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Factors influencing job loss and early retirement in working men with prostate cancer – findings from the population based Life After Prostate Cancer Diagnosis (LAPCD) study.

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Purpose: To investigate factors associated with job loss and early retirement in men diagnosed with prostate cancer (PCa) 18-42 months previously. Methods: Men ≤ 60 years at diagnosis who completed the Life After Prostate Cancer Diagnosis (LAPCD) survey were identified. Men who moved from employment at diagnosis to unemployment (EtoU) or retirement (EtoR) at survey (18-42 months post-diagnosis) were compared to men remaining in employment (EtoE). Sociodemographic, clinical and patient-reported factors were analysed in univariable and multivariable analysis. Results: There were 3218 men (81.4%) in the EtoE, 245 (6.2%) in EtoU and 450 (11.4%) in the EtoR groups. Men with stage IV disease (OR = 4.7 95% CI 3.1-7.0, relative to stage I/II) and reporting moderate/big bowel (OR = 2.5, 95% CI 1.6-3.9) or urinary problems (OR = 2.0, 95% CI 1.4-3.0) had greater odds of becoming unemployed. Other clinical (≥ 1 comorbidities, symptomatic at diagnosis) and sociodemographic (higher deprivation, divorced/separated), living in Scotland or Northern Ireland (NI)) factors were predictors of becoming unemployed. Men who were older, from NI, with stage IV disease and with caring responsibilities had greater odds of retiring early. Self-employed and non-white men had lesser odds of retiring early. Conclusion: PCa survivors who retire early following diagnosis do not report worse urinary or bowel problems compared to men remaining in employment. However, we identified clinical and sociodemographic factors which increased unemployment risk in PCa survivors. Implications for cancer survivors: Targeted support and engagement with PCa survivors at risk of unemployment, including their families and employers, is needed.
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Factors influencing job loss and early retirement in working men
with prostate cancerfindings from the population-based Life After
Prostate Cancer Diagnosis (LAPCD) study
Damien Bennett
1
&Therese Kearney
1
&David W. Donnelly
1
&Amy Downing
2,3
&Penny Wright
2
&Sarah Wilding
2,3
&
Richard Wagland
4
&Eila Watson
5
&Adam Glaser
2,3
&Anna Gavin
1
Received: 6 June 2018 /Accepted: 13 July 2018 /Published online: 30 July 2018
#The Author(s) 2018
Abstract
Purpose To investigate factors associated with job loss and early retirement in men diagnosed with prostate cancer (PCa) 18
42 months previously.
Methods Men 60 years at diagnosis who completed the Life After Prostate Cancer Diagnosis (LAPCD) survey were identified.
Men who moved from employment at diagnosis to unemployment (EtoU) or retirement (EtoR) at survey (1842 months post-
diagnosis) were compared to men remaining in employment (EtoE). Sociodemographic, clinical and patient-reported factors
were analysed in univariable and multivariable analysis.
Results There were 3218 men (81.4%) in the EtoE, 245 (6.2%) in EtoU and 450 (11.4%) in the EtoR groups. Men with stage IV
disease (OR = 4.7 95% CI 3.17.0, relative to stage I/II) and reporting moderate/big bowel (OR = 2.5, 95% CI 1.63.9) or urinary
problems (OR = 2.0, 95% CI 1.43.0) had greater odds of becoming unemployed. Other clinical (1 comorbidities, symptomatic
at diagnosis) and sociodemographic (higher deprivation, divorced/separated), living in Scotland or Northern Ireland (NI)) factors
were predictors of becoming unemployed. Men who were older, from NI, with stage IV disease and with caring responsibilities
had greater odds of retiring early. Self-employed and non-white men had lesser odds of retiring early.
Conclusion PCa survivors who retire early following diagnosis do not report worse urinary or bowel problems compared to men
remaining in employment. However, we identified clinical and sociodemographic factors which increased unemployment risk in
PCa survivors.
Implications for Cancer Survivors Targeted support and engagement with PCa survivors at risk of unemployment, including their
families and employers, is needed.
Keywords Prostate cancer .Unemployment .Retirement .LAPCD
Adam Glaser and Anna Gavin are joint senior authors
Electronic supplementary material The online version of this article
(https://doi.org/10.1007/s11764-018-0704-x) contains supplementary
material, which is available to authorized users.
*Damien Bennett
damien.bennett@hscni.net
1
Northern Ireland Cancer Registry, Mulhouse Building, Queens
University Belfast, Mulhouse Rd., Belfast BT12 6DP, Northern
Ireland
2
Leeds Institute of Cancer and Pathology, University of Leeds,
Leeds LS2 9JT, UK
3
Leeds Institute of Data Analytics, University of Leeds, Leeds LS2
9JT, UK
4
Faculty of Health Sciences, University of Southampton,
Southampton, UK
5
Faculty Health and Life Sciences, Oxford Brookes University,
Oxford OX3 0BP, UK
Journal of Cancer Survivorship (2018) 12:669678
https://doi.org/10.1007/s11764-018-0704-x
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Background
As the diagnosis, treatment and survival of most cancers have
improved, the number of cancer survivors has increased, with
this trend set to continue [1]. Prostate cancer (PCa) survivors
account for a large proportion of these, with 30% of UK can-
cer survivors living with the disease [2]. Although PCa inci-
dence is more common in older men, approximately 30% of
UK survivors are of working age and the effect of cancer and
its treatment can adversely impact working life and employ-
ment status [3,4]. Indeed, a UK study found the greatest
increase in PCa incidence rates between 2000 and 2010 was
in men under 60 years of age [5].
Recently, there has been increased focus on workers diag-
nosed with cancer to ensure that appropriate assistance and
information is given to support decisions about work and per-
sonal finances [6]. Work can be important for men recovering
from cancer as it allows them support themselves and their
families, socialise with colleagues and regain a sense of nor-
mality which can help them to move on[7,8]. Studies of risk
factors for job loss in PCa survivors have involved small
numbers of PCa survivors and usually been part of larger
cancer cohorts from Nordic countries, the USA or Australia
[9]. Although previous studies describe demographic, clinical
and work-related characteristics associated with work ability,
employment status and return to work for cancer survivors
across a range of tumour sites, variable findings have been
reported and few focus specifically on PCa survivors [9]. A
study which reported on 100 PCa survivors in Ireland 6
24 months post-diagnosis found those who were self-
employed had lower household income and did not have sur-
gery were more likely to continue working following diagno-
sis, while those with lower educational level, medical card
entitlement (providing free access to public health services)
and not receiving sick pay were more likely not to resume
work following diagnosis [10]. However, the effect of recent
diagnosis of PCa on subsequent employment, and particularly
unemployment and early retirement, have not been previously
reported in a large-scale study. This study aimed to identify
factors associated with movement from employment to unem-
ployment or early retirement in working age men diagnosed
with PCa in the UK.
Methods
Data were collected as part of the UK-wide Life After Prostate
Cancer Diagnosis (LAPCD) study. The study design has been
reported elsewhere [11]. PCa survivors between 18 and
42 months following first diagnosis were identified from
population-based cancer registries in England, Wales and
Northern Ireland (NI) and from hospital activity data in
Scotland. A postal questionnaire was sent to 58,930 men.
Respondents answered questions on functional outcomes
and personal and sociodemographic characteristics and other
measures including health-related quality of life (HRQL), so-
cial difficulties, decision regret and emotional well-being.
Men aged 60 years and younger at time of diagnosis who
completed a questionnaire were included in this study. The
UK state pension age for men at the time of survey (October
2015 to November 2016) was 65 years [12] and the average
age of men withdrawing from the labour market was just
below 65 years (64.6 years) [13]. Consequently, we used a
practical threshold of 60 years and below at diagnosis for
inclusion. Although it is difficult to define early retirement,
men aged 60 years and below at diagnosis would have been
aged up to 63.5 years when they participated in LAPCD (18
42 months later), below the UK male state pension age. In the
UK, currently only 22% of men aged 60 and below have
retired suggesting this as a reasonable cutoff [13].
Responses to questions about employment status at time of
cancer diagnosis and time of survey were used to categorise
men as moving from employment to unemployment (EtoU),
from employment to retirement (EtoR) or remaining in em-
ployment (EtoE) (Survey in Supplementary File 1). Those
who chose full time employment(FTE), part time employ-
ment(PTE) or self-employed(SE) were categorised as
employedwhile those who chose unemployed, seeking
workor unemployed, unable to work for health reasons
were categorised as unemployedand those who chose re-
tiredwere classified as such. Those who recorded looking
after family/homeand otherwere excludedfrom analysis as
focus was on movement between employed and unemployed
and retired states and it would bedifficult to clearly delineate a
change in status between these states and the unemployed or
retired state.
