Marie I. Nilsson

Work situation and sickness absence in the initial period after breast cancer surgery

Abstract Background. Breast cancer is the most common cancer diagnosis in women, many of whom are of working age, and the five-year survival rate in Sweden is approaching 90%. Accordingly, aspects of working life and sickness absence are of increasing importance for breast cancer survivors and may have a long-term impact on health and quality of life of these women. The aim was to elucidate the work situation and sickness absence during the initial period after breast cancer surgery and to explore factors associated with sickness absence. Material and methods. This is a cross-sectional questionnaire study 4–6 weeks after breast cancer surgery of women aged 20–63 years, and living in Stockholm. A consecutive sample of 933 women were invited and 756 (81%) accepted to participate. Logistic regression analyses were computed to estimate crude and adjusted odds ratios for associations between sick leave and other variables. Results. Most women (86%) were employed (including self-employed) at diagnosis, and 91% of those worked ≥75% of full-time. At time of survey, 56% were on sick leave, the majority for full-time. Low self-rated health, poorer health than before diagnosis, having a strenuous work posture, and younger age were associated with sick leave during the initial period after breast cancer surgery in both univariate and multivariate analyses. Discussion. The results of this study is not fully consistent compared to previous studies in this field, often performed in later phases after breast cancer surgery or after other cancer diagnoses. Therefore our results indicate that knowledge is needed during all phases of the breast cancer trajectory to determine factors of importance regarding sick leave and their impact throughout the disease trajectory.

Women's reflections and actions regarding working after breast cancer surgery – a focus group study

To better understand processes affecting return to work (RTW) after breast cancer, more knowledge from the perspective of sickness absentees is warranted. Still, research based on womens own reasoning and actions in RTW is very scarce. This study aims to elucidate how women with breast cancer reflect and act on work‐related issues.

Adjustment and social support at work early after breast cancer surgery and its associations with sickness absence

As half of the women with breast cancer are of working ages and usually survive, knowledge is needed on how to support them early regarding work‐related problems caused by treatments. Most previous studies have focused on individual and disease‐related factors, whereas few have focused on work‐related factors such as work adjustment and social support. The aim of this study was to investigate received and perceived social support from supervisor and colleagues as well as work adjustments, and their associations with sickness absence, among women who recently had had breast cancer surgery.

The case of value-based healthcare for people living with complex long-term conditions

BackgroundThere is a trend towards value-based health service, striving to cut costs while generating value for the patient. The overall objective comprises higher-quality health services and improved patient safety and cost efficiency. The approach could align with patient-centred care, as it entails a focus on the patient’s experience of her or his entire cycle of care, including the use of well-defined outcome measurements. Challenges arise when the approach is applied to health services for people living with long-term complex conditions that require support from various healthcare services. The aim of this work is to critically discuss the value-based approach and its implications for patients with long-term complex conditions. Two cases from clinical practice and research form the foundation for our reasoning, illustrating several challenges regarding value-based health services for people living with long-term complex conditions.DiscussionAchieving value-based health services that provide the health outcomes that matter to patients and providing greater patient-centredness will place increased demands on the healthcare system. Patients and their informal caregivers must be included in the development and establishment of outcome measures. The outcome measures must be standardized to allow evaluation of specific conditions at an aggregated level, but they must also be sensitive enough to capture each patient’s individual needs and goals. Healthcare systems that strive to establish value-based services must collaborate beyond the organizational boundaries to create clear patient trajectories in order to avoid fragmentation.SummaryThe shift towards value-based health services has the potential to align healthcare-service delivery with patient-centred care if serious efforts to take the patient’s perspective into account are made. This is especially challenging in fragmented healthcare systems and for patients with long-term- and multi-setting-care needs.

Arm morbidity and sick leave among working women shortly after breast cancer surgery.

BACKGROUND There is limited knowledge about the impact of arm morbidity on sick leave in the immediate period after breast cancer surgery. PURPOSE To determine if arm morbidity was associated with sick leave shortly after breast cancer surgery and to investigate the association between arm morbidity and sick leave, adjusted for treatment, work characteristics, co-morbidity, time since surgery, and sociodemographic factors. SAMPLE AND METHODS Included were 511 women who within 12 weeks had had breast cancer surgery, were aged 20-63 years, had no distant metastasis, pre-surgical chemotherapy, or previous breast cancer, and worked ≥75% before breast cancer diagnosis. Percentages and odds ratios (OR) for being on sick leave were calculated, using multivariable analyses. RESULTS Of the women, 10% reported arm morbidity, 43% had had a total axillary clearance, and 60% were on sick leave. In multivariable analysis, those with planned chemotherapy had the highest OR (4.69; 95% CI 2.97-7.41) for being on sick leave. Nevertheless, those reporting arm morbidity had the second highest OR (2.71; 1.23-5.97) which was higher than if having strenuous work postures (2.49; 1.50-4.15) or having had an axillary clearance (1.64; 1.04-2.60). CONCLUSION Arm morbidity is an important factor for whether being on sick leave or not shortly after breast cancer surgery, even more important than type of axillary surgery or work situation. However, planned chemotherapy had the greatest impact for being on sick leave already shortly after breast cancer surgery.

