Sickness absence and disability pension among swedish women prior to breast cancer relapse with a special focus on the roles of treatment and comorbidity

Abstract

Objective We aimed to determine the longitudinal prevalence and the predictors of sickness absence (SA) and disability pension (DP) in breast cancer (BC) women who eventually developed relapse. Methods A total of 1293 BC women, who were ages 20–63 years, diagnosed between 1996 and 2011 and by 2016 had all developed relapse, were identified in Swedish registers and were followed from two years before to five years after their primary diagnosis, while they were relapse‐free. Annual prevalence of SA and DP was calculated. Logistic regression was used to estimate adjusted odds ratios (AOR) for long‐term SA (>30 days) at one (y1) and three (y3) years post‐diagnosis. Results Prevalence of long‐term SA was 68.1% in y1 and 16.3% in y5. Prevalence of DP progressively increased from 16.3% in y1 to 29.0% in y5. Predictors of long‐term SA included age <50 years (y1:AOR = 1.79 [1.39–2.29]), TNM stage III (y1:AOR = 1.54 [1.03‐2.31]; y3:AOR = 2.21 [1.32–3.72]), metastasis (y1:AOR = 1.64 [1.26–2.12]; y3:AOR = 1.51 [1.05–2.18]), comorbidity (y1:AOR = 2.41 [1.55–3.76]; y3 AOR = 4.62 [2.49–8.57]) and any combination of radiotherapy, chemotherapy and hormonal therapy (y1:AOR = 2.05–5.71). Conclusion Among BC women who later developed relapse, those who had higher stages of BC, had comorbidity and received neoadjuvant and/or adjuvant therapy were at significantly higher risk of needing long‐term SA after their diagnosis.

Use of sickness benefits by patients with metastatic breast cancer—A Swedish cohort study

“…Based on regression analysis, we determined that risk factors for long-term SA during the rst and second years after mBC diagnosis included having more than 90 days of SA in the year before mBC diagnosis, developing metachronous mBC, and being of younger age. Others have shown that the frequent use of SA before a diagnosis of eBC can be a proxy for other comorbidities, as well as that the frequent use of SA before mBC diagnosis can be a proxy for prodromal illness just prior to the discovery of advanced cancer [13,[31][32][33][34]. Evidence suggests that the higher risk of long-term SA that we observed after the diagnosis of mBC in patients with metachronous (vs. synchronous) mBC could be the result of residual physical and recurrent emotional sequelae from the past diagnosis and treatment of eBC [32][33][34].…”

“…Others have shown that the frequent use of SA before a diagnosis of eBC can be a proxy for other comorbidities, as well as that the frequent use of SA before mBC diagnosis can be a proxy for prodromal illness just prior to the discovery of advanced cancer [13,[31][32][33][34]. Evidence suggests that the higher risk of long-term SA that we observed after the diagnosis of mBC in patients with metachronous (vs. synchronous) mBC could be the result of residual physical and recurrent emotional sequelae from the past diagnosis and treatment of eBC [32][33][34]. Our nding of a higher risk of long-term SA in younger patients after the diagnosis of mBC is consistent with a 1999 survey of patients with mBC, in which a multivariate regression model showed that younger age was one of the factors signi cantly associated with a reduced desire to resume working [35].…”

“…Possible explanations for the high prevalence of use of long‐term sickness benefits in the year before mBC diagnosis include the presence of comorbidities and the onset of prodromal illness just prior to the discovery of advanced cancer; indeed, the frequent use of SA has been shown to be a proxy for both of these (Gernaat et al, 2020; Hauglann et al, 2014; Kvillemo et al, 2017; Plym et al, 2019; Sjövall et al, 2012). Another potential explanation for this high prevalence could be the sequelae of the treatment of eBC.…”

“…Many cancer survivors are forced because of illness to leave full‐time work (Cardoso et al, 2016; Stergiou‐Kita et al, 2014; Tamminga et al, 2012). For women with mBC, there are specific patient‐ and tumour‐related factors that can impact their prognosis and employment status, including age, performance status, sites of metastases and disease‐free intervals between primary BC and metastases (Gernaat et al, 2020), as well as minority ethnicity, symptom burdens and capacity to work full‐time (Glare et al, 2017; Samuel et al, 2020; Tevaarwerk et al, 2016).…”

Impact of breast cancer care pathways and related symptoms on the return-to-work process: results from a population-based French cohort study (CONSTANCES)

“…Consequently, different BC care pathways should be considered when investigating their influence on RTW [ 17 , 19 , 21 ]. However, to our knowledge, only few studies assessed the cumulative impact of different BC treatments on the RTW process, and none considered their sequence and duration [ 5 , 14 , 22 ].…”