Sick leave and disability pension among Swedish testicular cancer survivors according to clinical stage and treatment

Nord, Carina; Olofsson, Sven-Erik; Glimelius, Ingrid; Cedermark, Gabriella Cohn; Ekberg, Sara; Cavallin‐Ståhl, Eva; Neovius, Martin; Smedby, Karin E.

doi:10.3109/0284186x.2015.1020967

Cited by 17 publications

(25 citation statements)

References 25 publications

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“…On the other hand, our results suggest that women who had a malignant neoplasm are more likely to exit the labor market because of partial retirement and permanent disability that those with other pathologies. These results are in line with prior studies that have assessed the risk of dropping out comparing with healthy working populations [12–14, 19, 20]. Compared to other disabling diagnoses (e.g.…”

Section: Discussionsupporting

confidence: 91%

“…Moreover, in the years following a cancer diagnosis, survivors are among 40–60% more likely to go on early retirement [12, 13]. Compared to healthy population, cancer survivors have showed to be more likely to have extended or repeated periods of sickness absence (SA) and increased risk for disability pension [14]. Apart from those factors directly related to the disease, old age, low income and low educational level, living alone, having comorbidities and sickness absence benefits in the previous year might also play a role [12–14].…”

Section: Introductionmentioning

confidence: 99%

“…Compared to healthy population, cancer survivors have showed to be more likely to have extended or repeated periods of sickness absence (SA) and increased risk for disability pension [14]. Apart from those factors directly related to the disease, old age, low income and low educational level, living alone, having comorbidities and sickness absence benefits in the previous year might also play a role [12–14]. Prior research focused on cancer and labor market participation used dichotomized outcome measures, simplifying the potential consequences of a cancer disease in future working life [11].…”

Section: Introductionmentioning

confidence: 99%

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Labor market situation after an episode of sickness absence due to malignant neoplasia. Evidence from a Spanish cohort

2019

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Background Due to the progress in screening and cancer treatments, survivor’s prognosis has improved enabling a more likely return to work. However, return to work after a cancer diagnosis may be complex because of an unbalanced health status and work demands relationship that may push them out of the labor market. The aim of this study is to assess the risk of dropping out of the labor market due to unemployment, partial retirement, and permanent disability during the year following an episode due to a malignant neoplasm compared to other non-malignant pathologies. Methods Cohort study of 9699 workers affiliated with the Social Security System in Catalonia, who had a sickness absence episode between 2012 and 2013 due to malignant neoplasm, mental, musculoskeletal disorders, cardiovascular diseases and injuries. Competing risk regression models were applied to assess the risk of dropping out of the labor market, by calculating subhazard ratios (SHR) in both sexes. Models were adjusted for age, occupational category, type of contract, economic activity, annual median salary and duration of the SA episode as potential confounders. Results Sickness absence due to malignant neoplasia represented 1.7% out of the 9699 episodes included between 2012 and 2013. Although, 80% of individuals continued working in the year following an episode due to malignant neoplasm, women showed a trend towards exiting the labor market because of partial retirement [SHR = 8.4(1.5–45.5)] and permanent disability [SHR = 5.8(1.5–22.9)] compared to non-malignant pathologies. There were no significant differences for unemployment either in women [SHR = 0.4(0.2–0.9)] and in men [SHR = 0.2(0.1–0.6)]. Conclusions Although return to work is a common pathway among cancer survivors, partial retirement and permanent disability seem to be potential pathways to exit the labor market among women.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Labor market situation after an episode of sickness absence due to malignant neoplasia. Evidence from a Spanish cohort

2019

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“…Recently, Nord et al [21] reported on economic consequences of testicular cancer investigating data on sick leave of 2.146 Swedish men diagnosed with TC between 1995 and 2005. They concluded that men receiving limited treatment, which meant AS, radiotherapy, or <3 cycles of chemotherapy, were not at increased risk of long-term work loss compared with those extensively treated.…”

Section: Discussionmentioning

confidence: 99%

Economy of Standards: European Association of Urology Guideline Changes Influence Treatment Costs in Stage I Testicular Cancer Patients