Clinical characteristics, sociodemographic factors
and patient-reported symptoms
Stage and age at diagnosis and UK nation of residence were
determined from cancer registration data. Deprivation levels
were determined from UK Indices of Multiple Deprivation
(IMD) derived from patientshome postcode at diagnosis
[1417]. Respondentsself-reported employment status; relation-
ship status; ethnicity; height and weight (from which BMI was
derived [18]); whether they had carer responsibilities; whether
they had ever seen a healthcare professional for problems with
emotions; nerves or use of alcohol or drugs; treatment type;
comorbidities (total number of long-term conditions (LTCs),
e.g. stroke, diabetes) and overall urinary and bowel function
(from the Expanded Prostate Cancer Index Composite short form
(EPIC-26) questions How big a problem has your urinary/bowel
function been for you during the last 4 weeks?[19] were taken
from the survey data (Supplementary File 1).
670 J Cancer Surviv (2018) 12:669678
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Statistical analysis
Univariable analyses were undertaken to assess differences in
sociodemographic and clinical characteristics between both
the EtoU and EtoR groups and the EtoE group. Differences
in categorical variables were assessed using Chi-squared tests
and continuous variables using ttests. Bonferroni correction
was used to compensate for multiple comparisons. Variables
were entered as predictors in regression analysis using a
univariable analysis cutoff of p< 0.2 or if they were of a priori
importance (e.g., age, patient-reported symptoms). Treatment
type (surgery, radiotherapy, etc.) was not included in regres-
sion analysis. Certain treatments are more likely to lead to
specific function problems (e.g., surgery is associated with
worse urinary function) and it is the effect of resulting symp-
toms that is of interest. Multivariable logistic regression (back-
wards stepwise) analyses was performed with outcome vari-
ables being change in employment status from EtoU and from
EtoR with the reference category being no change in employ-
ment status (i.e. EtoE). Data were analysed with SPSS Version
22.0 (IBM Corp, Armonk, NY).
Results
Of the 58,930 men invited to participate, 35,823 returned com-
pleted questionnaires (60.8% response rate);14.1% (N= 5037/
35,823) of respondents were 60 years at PCa diagnosis. Non-
response on employment status was low: 1.5% (75/5037) did
not respond on employment status at diagnosis, 2.2% (N=109)
did not respond on employment status at time of survey and
3.1% (N= 155) did not respond on both. Non-responders were
more likely to be divorced, living in areas of greater depriva-
tion, of non-white ethnicity and report overall urinary problems.
Supplementary Table 1details the characteristics of employ-
ment status respondents and non-respondents.
Employment status and change in employment status be-
tween time of diagnosis and time of survey are shown in Table
1. Of those aged 60 years at diagnosis, 4014 were employed
at diagnosis and 3913 of these were employed, unemployed or
retired at survey. Of these 3913 men, there were 3218 (81.4%)
in the EtoE group, 245 (6.2%) in the EtoU group and 450
(11.4%) in the EtoR group (Fig. 1). Table 2details the char-
acteristics, treatment and patient-reported symptoms variables
in the three groups.
Men becoming unemployed
There was no difference in the proportion of EtoU men aged
5660 years (60.0%) compared to EtoE men (55.9%) (p=
0.29) (Table 2). Univariable analysis demonstrated there were
greater proportions of men who became unemployed who
were divorced, from deprived areas, from Scotland or NI, with
late stage disease at diagnosis, symptomatic at diagnosis, with
more comorbidities and reporting moderate or big problems
with urinary and bowel function (Table 2). There was no dif-
ference in ethnicity between EtoE and EtoU groups (Table 2).
A lower proportion of EtoU men had surgery and experienced
active surveillance, but a greater proportion had external beam
radiotherapy (EBRT) and androgen deprivation therapy
(ADT).
Multivariable logistic regression demonstrated a range of
sociodemographic, clinical and patient-reported factors were
predictive of movement from employment at diagnosis to
Table 1 Employment status at time of diagnosis and survey, and change in status, for men aged 60 years old and less at time of diagnosis
Employed Retired Unemployed Home Other Total Missing
At diagnosis 80.9% 10.4% 7.1% 0.8% 0.8% 100%
(4014) (516) (351) (42) (39) (4962) 75
At survey 66.7% 19.8% 11.3% 0.8% 1.3% 100%
(3289) (977) (559) (40) (63) (4928) 109
Employed to
employed (EtoE)
Employed to
retired (EtoR)
Employed to
unemployed (EtoU)
Employed to
home (EtoH)
Employed to
other (EtoO)
Total Missing
Change in employment status between diagnosis and survey
% (number) 81.4% 11.4% 6.2% 0.3% 0.8% 100%
(3218) (450) (245) (10) (32) (3955) 59
Employed at diagnosis
n = 3913
Employed at survey
n = 3218
n = 450
Unemployed at survey
n = 245
Fig. 1 Schematic of men who were employed at diagnosis and employed,
unemployed or retired at time of survey
J Cancer Surviv (2018) 12:669678 671
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Table 2 Sociodemographic, clinician and patient-reported urinary and bowel symptoms for EtoE, EtoU and EtoR groups for men aged 60 years and
below
Variable Employed to
employed
(EtoE)
Employed to
unemployed
(EtoU)
pvalue (comparing
EtoE and EtoU)
Total Employed to
retired (EtoR)
pvalue (comparing
EtoE and EtoR)
Tot al
Mean age (years) [SD] 55.4 [3.8] 55.9 [3.5] 0.03 (ttest) 57.7 [2.5] < 0.001* (ttest)
Age bands 0.290 < 0.001*
50 years 11.0% (353) 8.2% (20) 10.8% (373) 1.6% (7) 9.8% (360)
5155 33.2% (1067) 31.8% (78) 33.1% (1145) 15.3% (69) 31.0% (1136)
5660 55.9% (1798) 60.0% (147) 56.2% (1945) 83.1% (374) 59.2% (2172)
Total 100% (3218) 100% (245) 100% (3463) 100% (450) 100% (3668)
Marital status < 0.001* 0.036
Married/civil partnership 80.9% (2598) 68.3% (166) 80.0% (2764) 81.1% (365) 80.9% (2963)
Divorced/separated 10.1% (324) 19.8% (48) 10.8% (372) 8.0% (36) 9.8% (360)
Widowed 1.5% (47) 1.6% (4) 1.5% (51) 2.7% (12) 1.6% (59)
Single 4.7% (152) 7.0% (17) 4.9% (169) 6.7% (30) 5.0% (182)
Other 2.8% (90) 3.3% (8) 2.8% (98) 1.6% (7) 2.6% (97)
Total 100% (3211) 100% (243) 100% (3454) 100% (450) 100% (3661)
Deprivation < 0.001* 0.009
Q1 (Area of least
deprivation)
27.9% (876) 16.3% (39) 27.0% (915) 33.9% (151) 28.6% (1027)
Q2 26.2% (825) 19.2% (46) 25.7% (871) 26.5% (118) 26.3% (943)
Q3 18.7% (587) 18.8% (45) 18.7% (632) 19.1% (85) 18.7% (672)
Q4 16.0 (503) 21.3% (51) 16.4% (554) 13.9% (62) 15.7% (565)
Q5 (area of greatest
deprivation)
11.3% (354) 24.6% (59) 12.2% (413) 6.7% (30) 10.7% (384)
Total 100% (3145) 100% (240) 100% (3385) 100% (446) 100% (3591)
UK country of residence < 0.001* 0.003
England 85.3% (2744) 75.9% (186) 84.6% (2930) 81.6% (367) 84.8% (3111)
Wales 7.0% (225) 6.5% (16) 7.0% (241) 8.9% (40) 7.2% (265)
Scotland 4.5% (146) 9.8% (24) 4.9% (170) 3.3% (15) 4.4% (161)
Northern Ireland 3.2% (103) 7.8% (19) 3.5% (122) 6.2% (28) 3.6% (131)
Total 100% (3218) 100% (245) 100% (3463) 100% (450) 100% (3668)
Ethnicity 0.794 < 0.001*
White 92.6% (2938) 93.3% (223) 92.7% (3161) 97.5% (434) 93.2% (3372)
Non-white 7.4% (234) 6.7% (16) 7.3% (250) 2.5% (11) 6.8% (245)
