. Department of Oncology, Skåne University Hospital, Lund, Sweden

    J. Linderoth & M. Jerkeman

  4. Health Sciences Practice, Exponent, Inc., Menlo Park, California, and Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, USA

    E. T. Chang

Authors
  1. I. Glimelius
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  2. S. Ekberg
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  3. J. Linderoth
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  6. M. Neovius
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  7. K. E. Smedby
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Corresponding author

Correspondence to K. E. Smedby.

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sFigure 1

Total number and percentage of lost work days (days of sick leave or disability pension) per year during follow-up among Hodgkin lymphoma patients (register cohort) (A) and population comparators (B). Numbers within bars represent percentages of individuals experiencing work loss during each year, also shown on the y-axis to the left. The mean, 75th and 90th percentile lines refer to the annual number of lost work days shown on the y-axis to the right. Number of patients or comparators contributing with information every other year is listed below the graphs. Sick leave and disability pension data were available from 1994; individuals diagnosed 1992 (patients = 108, comparators = 432) are thus included from the 3rd year (+2y to +3y) and individuals diagnosed in 1993 (patients = 92, comparators = 368) from the 2nd year (+1y to +2y) after diagnosis, which explains why the number of patients and comparators are lower the diagnostic year (dx to +1y) than during the first years of follow-up. (DOCX 1021 kb)

sFigure 2

Mean annual lost work days (days on sick leave or disability pension) among Hodgkin lymphoma patients (register cohort) (A) and population comparators (B). The numbers in/above the bars indicate the mean number of lost work days separately for sick leave and disability pension. The number of individuals contributing with information for complete years of follow-up is indicated below the graph. Sick leave and disability pension data were available from 1994; individuals diagnosed in 1992 (patients = 108, comparators = 432) are thus included from the 3rd year (+2y to +3y) and individuals diagnosed in 1993 (patients = 92, comparators = 368) from the 2nd year (+1y to +2y). (DOCX 199 kb)

sTable 1

(DOCX 13 kb)

sTable 2

(DOCX 16 kb)

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Glimelius, I., Ekberg, S., Linderoth, J. et al. Sick leave and disability pension in Hodgkin lymphoma survivors by stage, treatment, and follow-up time—a population-based comparative study. J Cancer Surviv 9, 599–609 (2015). https://doi.org/10.1007/s11764-015-0436-0

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  • DOI: https://doi.org/10.1007/s11764-015-0436-0

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