Employment pathways in a large cohort of adult cancer survivors

Abstract

Objective To determine whether radiation therapy (RT) is denied to patients with lupus and cancer and whether RT causes unusual toxicity in those receiving it. Methods We included patients with lupus followed at the University of Toronto Lupus Clinic between 1972 and 2001 who had developed cancer. Demographic, clinical, and laboratory information were collected prospectively. Pathologic proof of cancer was obtained. Three radiation oncologists blinded for the diagnosis of lupus, the modalities of cancer treatment, and the hypothesis of the study reviewed patient data independently. They assessed the indication for RT and whether it should be curative or symptomatic. Recommendation for RT was considered when at least 2 of the 3 radiation oncologists concurred. A review of the literature was conducted. Results Forty cases of cancer in 38 patients were identified. Most frequent cancer sites were breast (8), skin (8), digestive (7), and hematologic (7). Median patient age was 58 years. The radiation oncologists recommended RT in 26 cases, either with a curative (14) or a symptomatic intent (12). Only 4 patients received RT, 3 with a curative intent and 1 with a symptomatic intent. None of these 4 patients developed any unusual toxicity. The literature review did not support the fact that lupus patients do not tolerate RT. Conclusion Sixty‐five percent of our lupus patients with cancer could have received curative or symptomatic RT but only 10% received it. No patient developed any toxicity. RT may be inappropriately withheld from lupus patients with cancer.

Long-term workforce participation patterns following head and neck cancer

“…15% of those who eventually returned to work took more than 12 months off, with the longest temporary absence from work being over 5 years. This result contradicts the assumption in much of the literature that workforce participation status is defined at 12 months post-diagnosis [21], and indicates that in a small but important proportion of individuals following HNC, time to return to work may be extended.…”

Work disability associated with cancer survivorship and other chronic conditions

“…Hospital employees obtained informed consent before subjects were interviewed. Forty-three percent of eligible cases (2076 patients) consented to be interviewed, and 88% of those who consented and survived (1763 subjects) completed the first interview (Short et al, 2005). Eighty-nine percent of surviving subjects who completed the first interview completed the second interview (1511 cases).…”

“…Studies of the employment consequences of cancer survivorship have focused more on employment rates than disability rates (Bradley et al, 2002a;Bradley et al, 2002b;Chirikos et al, 2002a;Chirikos et al, 2002b;Spelten et al, 2002;Hewitt et al, 2003;Maunsell et al, 2004;Yabroff et al, 2004;Bradley et al, 2005a;Bradley et al, 2005b;Short et al, 2005). However, disability rates provide a conceptually broader measure of the employment effect of cancer survivorship than employment rates.…”

“…From the first round of interviews with our survivor cohort, we reported that approximately 20% of those working at diagnosis reported disabilities that they perceived as cancer-related 1 to 5 years later (Short et al, 2005). There were significant differences in adjusted disability rates among working survivors by cancer site, stage at diagnosis, treatment status, cancer recurrence, the presence of co-morbidities, and occupation.…”

“…There have been relatively few attempts to measure the increase in disability attributable to cancer in the years following initial treatment (Hewitt et al, 2003;Short et al, 2005;Bradley and Bednarek, 2002;Chirikos et al, 2002b;Yabroff et al, 2004). From the first round of interviews with our survivor cohort, we reported that approximately 20% of those working at diagnosis reported disabilities that they perceived as cancer-related 1 to 5 years later (Short et al, 2005).…”