Total 100% (3172) 100% (239) 100% (3411) 100% (445) 100% (3617)
Stage at diagnosis < 0.001* 0.053
I/II 72.2% (2020) 50.5% (105) 70.7% (2125) 69.5% (267) 72.2% (2020)
III 20.9% (584) 23.6% (49) 21.1% (633) 20.1% (77) 20.8% (661)
IV 7.0% (195) 26.0% (54) 8.3% (249) 10.4% (40) 7.4% (235)
Total 100% (2799) 100% (208) 100% (3007) 100% (384) 100% (3183)
Treatment type < 0.001* 0.071
Active surveillance and
watchful waiting
16.1% (517) 4.5% (11) 15.3% (528) 15.8% (71) 16.0% (588)
Surgery 41.5% (1336) 25.7% (63) 40.4% (1399) 35.3% (159) 40.8% (1495)
ERBT 2.5% (81) 4.1% (10) 2.6% (91) 2.2% (10) 2.5% (91)
Brachytherapy 6.9% (221) 4.9% (12) 6.7% (233) 7.6% (34) 7.0% (255)
ADT 1.3% (42) 3.7% (9) 1.5% (51) 2.9% (13) 1.5% (55)
EBRT + ADT 9.9% (318) 16.3% (40) 10.3% (358) 12.4% (56) 10.2% (374)
Surgery + EBRT/ADT 8.2% (265) 9.4% (23) 8.3% (288) 8.9% (40) 8.3% (305)
ADT + systemic
treatment
1.0% (32) 4.1% (10) 1.2% (42) 1.8% (8) 1.1% (40)
EBRT + systemic
treatment
1.4% (45) 6.1% (15) 1.7% (60) 1.6% (7) 1.4% (52)
Other 11.2% (360) 21.2% (52) 11.9% (412) 11.6% (52) 11.2% (412)
Total 100% (3217) 100% (245) 100% (3462) 100% (450) 100% (3667)
Comorbidities < 0.001* 0.003*
None 47.7% (1536) 27.3% (67) 46.3% (1603) 40.4% (182) 46.8% (1718)
1 33.3% (1070) 33.9% (83) 33.3% (1153) 36.4% (164) 33.6% (1234)
2 12.1% (389) 20.4% (50) 12.7% (439) 12.2% (55) 12.1% (444)
3 3.6% (115) 9.0% (22) 4.0% (137) 6.7% (30) 4.0% (145)
4 or more 3.4% (108) 9.4% (23) 3.8% (131) 4.2% (19) 3.5% (127)
Total 100% (3218) 100% (245) 100% (3463) 100% (450) 100% (3668)
Symptomatic at
diagnosis
<0.001* 0.713
No 48.9% (1555) 31.8% (76) 47.7% (1631) 47.9% (214) 48.8% (1769)
672 J Cancer Surviv (2018) 12:669678
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unemployment at follow-up (i.e. comparing EtoU to EtoE
groups) (Table 3). Late stage at diagnosis (OR = 4.7 (95% CI
3.17.0), stage IV relative to stage I/II) and greater comorbid-
ity (OR ranging from OR 1.6 (95% CI 1.12.3) for 1 LTC to
3.5 (95% CI 1.86.8) for 4 LTCs compared to none) were
the strongest predictors of movement to unemployment.
Problems with bowel (OR = 2.5 (95% CI 1.63.9) moderate/
big compared to no/very small/small problems) and urinary
function (OR = 2.0 (95% CI 1.42.9) moderate/big compared
to no/very small/small problems) and having symptoms at
diagnosis (OR = 1.5 (95% CI 1.02.1)) were also predictors
of movement to unemployment (Table 3). Living in areas of
greater deprivation (OR = 2.6 (95% CI 1.64.3] most relative
to least deprived), being divorced/separated (OR = 2.5 (95%
CI 1.73.8]) and living in Scotland (OR = 2.1 (95% CI 1.2
3.6]) or NI (OR = 3.1 (95% CI 1.75.6] compared to living in
England) were also significant predictors of becoming
unemployed.
Men retiring early
In the univariable analysis, there were no differences in dis-
ease stage at diagnosis or the proportions who were symptom-
atic at diagnosis between men retiring early and those who
remained in employment (Table 2). There were no differences
in treatment type or overall urinary or bowel function between
the EtoR and EtoE group. Men remaining in employment
were significantly younger (mean age = 55.4 years, p<
0.001) than those retiring early (mean age = 57.7 years), with
a difference of over 2 years between the groups. There was a
greater proportion of older men in the EtoR group with 83.1%
aged 5660 years compared to 55.9% in the EtoE group
(Table 2). There were greater proportions of EtoR relative to
EtoE men of white ethnicity, from less-deprived areas and
with caring responsibility and lower proportions of EtoR com-
pared to EtoE men living in England and reporting no comor-
bidities (Table 2).
Tabl e 2 (continued)
Variable Employed to
employed
(EtoE)
Employed to
unemployed
(EtoU)
pvalue (comparing
EtoE and EtoU)
Total Employed to
retired (EtoR)
pvalue (comparing
EtoE and EtoR)
Tot al
Yes 51.1% (1623) 68.2% (163) 52.3% (1786) 52.1% (233) 51.2% (1856)
Total 100% (3178) 100% (239) 100% (3417) 100% (447) 100% (3625)
Overall urinary
symptoms
<0.001* 0.831
No/very small/small
problem
89.4% (2868) 69.0% (167) 88.0% (3035) 89.9% (400) 89.5% (3268)
Moderate/big problem 10.6% (339) 31.0% (75) 12.0% (414) 10.1% (45) 10.5% (384)
Total 100% (3207) 100% (242) 100% (3449) 100% (445) 100% (3652)
Overall bowel symptoms < 0.001* 0.614
No/very small/small
problem
94.7% (3034) 77.3% (187) 93.4% (3221) 94.0% (420) 94.6% (3454)
Moderate/big problem 5.3% (171) 22.7% (55) 6.6% (226) 6.0% (27) 5.4% (198)
Total 100% (3205) 100% (242) 100% (3447) 100% (447) 100% (3652)
BMI < 0.001* 0.092
< 25 kg/m
2
26.7% (810) 21% (47) 26.3% (857) 30% (131) 27.1% (941)
2529.9 kg/m
2
48% (1459) 40.2% (90) 47.5% (1549) 49.1% (214) 48.1% (1673)
30 kg/m
2
25.3% (770) 38.8% (87) 26.3% (857) 20.9% (91) 24.8% (861)
Total 100% (3039) 100% (224) 100% (3263) 100% (436) 100% (3475)
Employment type 0.029 < 0.001*
Full time 72.3% (2327) 73.1% (179) 72.4% (2506) 77.8% (350) 73% (2677)
Part time 5.4% (174) 9% (22) 5.7% (196) 10.7% (48) 6.1% (222)
Self-employed 22.3% (717) 18% (44) 22% (761) 11.6% (52) 21% (769)
Total 100% (3218) 100% (245) 100% (3463) 100% (450) 100% (3668)
Seen HC professional for
mental health issues
<0.001* 0.183
Yes 22% (700) 33.7% (82) 22.8% (782) 24.8% (111) 22.3% (811)
No 78% (2489) 66.3% (161) 77.2% (2650) 75.2% (337) 77.7% (2826)
Total 100% (3189) 100% (243) 100% (3432) 100% (448) 100% (3637)
Caring responsibilities 0.875 0.003*
Yes 22.3% (707) 22.9% (55) 22.3% (762) 28.7% (127) 23% (834)
No 77.7% (2470) 77.1% (185) 77.7% (2655) 71.3% (316) 77% (2786)
Total 100% (3177) 100% (240) 100% (3417) 100% (443) 100% (3620)
EBRT external beam radiotherapy, ADT androgen deprivation therapy
*Significant at p< 0.05 after Bonferroni adjustment for multiple comparisons
Ever seen a healthcare professional for problems with emotions or nerves or use of alcohol or drugs
J Cancer Surviv (2018) 12:669678 673
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In the multivariable analysis, age, ethnicity, employment sta-
tus, UK country of residence, stage at diagnosis and carer re-
sponsibilities were significantly associated with moving from
employment to retirement (Table 4). Older age was the strongest
predictor of early retirement (OR 8.5 (95% CI 4.018.3), age
5560 years). Men living in NI (OR = 2.3 (95% CI 1.43.6)),
with later disease stage disease (OR = 1.8 (95% CI 1.22.6),
stage IV) and carer responsibilities (OR = 1.3 (95% CI 1.0
1.7)) were also significantly more likely to move to early retire-
ment. Men who were self-employed (OR = 0.40 (95% CI 0.28
0.57)) and of non-white ethnicity (OR = 0.32 (95% CI 0.16
0.63)) were significantly less likely to move to early retirement.
Discussion
The clinical factors of advanced disease stage, presence of bow-
el and urinary problems, having symptoms at diagnosis and
greater levels of comorbidity increased the odds of job loss in
PCa survivors, alongside the sociodemographic factors of dep-
rivation, divorce/separation and living in Scotland or NI. In
contrast, having bowel or urinary problems or greater comor-
bidity were not significantly associated with early retirement in
PCa survivors. Men who were older, of white ethnicity, in full-
time employment, with most advanced disease (stage IV) or
with caring responsibilities had greater odds of early retirement.