John¹,

Baumgart

Worst

et al. 2018

Urol Int

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Objective: The study aimed to calculate direct medical costs (DMC) during the first year of diagnosis and to evaluate the impact of guideline changes on treatment costs in clinical stage (CS) I testicular germ cell tumor (TGCT) patients in a German healthcare system. Materials and Methods: Healthcare expenditures as DMC during the first year of diagnosis for 307 TGCT patients in CS I treated at our institution from 1987 to 2013 were calculated from the statutory health insurance perspective using patient level data. Three periods were defined referring to the first European Association of Urology (EAU) guideline in 2001 as well as to subsequent major guideline changes in 2005 and 2010. Data source for cost calculations were the German Diagnosis Related Groups system for inpatient stays (version 2014) and the German system for reimbursement of outpatient care (EBM – Einheitlicher Bewertungsmaßstab, edition 2014). Results: During our 25 years of study period, mean DMC in the first year after diagnosis for the entire cohort of TGCT patients in CS I almost halved from EUR 13.000 to EUR 6.900 (p < 0.001). From 1987 to 2001, DMC for CS I seminomatous germ cell tumor (SGCT) patients were EUR 13.790 ± 4.700. From 2002 to 2010, mean costs were EUR 10.900 ± 5.990, and from 2011 to 2013, mean costs were EUR 5.190 ± 3.700. For CS I non-seminomatous germ cell tumor (NSGCT) patients, from 1987 to 2001, mean DMC were EUR 11.650 ± 5.690. From 2002 to 2010, mean costs were EUR 11.230 ± 5.990, and from 2011 to 2013, mean costs were EUR 11.170 ± 7.390. Follow-up examinations became less frequent over time, which caused a significant cost reduction for NSGCT (p = 0.042) while costs remained stable for SGCT. When adding costs of relapse treatment, active surveillance (AS) was the most cost-effective adjuvant treatment option in CS I NSGCT whereas one course carboplatin or AS caused similar expenditures in SGCT patients. Conclusion: The introduction of the EAU guidelines in 2001 caused a decrease in DMC in CS I seminoma patients. This cost reduction mainly took place due to the declining importance of radiation therapy. No substantial changes were seen in patients with CS I NSGCT. Costs for follow-up care also diminished, but to a lesser degree. Even when considering expenditures for relapse treatment, AS remained cost-effective in CS I TCGT patients. Our data show that evidence-based medicine in TGCT can reduce DMC in the first year after diagnosis.

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“…Data on employment status among TC survivors (TCS), however, are sparse and derive largely from Europe ( 5 , 7–10 ). Swedish TCS ( 8 ) given over 4 cisplatin-based chemotherapy courses had fivefold risks of disability pension, characterized by at least 1 year of work leave for illness. Survivors also reported a higher average number of annual days of work loss for up to 10 years after diagnosis, but platinum-related toxicities were not considered.…”

mentioning

confidence: 99%

Relationship of Cisplatin-Related Adverse Health Outcomes With Disability and Unemployment Among Testicular Cancer Survivors

Kerns

Fung

Fosså

et al. 2020

JNCI Cancer Spectrum

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Background Few data exist on the relationship of cisplatin-related adverse health outcomes (AHOs) with disability, unemployment, and self-reported health (SRH) among testicular cancer survivors (TCS). Methods A total of 1815 TCS at least 1 year postchemotherapy underwent clinical examination and completed questionnaires. Treatment data were abstracted from medical records. A cumulative burden of morbidity score (CBMPt) encompassed the number and severity of platinum-related AHOs (peripheral sensory neuropathy [PSN], hearing loss, tinnitus, renal disease). Multivariable regression assessed the association of AHOs and CBMPt with employment status and SRH, adjusting for sociodemographic and clinical characteristics. Unemployment was compared with a male normative population of similar age, race, and ethnicity. Results Almost 1 in 10 TCS was out of work (2.4%, disability leave; 6.8%, unemployed) at a median age of 37 years (median follow-up = 4 years). PSN (odds ratio [OR] = 2.89, 95% confidence interval [CI] = 1.01 to 8.26, grade 3 vs 0, P = .048), renal dysfunction defined by estimated glomerular filtration rate (OR = 12.1, 95% CI = 2.06 to 70.8, grade 2 vs 0, P = .01), pain (OR = 10.6, 95% CI = 4.40 to 25.40, grade 2 or 3 vs 0, P < .001), and CBMPt (OR = 1.46, 95% CI = 1.03 to 2.08, P = .03) were associated with disability leave; pain strongly correlated with PSN (r2 = 0.40, P < .001). Statistically significantly higher percentages of TCS were unemployed vs population norms (age-adjusted OR = 2.67, 95% CI = 2.49 to 3.02, P < .001). PSN (OR = 2.44, 95% CI = 1.28 to 4.62, grade 3 vs 0, P = .006), patient-reported hearing loss (OR = 1.82, 95% CI = 1.04 to 3.17, grade 2 or 3 vs 0, P = .04), and pain (OR = 3.75, 95% CI = 2.06 to 6.81, grade 2 or 3 vs 0, P < .001) were associated with unemployment. Increasing severity of most cisplatin-related AHOs and pain were associated with statistically significantly worse SRH. Conclusions Our findings have important implications regarding treatment-associated productivity losses and socioeconomic costs in this young population. Survivorship care strategies should include inquiries about disability and unemployment status, with efforts made to assist affected TCS in returning to the workforce.

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Sick leave and disability pension among Swedish testicular cancer survivors according to clinical stage and treatment

Cited by 17 publications

References 25 publications

Labor market situation after an episode of sickness absence due to malignant neoplasia. Evidence from a Spanish cohort

Labor market situation after an episode of sickness absence due to malignant neoplasia. Evidence from a Spanish cohort

Economy of Standards: European Association of Urology Guideline Changes Influence Treatment Costs in Stage I Testicular Cancer Patients

Relationship of Cisplatin-Related Adverse Health Outcomes With Disability and Unemployment Among Testicular Cancer Survivors

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