Predicting return-to-work status in male head and neck cancer survivors with World Health Organization disability assessment schedule 2.0 score: A nationwide cross-sectional study

Abstract

Even though return-to-work (RTW) status is crucial to the rehabilitation of head and neck cancer (HNC) survivors, few large-scale studies have objectively quantified predictions of the RTW status of HNC survivors. The objective of this nationwide study in Taiwan was to predict work participation by using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) score as an objective assessment tool, to provide implications for clinicians to formulate an effective rehabilitation and facilitating RTW care plan. Data from between July 2012 and July 2017 regarding 1171 male HNC survivors with disability aged < 50 years were obtained from the Taiwan Data Bank of Persons with Disability (TDPD). Demographic data and the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) scores were analyzed to compare employment statuses among HNC survivors. The receiver operating characteristic (ROC) curve was used to investigate the accuracy of the WHODAS 2.0 scores in predicting the RTW status, and the optimal cutoff point was determined using the Youden index. Binary logistic regression was used to identify predictors for the RTW status of HNC survivors. The WHODAS 2.0 scores in all the domains were lower in unemployed than in employed HNC survivors ( P < 0.001). The ROC curve revealed that the summary WHODAS 2.0 score (area under curve > 0.8) was an extremely accurate predictive tool. Binary logistic regression revealed that the severity levels of impairment and standardized WHODAS 2.0 summary scores less than the cutoff value (27.81) were predictors for the RTW status of HNC survivors with disability in the working age group. The WHODAS 2.0 score not only provides a reliable and applicable summary of the functionality and disability of HNC survivors but also is an objective quantitative assessment tool for evaluating the RTW possibility in this patient group.