Table 3 Significant independent
predictors of movement between
employment and unemployment
for men aged 60 years and below
using logistic regression
modelling
Odds ratio 95% CI lower 95% CI upper pvalue
Deprivation
Q1 (area of least deprivation) 1.00
Q2 0.87 0.50 1.50 0.618
Q3 1.57 0.93 2.63 0.090
Q4 1.92 1.16 3.19 0.011*
Q5 (area of greatest deprivation) 2.58 1.56 4.26 < 0.001*
Marital status
Married/civil partnership 1.00
Divorced/separated 2.50 1.65 3.80 < 0.001*
Widowed 1.58 0.51 4.93 0.42
Single 1.51 0.80 2.87 0.205
Other 1.29 0.52 3.16 0.580
UK country
England 1.00
Wales 1.08 0.57 2.05 0.811
Scotland 2.08 1.20 3.61 0.009*
Northern Ireland 3.11 1.71 5.64 < 0.001*
Stage
Stage I/II 1.00
Stage III 1.72 1.17 2.53 0.006*
Stage IV 4.68 3.11 7.03 < 0.001*
Symptomatic at diagnosis
No 1.00
Yes 1.47 1.04 2.06 0.028*
Comorbidities
No comorbidities 1.00
1 comorbidity 1.57 1.07 2.32 0.023
2 comorbidities 2.27 1.44 3.57 < 0.001*
3 comorbidities 2.47 1.30 4.68 0.006*
4 or more comorbidities 3.49 1.80 6.79 < 0.001*
Bowel symptoms (overall)
No/very small/small problems 1.00
Moderate/big problems 2.54 1.64 3.94 < 0.001*
Urinary symptoms (overall)
No/very small/small problems 1.00
Moderate/big problems 2.02 1.37 2.97 < 0.001*
Factors contributing significantly to the model (p < 0.05) are reported. Variables included in the model were age,
relationship status, deprivation quintile, UK country of residence, ethnicity, BMI, type of employment at diag-
nosis, stageat diagnosis, whether symptomatic at diagnosis, whether had PSA testing at diagnosis, comorbidities,
overall urinary problems, overall bowel problems, having ever seen a professional for mental health issues and
caring responsibilities
674 J Cancer Surviv (2018) 12:669678
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Movement to unemployment
In our study, advanced disease stage at diagnosis was the
strongest predictor of becoming unemployed, with the odds
of men with stage IV disease becoming unemployed almost
five times those of men with stage I/II disease. Problems with
bowel and urinary function were also strong predictors of
becoming unemployed. This suggests that more severe dis-
ease and treatment side effects adversely impact on employ-
ment. Previous studies of cancer survivors report associations
between both cancer severity and adverse effects and delayed
returning to work [20]. However, those involving PCa survi-
vors report variable associations between clinical factors and
employment status, productivity and work engagement
[2124]. However, these studies were not population based,
involved small numbers of PCa survivors (n< 180) and were
non-UK based. More severe bowel symptoms have, for exam-
ple, been associated with greater number of missed workdays
in irritable bowel syndrome (IBS) sufferers [25], who have
been reported to experience significant work impairment with
substantial productivity and cost implications [26,27].
Comorbidity was also a significant predictor of becoming un-
employed with the likelihood of job loss increasing with the
number of comorbidities. Greater comorbidity has been asso-
ciated with reduced work ability in Nordic PCa survivors [28],
but greater disability was not associated with higher job quit-
ting rates in a US study of PCa survivors [29].
We have identified sociodemographic factors that predict
job loss. Men living in the most deprived areas had over twice
the odds of becoming unemployed. A study reporting on 100
PCa survivors in Ireland found more socioeconomically de-
prived men were less likely to resume work following diag-
nosis [10]. A possible reason may have been difficulty main-
taining physically demanding or manual jobs, which are more
common in men in deprived areas [30]. Cancer survivors with
physically demanding jobs, such as heavy lifting, found their
jobs more challenging [31,32], and manual labour was found
to negatively impact on survivors return-to-work [33]. As men
from more deprived areas may have more physically demand-
ing or manual jobs this may have been a possible reason for
their higher odds of unemployment. Divorced or separated
men had 2.5 times greater odds of becoming unemployed
Table 4 Significant independent
predictors of movement between
employment and retirement for
men aged 60 years and below
using logistic regression
modelling
Odds ratio 95% CI lower 95% CI upper pvalue
Age band
< 50 years 1.00
5054 years 2.57 1.16 5.71 0.021
5560 years 8.52 3.97 18.28 < 0.001*
Ethnicity (reference)
White 1.00
Non-white 0.32 0.16 0.63 0.001*
Employment type
Full-time employment 1.00
Part-time employment 1.38 0.94 2.03 0.099
Self-employed 0.40 0.28 0.57 < 0.001*
UK country
England 1.00
Wales 1.25 0.83 1.87 0.281
Scotland 0.67 0.36 1.25 0.208
Northern Ireland 2.29 1.44 3.64 < 0.001*
Stage
Stage I/ II 1.00
Stage III 0.99 0.75 1.31 0.934
Stage IV 1.79 1.22 2.62 0.003*
Carer responsibilities
No 1.00
Yes 1.29 1.00 1.66 0.050*
Factors contributing significantly to the model (p< 0.05) are reported. Variables included in the model were age,
relationship status, deprivation quintile, UK country of residence, ethnicity, BMI, type of employment at diag-
nosis, stage at diagnosis, comorbidities, overall urinary problems, overall bowel problems, having ever seen a
professional for mental health issues and caring responsibilities
J Cancer Surviv (2018) 12:669678 675
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
compared to married men. Men living in NI and Scotland
were over twice as likely to become unemployed as English
men, which broadly reflect unemployment patterns between
2013 and 2016 in which, against a background downward
trend in all UK countries, unemployment rates in NI and
Scotland were slightly higher than the UK average [34].
Early retirement
Our findings for men who moved from employment to early
retirement were very different, and men with more severe
urinary and bowel problems or a greater number of comorbid-
ities were not more likely to retire early. Older age was the
strongest predictor of early retirement with the odds of retiring
early for men aged 5560 years almost nine times greater than
that of men less than 50 years old, although numbers in the
reference category (< 50 years) were small (N=20). Itisnot
surprising that older men were more likely to retire than youn-
ger men in this study. However, older men were not more
likely to be become unemployed, with no significant relation-
ship between age and movement to unemployment on logistic
regression analysis.
Those of non-white ethnicity were significantly less likely
to retire early, although numbers in this group were small.
Male ethnic minorities in the UK experience higher rates of
unemployment [35] and have, on average, lower income than
the white population [36], with earning differentials at least
10% less than comparable white men [37]. Consequently,
white UK men may be more economically able to support
themselves and their families in retirement at an earlier age.
Employment type (e.g. full-time, part-time, self-employed)
predicted move to early retirement, but not to unemployment.
The odds of self-employed men moving to early retirement
were 60% less than men in full-time employment, which sup-
ports the finding of Sharp et al. that self-employed PCa survi-
vors were more likely to continue working following diagno-
sis [10].
The findings from the present study suggest that men who
became unemployed and those who retired early following
PCa diagnosis represent very different groups. Compared with
men who remain in employment, those who become unem-
ployed had different socioeconomic characteristics, more se-
vere disease and worse clinical symptoms. In contrast, the
sociodemographic profile and symptom characteristics of
men who retire early was similar to men who continue to
work. Men with PCa who retired early had no worse urinary
or bowel symptoms than those who remain in employment.
They were less likely to be self-employed and not more de-
prived. However, they are more likely to have caring respon-
sibilities, suggesting this may be a possible reason for retiring
early. Although it is unsurprising that those from more de-
prived areas had greater odds of becoming unemployed and
those from less-deprived areas had greater odds of retiring
early, there are few studies which consider factors associated
with change in employment status of cancer survivors follow-
ing diagnosis (i.e. moving from employment to either unem-
ployment or early retirement compared to those who stay in
employment) and none involving a population-based study of
prostate cancer survivors.
Practical implications
This study has identified characteristics associated with job
loss and early retirement, which can be used by health and
social care staff, employers and human resources staff to target
information, advice and support for PCa survivors to mitigate
work impairment and support return to work. Local networks
integrated with existing care systems have been suggested as a
model, which can support urological cancer survivors who
wish to stay in employment [38] and workplace counselling
[39], workplace evaluation [40] and workplace rehabilitation
[41] may help sustain cancer survivors in employment.
Ideally, PCa survivors at risk of unemployment would be
empowered to actively seek assistance, which could maintain
employment.
