Sick leave and disability pension in Hodgkin lymphoma survivors by stage, treatment, and follow-up time—a population-based comparative study
Menée en Suède à partir de données portant sur 1 989 patients âgés de 18 à 60 ans (âge médian : 33 ans) et 7 956 témoins, cette étude analyse les arrêts de travail pour raisons médicales et le versement de pensions d'invalidité chez des survivants à long terme d'un lymphome hodgkinien, en fonction du stade de la maladie au diagnostic et de l'intensité des traitements reçus
Purpose : This study seeks to investigate the long-term public health burden of Hodgkin lymphoma (HL) in terms of work loss following contemporary treatment protocols and associations with established treatment complications and lymphoma relapse. Methods : We identified 1,989 Swedish HL patients (1,082 with clinical information) aged 18–60 (median 33) years at diagnosis 1992–2009, and matched 1:4 to population comparators. Sick leave, disability pension (work loss), and comorbidity were retrieved through September 2013. Relative risks (RR) with 95 % confidence intervals (CI) were calculated using Poisson regression, and mean lost work days were estimated yearly during follow-up. Results : The risk of annual work loss was elevated in HL survivors versus comparators up to the 15th year post-diagnosis (RR5th year 1.64, 95 % CI 1.46–1.84; RR10th year 1.33, 95 % CI 1.15–1.34; and RR15th year 1.30, 95 % CI 1.04–1.62). The risk remained elevated up to the 10th year after adjustment for secondary malignancies and cardiovascular disease (RR10th year 1.31, 95 % CI 1.13–1.52). Advanced-stage patients had more lost days than comparators (mean number5th year 66 versus 33, mean difference 34, 95 % CI 20–48) as did patients receiving 6–8 chemotherapy courses (62 versus 33, mean difference5th year 30, 95 % CI 17–43). Among patients in the first complete remission, a difference was still observed for advanced-stage (51 versus 33, mean difference5th year 19, 95 % CI 5–34) but not early-stage disease. Conclusions : Advanced-stage HL survivors treated with full-dose chemotherapy were at increased risk of work loss, not only explained by relapse, secondary malignancies, or cardiovascular disease. Implications for Cancer Survivors : The results call for increased awareness and evaluation of reasons for long-term work disability following intensive chemotherapy among young HL survivors.