Sickness absence in relation to breast and arm symptoms shortly after breast cancer surgery

PURPOSE To determine whether and, to what extent, breast and arm symptoms are associated with sick leave (SL) shortly after breast cancer (BC) surgery, and to investigate the associations of these symptoms and different surgical procedures with SL, adjusting for age and work posture. Women (n = 511), aged 26-63 years, who worked ≥ 75% before a BC diagnosis, were included within 12 weeks of surgery. RESULTS 31% reported breast symptoms and 22% arm symptoms; and, of these, 47% reported both. Having strenuous work postures increased the OR for being on SL most (OR 2.60), followed by breast symptoms (OR 2.40), more extensive axillary (OR 2.24) or breast surgery (OR 2.13), and arm symptoms (OR 2.06). CONCLUSIONS Breast and arm symptoms are as strongly associated with being on SL as types of breast and/or axillary surgery. Early self-reported symptoms are important to consider in guidelines for SL and rehabilitation after BC surgery.

Sexual Function and Testosterone Level in Men With Conservatively Treated Chronic Kidney Disease

Sexual dysfunctions are common, but underrecognized, in patients with chronic kidney disease (CKD) and are inversely associated with the glomerular filtration rate (GFR). Sexual dysfunctions may affect quality of life in males with CKD. The aim of this study was to analyze the relationship among sex hormones, sexual function, and sexual satisfaction in a group of men between 18 and 50 years of age with CKD Stages 1 to 5 not treated with hemodialysis or peritoneal dialysis. Fasting blood samples for hemoglobin, testosterone, prolactin, and luteinizing hormone and questionnaire surveys (Sexual Complaints Screener for Men, International Index of Erectile Function, and Aging Male Symptom scale) were evaluated in 100consecutive men. Higher CKD stage (i.e., lower renal function) had a statistically significant (p < .01) correlation with lower total testosterone, free testosterone, and hemoglobin levels, and higher luteinizing hormone and prolactin levels. Sexual function/dysfunctions were not significantly associated with CKD stage, even after adjustment for age and serum testosterone. The results indicate that CKD stage is a factor affecting testosterone levels in combination with age in men between 18 and 50 years of age at different stages of CKD but not treated with hemodialysis or peritoneal dialysis. Sexual dysfunctions are common but not strongly correlated to testosterone levels, prolactin levels, and survey (Sexual Complaints Screener for Men, International Index of Erectile Function, and Aging Male Symptom scale) responses in patients with CKD.

Can breast cancer register data on recommended adjuvant treatment be used as a proxy for actually given treatment

PURPOSES To study agreement between recommended adjuvant treatment after primary breast cancer (BC) surgery from the clinical based National Breast Cancer Register and initiated adjuvant treatment from medical records; factors associated with agreement; and reasons for discontinuation or change of planned treatment. METHOD Included were 970 women who had undergone BC surgery, aged 20-63 years, living in Stockholm County, and literate in Swedish. EXCLUSION CRITERIA Distant metastases, pre-surgical chemotherapy, and/or a previous BC diagnosis. Information on clinical tumor stage, surgical treatment, recommended adjuvant radiotherapy, chemotherapy, and endocrine therapy was obtained from the BC register. Type of initiated adjuvant treatments, if treatment plan was followed, and reasons for discontinuation were extracted from medical records. RESULTS The register had high completeness and agreement was high, 94-96%, (κ 0.801-0.908) for all types of treatment. Disagreement regarding radiotherapy and chemotherapy was associated with having ≥1 lymph node metastases and more extended axillary surgery, and for radiotherapy also more extended breast surgery. There were no such associations with age, tumor size, or invasiveness. None of these factors were associated with disagreement regarding recommended versus initiated endocrine therapy. Endocrine therapy was most often discontinued (24%), mostly due to toxicity which was also the most common reason for discontinuation of chemotherapy. CONCLUSIONS Swedish register data on recommended treatment has high validity in women aged 24-63 years, with limited BC, and demonstrates utility as a proxy for initiated treatment in this group. This is of interest since extracting data from medical records is resource demanding.