Factors associated with employment outcomes for cancer
survivors include health and well-being, symptom control
and function as well as work demands, work environment
and policies and economic factors [42]. Our study found that
men with worse urinary and bowel symptoms had greater
odds of becoming unemployed. Men with a greater number
of comorbidities, and likely poorer function, also had greater
odds of losing their job. Men who were divorced/separated
or living in deprived areas also had greater odds of losing
their job. Targeted support to maintain employment may be
warranted for PCa survivors who are, for example, divorced
or separated, from more deprived backgrounds and with a
number of comorbidities, especially those experiencing uri-
nary or bowel symptoms following treatment. This study
will also help inform future research into maintaining em-
ployment following PCa diagnosis. Such research could fo-
cus on disease-specific symptoms and general health status
alongside social and demographic factors, ideally in longitu-
dinal studies which would also consider work-related
factors.
Limitations
Although this is the first study to investigate a range of
sociodemographic, clinical and patient-reported factors asso-
ciated with movement from employment at time of PCa diag-
nosis to unemployment or early retirement in a large-scale UK
population-based study, there were a number of limitations.
We did not have details of when men became unemployed, of
income, pension or educational levels or of work-related fac-
tors, such as type of occupation (e.g. service and
676 J Cancer Surviv (2018) 12:669678
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
manufacturing) and hours worked, which may have been as-
sociated with movement to unemployment or early retirement.
Although we report significant associations with movement to
unemployment or early retirement, we cannot assume causal
relationships. We acknowledge that some of the observed
movement to early retirement may have occurred independent
of PCa diagnosis. We compared both EtoU and EtoR groups
with recently diagnosed PCa survivors who were employed
both at diagnosis and follow-up (EtoE group) and assumed
these men remained in employment during that period. Some
variables had low numbers in sub-categories (e.g. those of
non-white ethnicity who retired early, N=11)which warrant
caution in interpretation. However, these were in the context
of large category numbers (e.g. 261 men of non-white ethnic-
ity in the sample) and overall group numbers (3218 in EtoE,
245 in EtoU and 450 in the EtoR groups) which were much
greater than previous studies of job loss and early retirement
involving PCa survivors.
Conclusion
Men who retire early following PCa diagnosis do not report
worse overall urinary or bowel problems or different socio-
economic characteristics to men remaining in employment.
However, this study has identified risk factors for job loss in
PCasurvivors,whichcanbeusedtosupportmenfollowing
diagnosis. Targeted support and engagement with these men,
their families and their employers is needed.
Acknowledgements The authors thank all the men who completed the
surveys. The authors acknowledge the following people for their contri-
bution to the development, setting up and running of the study: Heather
Kinnear, Victoria Cairnduff, Oonagh McSorley, Conan Donnelly, Linda
Roberts, Rebecca Mottram, Majorie Allen, Adrian Slater, the LAPCD
User Advisory Group and Clinical & Scientific Advisory Group, Picker
Institute Europe and Business Services Organisation (NI). This study is
based in part on information collected and quality assured by the cancer
registries in each nation. This work uses data provided by patents and
collected by health services as part of their care and support.
Funding The Life After Prostate Cancer Diagnosis study was funded by
the Movember Foundation, in partnership with Prostate Cancer UK, as
part of the Prostate Cancer Outcomes programme (grant number BO26/
MO).
Compliance with ethical standards
Conflict of interest The authors declare that they have no competing
interests.
Ethical approval The study received the following ethical approvals:
Newcastle & North Tyneside 1 Research Ethics Committee (15/NE/
0036), Confidentiality Advisory Group (15/CAG/0110), NHS Scotland
Public Benefit and Privacy Panel (05160364), Office of Research Ethics
Northern Ireland (16/NI/0073) and NHS R&D approval from Wales,
Scotland, and Northern Ireland. All procedures performed in studies
involving human participants were in accordance with the ethical stan-
dards of the institutional and/or national research committee and with the
1964 Helsinki declaration and its later amendments or comparable ethical
standards.
Informed consent Informed consent was obtained from all individual
participants included in the study.
Open Access This article is distributed under the terms of the Creative
Commons Attribution 4.0 International License (http://
creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
distribution, and reproduction in any medium, provided you give
appropriate credit to the original author(s) and the source, provide a link
to the Creative Commons license, and indicate if changes were made.
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... Bradley et al. (2006) reported that men missed an average of 27 days of work due to prostate cancer treatment (with either one treatment or a combination of radical prostatectomy, radiation therapy, and androgen deprivation therapy). Although the findings of several studies indicated that return to work rates were over 70% within the first year of treatment (Dahl et Plym et al., 2016;Sveitstrup et al., 2016), in eight studies the resumption of work responsibilities was reported to be shaped by a range of issues including the type of treatment and experience of sideeffects (Arndt et al., 2019;Bennett et al., 2018;Dahl et al., 2014Dahl et al., , 2016Dahl et al., , 2020Plym et al., 2016;Sveitstrup et al., 2016;Yu Ko et al., 2020). The connections between radical prostatectomy and men's ability to return to work were explicitly explored. ...
... Age was identified in nine studies as an influencing factor in men's work decisions after prostate cancer treatment (Arndt et al., 2018;Bennett et al., 2018;Dahl et al., 2015Dahl et al., , 2016Dahl et al., , 2020Nilsson et al., 2020;Sveitrup et al., 2016;Ullrich et al., 2017;Yu Ko et al., 2020). For example, in a study involving 837 German men who underwent radical prostatectomy and who subsequently received rehabilitation therapy, Ullrich et al. (2017) reported that men over the age of 60 were more likely to withdraw permanently from work and apply for disability pension than men in their 50s. ...
... Ullrich et al. (2020) suggested that higher prostate cancer stage may be associated with a more aggressive cancer treatment regime resulting in greater or more intense side-effects and longer posttreatment recovery times. Regarding the impact of prostate cancer treatment side-effects, urinary incontinence has been reported to be a major factor influencing men's decisions related to the resumption of work activities in eight studies (Arndt et al., 2018;Bennett et al., 2018;Dahl, et al., 2015Dahl, et al., , 2016Dahl, et al., , 2020Grunfeld et al., 2013;Nilsson et al., 2020;Yu Ko et al., 2020). In a British qualitative study, Grunfeld et al. (2013) reported that treatment-induced urinary incontinence challenged men's opportunities to socialize with co-workers and severely affected their masculine identities, despite efforts to manage urinary incontinence by hiding leakage to present a self-image of control at work. ...
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Prostate cancer is the most common malignancy diagnosed in North American men. Although medical advances have improved survival rates, men treated for prostate cancer experience side-effects that can reduce their work capacity, increase financial stress, and affect their career and/or retirement plans. Working-age males comprise a significant proportion of new prostate cancer diagnoses. It is important, therefore, to understand the connections between prostate cancer and men’s work lives. This scoping review aimed to summarize and disseminate current research evidence about the impact of prostate cancer treatment on men’s work lives. Electronic databases were searched to identify peer-reviewed articles published between 2006 and 2020 that reported on the impact of prostate cancer treatment on men’s work. Following scoping review guidelines, 21 articles that met inclusion criteria were identified and analyzed. Evidence related to the impact of prostate cancer on work was grouped under three themes: (1) work outcomes after prostate cancer treatment; (2) return to work considerations, and (3) impact of prostate cancer treatment on men’s finances. Findings indicate that men’s return to work may be more gradual than expected after prostate cancer treatment. Some men may feel pressured by financial stressors and masculine ideals to resume work. Diverse factors including older age and social benefits appear to play a role in shaping men’s work-related plans after prostate cancer treatment. The findings provide direction for future research and offer clinicians a synthesis of current knowledge about the challenges men face in resuming work in the aftermath of prostate cancer treatment.
... effects when they are just about to reach retirement age is not worthwhile. In this sense, a study carried out in the UK in men who survived prostate cancer found early retirement to be 9-times more likely in older men (aged 55-60 years) than men aged < 50 years 45 . ...
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Cancer incidence and survival rates have increased in the last decades and as a result, the number of working age people diagnosed with cancer who return to work. In this study the probability of accumulating days of employment and employment participation trajectories (EPTs) in a sample of salaried workers in Catalonia (Spain) who had a sickness absence (SA) due to cancer were compared to salaried workers with SA due to other diagnoses or without SA. Each individual with SA due to cancer between 2012 and 2015 was matched by age, sex, and onset of time at risk to a worker with SA due to other diagnoses and another worker without SA. Accumulated days of employment were measured, and negative binomial models were applied to assess differences between comparison groups. Latent class models were applied to identify EPTs and multinomial regression models to analyse the probability of belonging to one EPT of each group. Men and women without SA or with SA due to other diagnoses had at least a 9% higher probability of continuing in employment compared to workers who had a SA due to cancer, especially among men without SA (adjusted IRR 1.27, 95% CI 1.06‒1.53). Men without SA had the highest probability of having high stable EPT compared to workers who had a SA due to cancer (adjusted RRR 3.21, 95% CI 1.87‒5.50). Even though workers with SA due to cancer continue working afterwards, they do it less often than matched controls and with a less stable employment trajectory. Health and social protection systems should guaranty cancer survivors the opportunity to continue voluntary participation in the labour market.
