Evelien Spelten

Cancer, fatigue and the return of patients to work—a prospective cohort study

Fatigue is a highly prevalent and debilitating symptom in cancer survivors. The aim of this study was to assess the impact of fatigue and other cancer-related symptoms on the return to work of cancer survivors. A prospective inception cohort study with 12 months of follow-up was initiated. At 6 months following the first day of sick leave, levels of fatigue, depression, sleep problems, physical complaints, cognitive dysfunction and psychological distress were assessed, in addition to clinical, sociodemographic and work-related factors. Data were obtained from one academic hospital and two general hospitals in the Netherlands. 235 patients who had a primary diagnosis of cancer and underwent treatment with curative intent were included. The rate of return to work was measured at 6, 12 and 18 months. Hazard ratios (HRs) for the duration of sick leave up to 18 months following the first day of sick leave were calculated. The rate of return to work increased from 24% at 6 months to 64% at 18 months following the first day of sick leave. Fatigue, diagnosis, treatment type, age, gender, depression, physical complaints and workload were all related to the time taken to return to work. Fatigue scores were also strongly related to diagnosis, physical complaints, and depression scores. Fatigue at 6 months predicted a longer sick leave with a hazard ratio of 0.71 (95% Confidence Interval (C.I.) 0.59-0.85), adjusted for diagnosis, treatment type, age and gender. In a multivariate Cox regression analysis, diagnosis, treatment, age, physical complaints and workload remained the only significant predictors of duration of the sick leave. 64% of cancer survivors returned to work within 18 months. Fatigue levels predicted the return to work. This was independent of the diagnosis and treatment, but not of other cancer-related symptoms. Better management of cancer-related symptoms is therefore needed to facilitate the return to work of cancer patients.

Work ability and return-to-work in cancer patients

The extent to which self-assessed work ability collected during treatment can predict return-to-work in cancer patients is unknown. In this prospective study, we consecutively included employed cancer patients who underwent treatment with curative intent at 6 months following the first day of sick leave. Work ability data (scores 0–10), clinical and sociodemographic data were collected at 6 months, while return-to-work was measured at 6, 12 and 18 months. Most of the 195 patients had been diagnosed with breast cancer (26%), cancer of the female genitals (22%) or genitourological cancer (22%). Mean current work ability scores improved significantly over time from 4.6 at 6 months to 6.3 and 6.7 at 12 and 18 months, respectively. Patients with haematological cancers and those who received chemotherapy showed the lowest work ability scores, while patients with cancer of urogenital tract or with gastrointestinal cancer had the highest scores. Work ability at 6 months strongly predicted return-to-work at 18 months, after correction for the influence of age and treatment (hazard ratio=1.37, CI 1.27–1.48). We conclude that self-assessed work ability is an important factor in the return-to-work process of cancer patients independent of age and clinical factors.

Physical and psychosocial problems in cancer survivors beyond return to work: a systematic review.

Attention for the expanding group of cancer survivors at work, and the late effects they are confronted with while working, has been limited. The objective of this systematic review is to identify and summarize studies, exploring ongoing physical and/or psychosocial problems related to functioning of employees with a history of cancer, beyond their return to work.

The role of neuropsychological functioning in cancer survivors' return to work one year after diagnosis.

Objective: The objective of this study was to investigate the relationship between neuropsychological functioning and the ability to work in cancer survivors.

Maternity leave duration and adverse pregnancy outcomes: An international country-level comparison

Aim: Preterm birth and low birthweight (LBW) lead to infant morbidity and mortality. The causes are unknown. This study evaluates the association between duration of maternity leave and birth outcomes at country level. Method: We compiled data on duration of maternity leave for 180 countries of which 36 specified prenatal leave, 190 specified income, 183 specified preterm birth rates and 185 specified the LBW rate. Multivariate and seemingly unrelated regression analyses were done in STATA. Results: Mean maternity leave duration was 15.4 weeks (SD=7.7; range 4–52 weeks). One additional week of maternity leave was associated with a 0.09% lower preterm rate (95% confidence interval [CI] –0.15 to −0.04) adjusting for income and being an African country. An additional week of maternity leave was associated with a 0.14% lower rate of LBW (95% CI –0.24 to −0.05). Mean prenatal maternity leave across 36 countries was six weeks (SD=2.7; range 2–14 weeks). One week of prenatal maternity leave was associated with a 0.07% lower preterm rate (95% CI –0.10 to 0.24) and a 0.06% lower rate of LBW (95% CI –0.14 to 0.27), but these results were not statistically significant. By adjusting for income status categories, the preterm birth rate was 1.53% higher and the LBW rate was 2.17% higher in Africa compared to the rest of the world. Conclusions: Maternity leave duration is significantly associated with birth outcomes. However, the association was not significant among 36 countries that specified prenatal maternity leave. Studies are needed to evaluate the correlation between prenatal leave and birth outcomes.