Professional rehabilitation of lymphoma patients: a study of psychosocial factors associated with return to work

Abstract

During the last ten years a substantial reduction in mortality has been obtained for Hodgkin's and non-Hodgkin's lymphoma. Since lymphoma treatment is often accompanied by side effects and long-term sequelae, however, patients often have problems with rehabilitation. It is thus very important that these problems and needs be identified. Going back to work is one of the main objectives of rehabilitation and can be taken as a valuable indicator of the problems and needs of such patients. We therefore conducted a study at the Jules Bordet Institute between December 1989 and December 1990. Of the patients in remission and able to go back to work, only 54% of them have done so. Anxiety, depression, and treatment toxicity interfere with return to work, and the likelihood of job reentry increases with the time lapse since the end of treatment. Rehabilitation programs must focus on alleviating illness and treatment sequelae as soon as treatment ends.

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

“…Median follow-up was 10.2 years in the register cohort ( Table 1). The distributions of patients and Morbidity during follow-up Relapse 166 (15) comparators were similar with regard to sex, age, and calendar year (matching factors), but patients had a slightly higher education level (Table 1). Also, as expected, more patients than comparators developed secondary malignancies or cardiovascular disease.…”

“…Other clinical studies of cancer survivors indicate a positive association between chemotherapy or treatment toxicity and work loss, but conclusions regarding HL-specific treatments cannot be made due to the limited number of HL patients [14][15][16] or lack of separation by lymphoma subtype [7] in these previous studies. Our results, reflecting limited radiotherapy, did not show more lost work days among radiotherapy-only-treated patients than comparators, nor any striking differences among patients with combined radio-and chemotherapy as opposed to chemotherapy only.…”

“…As side effects of cancer treatments vary by cancer site and treatment modality (in addition to patient factors), results for other cancer patients are not always generalizable to HL survivors [8][9][10]. Previous studies on work loss after HL [11][12][13], or HL and other lymphomas or blood malignancies [9,10,[14][15][16], often lack comparison to expected population rates [9,11,[14][15][16], and the few studies with a comparison group show disparate results, including an increased risk [10,12] and no change [13]. In the previous studies showing an increased risk versus comparators of work loss after HL [10,12], it is unclear to what extent the excess risk could be explained by lymphoma relapse and salvage therapy.…”

“…In the previous studies showing an increased risk versus comparators of work loss after HL [10,12], it is unclear to what extent the excess risk could be explained by lymphoma relapse and salvage therapy. Other limitations of previous studies include small numbers of HL patients (<200) [14][15][16] and questionnaire-based assessments of work loss [11][12][13][14][15][16], which are potentially subject to selection bias and misclassification. Importantly, most previous studies do not reflect effects of modern treatment with involved-field radiotherapy and intensified chemotherapy.…”

What do cancer patients mean when they complain of concentration and memory problems?

“…Patients treated for Hodgkin's disease and many patients with non-Hodgkin's lymphoma have an excellent prognosis in terms of survival, but the quality of their functional recovery has been called into question (van Tulder, 1994;Razavi et al, 1993), and cognitive dysfunction may be a relevant factor. This patient population, therefore, offers the opportunity to examine the relationship between subjective complaints of concentration and memory difficulties and performance on objective testing in a setting in which the impact of active disease process and transient pharmacological effects can be excluded and the issue has clinical significance for patients' quality of life.…”