... This trend of improved survival is mainly due to advances in cancer diagnostic technology and therapeutics resulting from cancer science and trials [68]. Similar to trends in survivorship, clinical trials on survivorship have also increased during the past two decades [69][70][71][72][73]. Yet, only 5 percent of cancer survivors were engaged in these trials, although 26 percent of survivors reported willingness to be involved [70]. ...
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Oncology trials are the cornerstone of effective and safe therapeutic discoveries. However, there is increasing demand for pragmatism and patient engagement in the design, implementation and dissemination of oncology trials. Many researchers are uncertain about making trials more practical and even less knowledgeable about how to meaningfully engage patients without compromising scientific rigor to meet regulatory requirements. The present work provides practical guidance for addressing both pragmaticism and meaningful patient engagement. Applying evidence-based approaches like PRECIS-2-tool and the 10-Step Engagement Framework offer practical guidance to make future trials in oncology truly pragmatic and patient-centered. Consequently, such patient-centered trials have improved participation, faster recruitment and greater retention, and uptake of innovative technologies in community-based care.
... Living longer with PCa does not necessarily equate to living well [169]. There is clear evidence of unmet needs and ongoing support requirements for some men after diagnosis and treatment for PCa [170]. Cancer impacts the wider family, and cognitive behavioural therapy can help reduce depression, anxiety, and stress in caregivers [171]. ...
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Objective To present a summary of the 2020 version of the European Association of Urology (EAU)-European Association of Nuclear Medicine (EANM)-European Society for Radiotherapy & Oncology (ESTRO)-European Society of Urogenital Radiology (ESUR)-International Society of Geriatric Oncology (SIOG) guidelines on the treatment of relapsing, metastatic, and castration-resistant prostate cancer (CRPC). Evidence acquisition The working panel performed a literature review of the new data (2016–2019). The guidelines were updated, and the levels of evidence and/or grades of recommendation were added based on a systematic review of the literature. Evidence synthesis Prostate-specific membrane antigen positron emission tomography computed tomography scanning has developed an increasingly important role in men with biochemical recurrence after local therapy. Early salvage radiotherapy after radical prostatectomy appears as effective as adjuvant radiotherapy and, in a subset of patients, should be combined with androgen deprivation. New treatments have become available for men with metastatic hormone-sensitive prostate cancer (PCa), nonmetastatic CRPC, and metastatic CRPC, along with a role for local radiotherapy in men with low-volume metastatic hormone-sensitive PCa. Also included is information on quality of life outcomes in men with PCa. Conclusions The knowledge in the field of advanced and metastatic PCa and CRPC is changing rapidly. The 2020 EAU-EANM-ESTRO-ESUR-SIOG guidelines on PCa summarise the most recent findings and advice for use in clinical practice. These PCa guidelines are first endorsed by the EANM and reflect the multidisciplinary nature of PCa management. A full version is available from the EAU office or online (http://uroweb.org/guideline/prostate-cancer/). Patient summary This article summarises the guidelines for the treatment of relapsing, metastatic, and castration-resistant prostate cancer. These guidelines are evidence based and guide the clinician in the discussion with the patient on the treatment decisions to be taken. These guidelines are updated every year; this summary spans the 2017–2020 period of new evidence.
... For younger men who were active in the workplace prior to treatment, these changes were particularly difficult to adjust too. A large-scale UK population-based study that investigated factors associated with job loss and early retirement in men (age ≤ 60 years) diagnosed with PCa found that men with worse urinary and bowel symptoms had a greater likelihood of becoming unemployed [26]. The interview findings also offer a unique insight into the impact of PCa on wives/ partner's work lives and for members of the couple who are self-employed, something of which there is also minimal literature. ...
Article
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Purpose: Prostate Cancer (PCa) is often considered to be an illness affecting older men, however the prevalence in younger men (<=65 years) is rising. Diagnosis and treatment for PCa can have a significant impact on the lives of both the man with PCa and his partner. This study explored the experiences and needs of younger men and their partners affected by PCa. The findings will be used to inform service provision and develop interventions appropriate to need. Methods: Participants were recruited from respondents to a national PROMS study (Life After Prostate Cancer Diagnosis (LAPCD), who indicated on completed questionnaires their willingness to be interviewed. Semi-structured telephone interviews were conducted with twenty-eight couples, separately (56 participants). Data were analysed using the Framework Method. Results: Following the diagnosis of PCa, couples' experienced changes in their intimate relationships, parental/familial roles, work and finances, and social connections and activities. Couples adopted a range of strategies and behaviours to help their adjustment to PCa, such as communicating with each other, distancing, distraction, and adopting a positive mindset towards PCa. This, in turn, influenced how their identity as a couple evolved. Conclusions: Following a diagnosis of PCa, the identity of couples are continually evolving. It is important that these couples are provided with the appropriate information, support and resources to help them transition along the cancer pathway. Implications for cancer survivors: Key areas of support identified for younger couples include: 1) couple focused support programme to foster relationship strategies/behaviours that facilitate couple adjustment; 2) age-specific support, e.g. 'buddying systems' connecting younger couples affected by PCa and providing them with tailored information (written/online/app).
... Demographic factors such as age, gender, and education level influence the ability to continue work after cancer [16][17][18][19]. In Norway, fewer women than men are employed 5 years after cancer [20] and reducing working hours after cancer are more common among women than men [14]. ...
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OPEN ACCESS Aims: Our aim was to investigate labor-force participation, working hours, job changes, and education over 9 years among persons who have survived more than 10 years after cancer, and compare it to controls. Methods: Register data on 2629 persons who survived cancer were stratified by gender and compared to data on 5258 matched controls. Persons who survived cancer were aged 30–50 when diagnosed with cancer and had a work contract prior to diagnosis. Descriptive analysis and t-tests were performed. Results: The proportion of female persons who survived cancer in the labor force was reduced from 100% to 83.9% during follow-up, demonstrating a significant difference compared to controls for each year measured. The proportion of male persons who survived cancer dropped from 100% to 84.8%, but was only significantly different compared to controls in 2 years. The proportion of female persons who had survived cancer who worked full-time was lower in all years compared to both controls and male persons who survived cancer; in turn, male persons who had survived cancer worked full-time less than male controls. The proportion of female persons who had survived cancer who worked less than 20 hours per week increased compared to controls. The frequency of change of employer was higher among female persons who survived cancer compared to controls for some years, but no significant differences between male persons who survived cancer and controls were found. Female persons who survived cancer were in education more often than male persons who survived cancer.
... Studies on cancer-related symptoms, such as this one, are starting to suggest pathways by which financial hardship may lead to reduced QoL among survivors. In terms of explanations for our findings, experiencing cancer-related symptoms (including fatigue and pain) can hamper cancer survivors' ability to work, and increase their risk of unemployment and early retirement [48][49][50][51]. This suggests that the effects of CRF on work participation may, at least in part, explain our findings. ...
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IntroductionCancer-related fatigue (CRF) is the most commonly reported treatment-related side effect of prostate cancer (PCa). Recognition of financial hardship among cancer survivors is growing. We investigated, for the first time, associations between levels of financial stress and CRF among PCa survivors.Methods We used data from PCa survivors who had been identified through two population-based cancer registries covering the Republic of Ireland and Northern Ireland and had completed a postal questionnaire. CRF was measured by the fatigue subscale of the EORTC QLQ-C30. Financial stress was assessed as household ability to make ends meet (i) pre-diagnosis and (ii) at questionnaire completion (post-diagnosis). Multivariable logistic regression was used to relate financial stress to clinically important CRF (fatigue subscale score ≥ 39 of a possible 100).ResultsTwo thousand four hundred fifty-eight PCa survivors were included. Of these, 268 (10.9%) reported pre-diagnosis financial stress only, 317 (12.9%) post-diagnosis stress only and 270 (11.0%) both pre- and post-diagnosis stress (cumulative stress); 470 (19.1%) reported clinically important CRF. After controlling for confounders, survivors with cumulative financial stress exposure were significantly more likely to have CRF (OR = 4.58, 95% CI 3.30–6.35, p < 0.001), compared with those without financial stress. There was a suggestion of a dose-response relationship (OR = 1.83, 95% CI 1.27–2.65, p = 0.001 for pre-diagnosis financial stress only; and OR = 4.11, 95% CI 3.01–5.61, p < 0.001 for post-diagnosis financial stress only).Conclusions Financial stress may be an independent risk factor for CRF.Implications for Cancer SurvivorsThere may be benefits in targeting interventions for reducing CRF towards survivors with financial stress, or developing strategies to reduce financial stress.
