Abstract
PurposeTo longitudinally investigate overall and diagnosis-specific sickness absence (SA) and disability pension (DP) in colorectal cancer (CRC) survivors and references and to identify potential risk factors.MethodsThis longitudinal register-based cohort study included all patients living in Sweden, diagnosed with a first primary CRC in 2008–2011 when aged 18–62 (n=6679), and their matched references (n=26 716). Net days of SA (in SA spells >14 days) and DP were analyzed from 2 years before through 5 years after diagnosis, overall and by specific diagnoses. Among survivors, risk factors for future SADP were explored using logistic regression.ResultsIn survivors, SA peaked in year 1 postdiagnosis, with 62.5% having at least some SA, and then gradually decreased to 20.1% in year 5. In the 2 years after diagnosis, CRC was the most common SA diagnosis in survivors, while SA due to mental diagnoses remained similar to the references. Notable risk factors for postdiagnostic SA or DP were rectal cancer diagnosis, advanced cancer stage at diagnosis, lower educational level, born outside of Sweden, and pre-diagnostic SA, mental morbidity, and comorbidities.ConclusionDuring 5 years after a CRC diagnosis, CRC survivors had higher levels of postdiagnostic SA and DP than the references, which was mostly due to CRC diagnoses. Although their SA lowered gradually, it did not return to pre-diagnostic levels.Implications for Cancer SurvivorsOur results provide valuable information for patients with CRC diagnosis, especially that most have none or low levels of SA/DP after a few years.
Highlights
Colorectal cancer (CRC) is one of the most common cancer types, ranking third in cancer incidence and second in cancer mortality worldwide [1]
The project was approved by the Regional Ethical Review Board in Stockholm. In both CRC survivors (n=6679) and references (n=26,716), the majority were men (53.94%) and born in Sweden (84.2%), and 34.0% were diagnosed when aged 56–60 (Table 1). Survivors and their references differed regarding the distribution of pre-diagnostic Charlson Comorbidity Index (CCI) (17.6% of survivors vs. 4.2% of references with CCI score ≥2)
The corresponding baseline characteristics stratified by colon and rectal cancer survivors are presented in Online Resource 2
Summary
Colorectal cancer (CRC) is one of the most common cancer types, ranking third in cancer incidence and second in cancer mortality worldwide [1]. Most previous studies on CRC survivors’ work capacity have focused on the binary outcome return-to-work (measured as yes/no) [13, 14]. These studies only have a short follow-up, not accounting for long-term effects that CRC diagnosis and treatment may have on survivors’ work capacity. The few previous studies that used SA and DP as an outcome used data from patients diagnosed 1992–2005 and aged 45–54 at diagnosis [11], or measured SA as a binary outcome (yes/no) and not using a reference group [12], or only including rectal cancer survivors [15, 16]
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