Identifying Variables Associated with Leave From Work in Head and Neck Cancer Patients Receiving Radiotherapy

Abstract

Head and neck cancer (HNC) patients have a high rate of work discontinuation while receiving daily fractionated radiation (RT). In this analysis of HNC cancer patients treated with RT we compare baseline characteristics between working patients and not-working/not-retired patients and identify patient and treatment-related factors that can be targeted to reduce time lost from work. Number of days worked in the past week was prospectively recorded at each on treatment visit (OTV) for HNC patients receiving definitive or adjuvant (chemo)radiation from 6/2016-6/2018. Patients not working due to disability/unemployment were eligible; retired patients were excluded. Baseline characteristics were compared. Weekly patient weight (lbs), pain rating (0-10), fatigue (0-10), and ECOG status (0-5) changes were described by group. Weekly ECOG status was also analyzed dichotomously as ECOG 0 compared to ECOG ≥1. Impact of each variable on loss of working days was assessed in both univariate analysis (UVA) and multivariate analysis (MVA). A total of 69 patients were included, 29 of whom were working at the start of RT. Mean age was higher in working patients (58.8 vs 53.7 years, p = 0.004). Distance from cancer center, gender, tobacco use, alcohol use, hospitalizations during RT, presence of feeding tubes, surgery prior to RT, concurrent chemotherapy, p16 status, and location of tumor were not significantly different between working and disabled groups. Changes in weight percentages, pain, fatigue, and ECOG status between last OTV and baseline were not significantly different between the two groups. Differences in percent of patients with ECOG ≥1 in each OTV are described in the table below. In working patients, mean days worked steadily declined, starting at 4.1 days in week 1 to 1.1 in week 7. In UVA, 10% loss in weight from baseline results in 2.6 days/week lost from work (p<0.005). Pain increase by 1 unit results in 0.25 days/week lost, fatigue increase by 1 unit results in 0.28 days/week lost, and ECOG status increase by 1 unit results in 1.48 days/week lost (p<0.005 for all). In MVA, change in pain was significantly associated with days/week lost from work (p = 0.05). Changes in weight, fatigue, and ECOG status were non-significant (p = 0.08, 0.11, 0.07, respectively). The decision to work during radiation is not impacted by many baseline patient characteristics, and less than 50% of HNC patients attempt to work during radiation. In working patients, weight loss and increase in pain, fatigue, and ECOG status are significantly associated with reduction in working days per week. Of these, increase in pain has the most significant impact.Abstract 3869; TableWeek 1Week 2Week 3Week 4Week 5Week 6Week 7Working (%)10.310.317.244.848.355.671.4Not Working (%)35.045.052.555.055.075.077.8p-value0.0240.0030.0050.4690.6310.1170.741 Open table in a new tab