Article
Objectives Men living with prostate cancer have supportive and palliative needs. However, few studies detail unmet needs (vs quality of life measurement) or include data from those with advanced disease. We aimed to identify unmet needs of people living with prostate cancer (men, family carers), including those with advanced disease. Methods Mixed-methods national survey (patient Supportive Care Needs Survey; Carer Support Needs Assessment Tool) and health status (EuroQol Visual Analogue Scale). Quantitative data were explored using regression analysis. Free text data were subjected to thematic analysis. Results 216 men (mean age 65±8.5 years; active cancer 136 [63%]) and 97 carers (68 (70%) spouse/partner) provided data. 133 men (62%) reported moderate-to-high need which was more likely in advanced disease. Men’s health status was worse with active vs remitted disease (mean difference −11; 95% CI −17 to −5; p<0.001). 85 (88%) carers reported at least one unmet need relating to ‘enabling them to care’ and 83 (86%) relating to ‘their own well-being’. Carers with chronic illnesses had more unmet needs (p=0.01 to p=0.04) and patient receipt of palliative care independently predicted higher unmet carer needs (p=0.02). Free text data demonstrated widespread burden with: (1) poor communication/information, including about palliative care; (2) poorly managed symptoms/concerns and (3) poor care co-ordination. Incontinence, sexual dysfunction and hormone side-effects were serious problems, often left unaddressed. Conclusions Many living with prostate cancer continue with wide-ranging concerns. Lack of systematic, ongoing needs assessment and poor communication compound inadequate clinical pathways. Person-centred care, interdisciplinary working and integrated palliative care should be resourced.
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Background: Cancer incidence and survival rates have increased in the last decades and as a result, the number of working age people diagnosed with cancer who return to work. In this study the probability of accumulating days of employment and employment participation trajectories (EPTs) in a sample of salaried workers in Catalonia (Spain) who had a sickness absence (SA) due to cancer were compared to salaried workers with SA due to other diagnoses or without SA. Methods: Each individual with SA due to cancer between 2012-2015 was matched by age, sex, and time at risk to a worker with SA due to other diagnoses and another worker without SA. Accumulated days of employment were measured, and negative binomial Poisson models were applied to assess differences between comparison groups. Latent class models were applied to identify EPTs and multinomial regression models to analyse the probability of belonging to one EPT of each group. Results: Men and women without SA or with SA due to other diagnoses had at least a 9% higher probability of continuing in employment compared to workers who had an SA due to cancer, especially among men without SA (adjusted IRR 1.27, 95% CI: 1.06‒1.53). Men without SA had the highest probability of having high stable EPT compared to workers who had an SA due to cancer (adjusted RRR 3.21, 95% CI: 1.87‒5.50). Conclusions: Even though workers with SA due to cancer continue working after an SA, they do it less often than matched controls and with a less stable employment trajectory. Health and social protection systems should guaranty cancer survivors the opportunity to continue voluntary participation in the labour market.
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Objective: Early access to work-related psychosocial cancer care can contribute to return to work of cancer survivors. We aimed to explore: (a) the extent to which hospital healthcare professionals conduct conversations about work-related issues with cancer survivors, (b) whether cancer survivors experience these conversations as helpful, and (c) the possible financial implications for cancer survivors of (not) discussing their work early on. Methods: The Dutch Federation of Cancer Patient Organizations developed and conducted a cross-sectional online survey, consisting of 27 items, among cancer survivors in the Netherlands. Results: In total, 3500 survivors participated in this study (71% female; mean age (SD) 56 (11) years). Thirty-two percent reported to have had a conversation about work-related issues with a healthcare professional in the hospital. Fifty-four percent indicated that this conversation had been helpful to them. Conversations about work-related issues took place more frequently with male cancer survivors, those aged 55 years or below, those diagnosed with gynecological, prostate, breast, and hematological or lymphatic cancer, those diagnosed ≤2 years ago, or those who received their last treatment ≤2 years ago. There was no statistically significant association between the occurrence of conversations about work-related issues and experiencing the financial consequences of cancer and/or its treatment as burdensome. Conclusions: Although conversations about work-related issues are generally experienced as helpful by cancer survivors, early access to work-related psychosocial cancer care in the hospital setting is not yet systematically offered.
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Background Irritable bowel syndrome (IBS) affects 10–15% of adults in the US, and is associated with significant impairment in health-related quality of life (HRQoL); however, information specific to the diarrhea subtype (IBS-D) is lacking. We assessed the impact of IBS-D on HRQoL, work productivity, and daily activities, and the associated indirect costs, among a sample of the US population. Methods Respondents (≥18 years) from the 2012 US National Health and Wellness Survey who reported an IBS-D diagnosis by a physician or symptoms consistent with Rome II criteria for IBS-D were identified as having IBS-D. Controls included respondents without IBS-D or inflammatory bowel disease. HRQoL was assessed via the Short Form 36 Health Survey version 2 questionnaire and summarized into Mental and Physical Component Summary (MCS; PCS) scores and a Short Form-6 dimension (SF-6D) utility score. Work and activity impairment were assessed via the Work Productivity and Activity Impairment Questionnaire: General Health version (WPAI:GH), which measures absenteeism, presenteeism, overall work productivity loss, and daily activity impairment. Indirect costs were calculated using unit cost data from the Bureau of Labor Statistics and variables from the WPAI:GH. Generalized linear models were used to examine differences in health outcomes between respondents with IBS-D and controls, controlling for demographic and health characteristics. ResultsIn total, 66,491 respondents (1102 IBS-D; 65,389 controls) were analyzed. Mean age was 48.7 years; 50% were female. Compared with controls, the IBS-D cohort reported significantly lower HRQoL (mean MCS: 45.16 vs. 49.48; p < 0.001; mean PCS: 47.29 vs. 50.67; p < 0.001; mean SF-6D: 0.677 vs. 0.741; p < 0.001) and greater absenteeism (5.1% vs. 2.9%; p = 0.004), presenteeism (17.9% vs. 11.3%; p < 0.001), overall work productivity loss (20.7% vs. 13.2%; p < 0.001), and activity impairment (29.6% vs. 18.9%; p < 0.001). Respondents with IBS-D also incurred an estimated $2486 more in indirect costs ($7008 vs. $4522; p < 0.001). Conclusions Compared with controls, IBS-D is associated with significantly lower HRQoL, greater impairments in work and daily activities, and higher indirect costs, imposing a substantial burden on patients and employers. These findings suggest a significant unmet need exists for effective IBS-D treatments.
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Purpose: This study aimed to (1) describe the Quality of Working Life (QWL) of cancer survivors and (2) explore associations between the QWL of cancer survivors and health- and work-related variables. Methods: Employed and self-employed cancer survivors were recruited through hospitals and patient organizations. They completed the Quality of Working Life Questionnaire for Cancer Survivors (QWLQ-CS) and health- and work-related variables in this cross-sectional study. The QWL scores of cancer survivors were described, and associations between QWL and health- and work-related variables were assessed. Results: The QWLQ-CS was completed by 302 cancer survivors (28% male) with a mean age of 52 ± 8 years. They were diagnosed between 0 and 10 years ago with various types of cancer, such as breast cancers, gastrointestinal cancers, urological cancers, and haematological cancers. The QWL mean score of cancer survivors was 75 ± 12 (0-100). Cancer survivors had statistically significant lower QWL scores when they had been treated with chemotherapy or when they reported co-morbidity (p ≤ 0.05). Cancer survivors without managerial positions, with low incomes or physically demanding work, and who worked a proportion of their contract hours had statistically significantly lower QWL scores (p ≤ 0.05). Conclusions: This study described the QWL of cancer survivors and associations between QWL and health- and work-related variables. Based on these variables, it is possible to indicate groups of cancer survivors who need more attention and support regarding QWL and work continuation.
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Background Prostate cancer and its treatment may impact physically, psychologically and socially; affecting the health-related quality of life of men and their partners/spouses. The Life After Prostate Cancer Diagnosis (LAPCD) study is a UK-wide patient-reported outcomes study which will generate information to improve the health and well-being of men with prostate cancer. Methods and analysis Postal surveys will be sent to prostate cancer survivors (18–42 months postdiagnosis) in all 4 UK countries (n=∼70 000). Eligible men will be identified and/or verified through cancer registration systems. Men will be surveyed twice, 12 months apart, to explore changes in outcomes over time. Second, separate cohorts will be surveyed once and the design will include evaluation of the acceptability of online survey tools. A comprehensive patient-reported outcome measure has been developed using generic and specific instruments with proven psychometric properties and relevance in national and international studies. The outcome data will be linked with administrative health data (eg, treatment information from hospital data). To ensure detailed understanding of issues of importance, qualitative interviews will be undertaken with a sample of men who complete the survey across the UK (n=∼150) along with a small number of partners/spouses (n=∼30). Ethics and dissemination The study has received the following approvals: Newcastle and North Tyneside 1 Research Ethics Committee (15/NE/0036), Health Research Authority Confidentiality Advisory Group (15/CAG/0110), NHS Scotland Public Benefit and Privacy Panel (0516-0364), Office of Research Ethics Northern Ireland (16/NI/0073) and NHS R&D approval from Wales, Scotland and Northern Ireland. Using traditional and innovative methods, the results will be made available to men and their partners/spouses, the funders, the NHS, social care, voluntary sector organisations and other researchers.
