Work ability and cognitive impairments in young adult cancer patients: associated factors and changes over time—results from the AYA-Leipzig study

Abstract

Purpose Although young adults represent a significant portion of the working population, little is known about the work ability and cognitive impairments in adolescent and young adult (AYA) cancer patients (including the long-term course) following cancer treatment. Methods As part of the AYA-Leipzig study, we surveyed AYA cancer survivors (aged 18–39 years at diagnosis; time since diagnosis ≤ 4 years, including all cancer diagnoses) at two time points (t2 = 12 months after t1). Work ability (Work Ability Index, WAI-r) and cognitive impairments (Copenhagen Psychosocial Questionnaire, COPSOQ) were compared at both time points. We analysed predictors for work ability at, on average, 2 years post cancer diagnosis (t2) by using multivariate regression analyses. Results A total of 502 patients (74.7% women) participated in both measurements. Mean work ability increased significantly from t1 (6.0; SD = 2.3) to t2 (6.8; SD = 2.2) (t = −9.3; p < 0.001). As many as 380 (76%) AYA cancer survivors reported reduced work ability at t1; 1 year later, this still applied to 287 (57%) of them. Decreased work ability (t2) was associated with more cognitive impairment, higher effort coping with the disease, comorbidities, sick leave > 6 months (since diagnosis), and having children (adj R2 = .48). Cognitive impairments occurred in approximately every fifth patient at both surveys. Conclusions Achieving maximum work ability is a major challenge for AYAs. Our results show the need for multimodal cancer survivorship and rehabilitation programmes with a special focus on improving cognitive and psychosocial functioning. Implications for Cancer Survivors AYAs with cancer should receive targeted occupational counselling early in the course of the disease.

Cancer‐related cognitive impairment in survivors of adolescent and young adult non‐central nervous system cancer: A scoping review

“…Female AYA lymphoma survivors exhibited significantly more CRCI than males, 33 and females scored significantly higher on the negative Impact of Cancer summary scale and cognitive function subscale than males across all cancer types 34 . Other studies also report higher CRCI associated with being female 37,42,44 …”

“…CRCI was commonly associated with difficulties in role functioning 38,39,41,46–49 . Survivors reported worse concentration, memory, and attention 35,36,41,43,46,49 and were concerned about the impacts of these deficits on employment and education 38,42,43,46,49 . CRCI was the strongest predictor of reduced work ability 42 and it was associated with unemployment 33,34,40 …”

“…All studies comparing outcomes by gender reported a higher rate of self-reported CRCI among females. 33,34,37,42,44 Female AYA lymphoma survivors exhibited significantly more CRCI than males, 33 and females scored significantly higher on the negative Impact of Cancer…”

“…34 Other studies also report higher CRCI associated with being female. 37,42,44 3.3.4 | Comorbidities CRCI was associated with several comorbid conditions, most frequently fatigue and mental illness. 31,33,34,38,40,44 Husson et al 33,34 found that self-reported CRCI was associated with having physical fatigue or having two or more comorbid health conditions, such as diabetes or asthma.…”

“…Although some studies perpetuated the connotation that chemotherapy primarily causes CRCI, using phrases like 'chemo brain' 51 and 'chemo-fog', 49 this review indicates that chemotherapy is only one factor associated with CRCI and such language may promote the problematic bias attributing CRCI only to chemotherapy. Studies found associations between CRCI and leukemia, 34,39 Hodgkin's lymphoma, 34 breast and gynecological cancers, 37 and cancers with a lower survival rate 34 ; female gender 33,34,37,42,44 ; physical fatigue 33,34,38,44 ; and anxiety and/or depression. 31,33,34,38,40,44 Studies examining treatment type did find a relationship between chemotherapy and CRCI in AYA survivors, 32 but it was unclear whether a specific chemotherapy regimen or agent was responsible.…”