Societal costs after renal cancer surgery.

Abstract

512 Background: The hospital costs of radical or partial nephrectomy for treatment of confirmed or suspected renal cell carcinoma have been well described. We sought to estimate a previously unreported societal cost of renal cancer surgery by assessing surgery-related time off work (TOW) taken by patients and their caretakers. Methods: To a cohort of 315 subjects enrolled in an IRB-approved prospective renal quality-of-life study who underwent radical or partial nephrectomy at our institution, we administered an occupational survey asking subjects to recall employment status, physical demands at work (sedentary, moderate activity, heavy lifting), income by tax bracket, surgery-related TOW (in days), and caretaker assistance. We excluded subjects who underwent cytoreductive nephrectomy. We estimated potential wages lost using individual income and TOW, and used logistic regression to assess for factors predictive of TOW > 30 days. Results: Of the 108 subjects who responded to the survey, 69 were employed at time of surgery. 4 subjects did not return to work after surgery, all of whom were older than 65. 12 subjects were excluded per the above-described criteria, leaving 53 subjects with complete occupational information. Mean (SD) age was 54. The majority (54%) of subjects had sedentary jobs. Subjects’ time off work ranged from 14 to 88 days; mean (SD) and median (IQR) TOW was 38 (17) and 34 (26-45) days, respectively. Mean potential wages lost for TOW was $10,371 (SD=$7,966). 23 (43%) subjects had at least one caretaker take TOW (mean/median caretaker TOW: 10/5 days, respectively) to assist in post-operative recovery. On univariate and multivariable analysis, age, work physicality, type of surgery (radical vs partial nephrectomy), surgical approach (minimally invasive vs open), income bracket, post-operative complications, or caretaker assistance were not significantly associated with taking > 30 days off from work. Conclusions: Despite advances in minimally invasive surgery, most patients take over one month off from work after renal cancer surgery. Incorporating these societal costs may allow for more comprehensive cost-effectiveness analyses in renal cancer care. Future directions include assessing TOW prospectively in a larger, more diverse cohort.

Transition from open partial nephrectomy directly to robotic surgery: experience of a single surgeon to achieve “TRIFECTA”

“…With the advances of minimally invasive surgery, it is possible to reduce the hospitalization time and costs, not only of the surgery itself but the social costs, as described by the series of Chang et al they demonstrated a medium withdrawal time of 35 days from work, from 7 to 92 days, with a medium salary loss of US$ 10.152 in the United States ( 13 ).…”

The Predictive Value of Return to Work Self-efficacy for Return to Work Among Employees with Cancer Undergoing Chemotherapy

“…Depression was assessed with the 21-item Beck's Depression Inventory [39]. The total sum score of the scale ranges from 0 to 63 and was further categorized into the following: No depression (0-13), mild depression (14)(15)(16)(17)(18)(19), moderate depression (20)(21)(22)(23)(24)(25)(26)(27)(28), or severe depression . The BDI is a widely used valid measure of depression [40] with a Cronbach's alpha value of 0.90 found in a population of women with breast cancer [41].…”

“…Thus, to most people, job loss and sickness absence have considerable negative consequences [11]. Furthermore, the 1 financial burden of work disability due to cancer is high for society [15,16]. Hence, improving the work ability and the process of return to work (RTW) for the steadily increasing number of people with current or previous cancers is of major importance.…”