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Cancer, its therapy, and related adverse effects have been associated with reduced work performance, including absenteeism (i.e. absence from scheduled work due to health problems) and presenteeism (i.e. impaired on-the-job performance due to health problems) among cancer survivors. This review aimed to compare the work performance of employed cancer survivors with that of cancer-free controls, and to examine factors related to the impairment of work performance. The findings from this review could bring about suggestions for clinical interventions aimed at improving survivors' work performance. Literature searches on cancer survivors' work performance were conducted in three electronic databases (MEDLINE, CINAHL and PsycINFO). Twenty-six studies were identified. Most studies comprised survivors of breast, prostate, testicular and gastrointestinal cancer. Although survivors diagnosed within 5 years reported more absenteeism than did controls in the studies, there was no difference between controls and survivors diagnosed >5 years earlier. Survivors diagnosed within 5 years also reported more presenteeism than did controls. Many studies reported that the complications related to cancer and its therapy (e.g. fatigue and depression) were associated with presenteeism. A multifaceted intervention for the various factors identified in this review would contribute towards improved work performance among employed cancer survivors.
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Background: Prostate cancer incidence is rising in the United Kingdom but there is little data on whether the disease profile is changing. To address this, we interrogated a regional cancer registry for temporal changes in presenting disease characteristics. Methods: Prostate cancers diagnosed from 2000 to 2010 in the Anglian Cancer Network (n=21 044) were analysed. Risk groups (localised disease) were assigned based on NICE criteria. Age standardised incidence rates (IRs) were compared between 2000–2005 and 2006–2010 and plotted for yearly trends. Results: Over the decade, overall IR increased significantly (P<0.00001), whereas metastasis rates fell (P<0.0007). For localised disease, IR across all risk groups also increased but at different rates (P<0.00001). The most striking change was a three-fold increase in intermediate-risk cancers. Increased IR was evident across all PSA and stage ranges but with no upward PSA or stage shift. In contrast, IR of histological diagnosis of low-grade cancers fell over the decade, whereas intermediate and high-grade diagnosis increased significantly (P<0.00001). Conclusion: This study suggests evidence of a significant upward migration in intermediate and high-grade histological diagnosis over the decade. This is most likely to be due to a change in histological reporting of diagnostic prostate biopsies. On the basis of this data, increasing proportions of newly diagnosed cancers will be considered eligible for radical treatment, which will have an impact on health resource planning and provision.
Article
There is a growing body of evidence on the importance of work following a diagnosis of cancer and the need to provide better information, advice and related support to patients on work engagement. The aim of this study was to better understand the nature of those needs and to identify better ways to meet these for those with a urological cancer. The focus was on the issues that were common to three key stakeholder groups. Semi-structured interviews were conducted with stakeholders in North East Scotland: 12 individuals with kidney, bladder or prostate cancer, 10 healthcare providers and 10 managers from large organisations. Five key themes emerged from the Framework Analysis: perceived importance of work engagement; decision-making: treatment, work and cancer; roles and responsibilities; education and training; information, advice and support resources. The data confirmed that work engagement is important to those with urological cancer. It also made clear that the current provision of information and advice could be improved. Any such interventions should involve all three key stakeholder groups with greater clarity on their respective roles and responsibilities. Finally, any new system would be best integrated with existing care provision and supported by adequate education and training of those involved.
Article
There are currently two million cancer survivors in the United Kingdom, and in recent years this number has grown by 3% per annum. The aim of this paper is to provide long-term projections of cancer prevalence in the United Kingdom. METHODS National cancer registry data for England were used to estimate cancer prevalence in the United Kingdom in 2009. Using a model of prevalence as a function of incidence, survival and population demographics, projections were made to 2040. Different scenarios of future incidence and survival, and their effects on cancer prevalence, were also considered. Colorectal, lung, prostate, female breast and all cancers combined (excluding non-melanoma skin cancer) were analysed separately. RESULTS Assuming that existing trends in incidence and survival continue, the number of cancer survivors in the United Kingdom is projected to increase by approximately one million per decade from 2010 to 2040. Particularly large increases are anticipated in the oldest age groups, and in the number of long-term survivors. By 2040, almost a quarter of people aged at least 65 will be cancer survivors. CONCLUSION Increasing cancer survival and the growing/ageing population of the United Kingdom mean that the population of survivors is likely to grow substantially in the coming decades, as are the related demands upon the health service. Plans must, therefore, be laid to ensure that the varied needs of cancer survivors can be met in the future.
Article
The aim was to describe male cancer survivors' barriers towards participation in cancer rehabilitation as a means to guiding future targeted men's cancer rehabilitation. Symbolic Interactionism along with the interpretive descriptive methodology guided the study of 35 male cancer survivors representing seven cancer types. Data were generated through a 5-month fieldwork study comprising participant observations, semi-structured individual interviews and informal conversations. The analyses revealed two overarching findings shedding light on male cancer survivors' barriers to rehabilitation: 'Fear of losing control' and 'Striving for normality'. While 'Fear of losing control' signified what the men believed rehabilitation would invoke: 'Reduced manliness', 'Sympathy and dependency' and 'Confrontation with death', 'Striving for normality' was based on what the men believed rehabilitation would hinder: 'Autonomy and purpose', 'Solidarity and fellowship' and 'Forget and move on'. This study of male cancer survivors' and cancer rehabilitation documents how masculine ideals may constitute barriers for participation in rehabilitation and provides insights about why men are underrepresented in rehabilitation. The findings can guide practice to develop research-based rehabilitation approaches focused on preserving control and normality. Further empirical evidence is needed to: (1) explore the conduct of health professionals' towards male cancer patients and (2) address gender inequalities in cancer rehabilitation. © 2015 John Wiley & Sons Ltd.
Article
This paper aims to report on a systematic review of qualitative studies on men's reflections on participating in cancer rehabilitation. Nine databases were systematically searched to identify qualitative papers published between 2000 and 2013. Papers were selected by pre-defined inclusion criteria and subsequently critically appraised. Key themes were extracted and synthesised. Fifteen papers were selected and represented. Four central themes were identified in the analytical process: 'changed life perspective', 'the masculinity factor', 'a desire to get back to normal' and 'the meaning of work'. Six peripheral themes were identified: 'the meaning of context', 'music', 'physical training', 'religion', 'humour' and 'the unmentionable'. The themes were synthesised into an integrative model representing men's reflections on participating in cancer rehabilitation. We conclude that existing qualitative literature offers insight into men's reflections on cancer rehabilitation and highlights the interrelationship between men's reflections on their changed life perspective, masculinity, orientation towards a normal life and getting back to work. Further research-based knowledge is needed to explore (1) the underlying causes and patterns of the men's needs, preferences and choices in rehabilitation; and (2) the health professional perspective on male cancer rehabilitation.
Article
PURPOSETo investigate the effects of clinical, sociodemographic, and occupational factors on time to return to work (RTW) during the 2 years after cancer diagnosis and to analyze whether sex differences exist. PATIENTS AND METHODS This study was based on a French national cross-sectional survey involving 4,270 cancer survivors. Time to RTW was estimated through the duration of sick leave of 801 cancer survivors younger than 58 years who were employed during the 2-year survey. Multivariate analysis of the RTW after sick leave was performed using a Weibull accelerated failure time model.ResultsWe found some sex differences in the RTW process. Older men returned to work more slowly than older women (P = .013), whereas married men returned to work much faster than married women (P = .019). Duration dependence was also sex-specific. In men, the time spent on sick leave was independent of the probability of returning to work, whereas in women, this duration dependence was positive (P < .001). For both men and women, clinical factors including chemotherapy, adverse effects, and cancer severity were found to delay RTW (P = .035, P = .001, and P < .001, respectively). Survivors investing most strongly in their personal lives also delayed their RTW (P = .006), as did those with a permanent work contract (P = .042). The factor found to accelerate RTW was a higher educational level (P = .014). CONCLUSION The RTW process 2 years after cancer diagnosis differed between men and women. A better knowledge of this process should help the national implementation of more cost-effective strategies for managing the RTW of cancer survivors.