The effects of curative-intent cancer therapy on employment, work ability, and work limitations.

Abstract

It was our pleasure to read the recent article titled “Results From a Prospective Longitudinal Survey of Employment and Work Outcomes in Newly Diagnosed Cancer Patients During and After Curative-Intent Chemotherapy: A Wisconsin Oncology Network Study” by Tevaarwerk et al.1 The study investigated the effects of curative-intent therapy on work limitations and the ability to work along with its effects on employment in a US-based cohort. In this letter, we offer some points of discussion regarding the conclusions of the study. The authors defined the eligibility criteria for the subjects as an age ≥ 18 years and a previous diagnosis with a solid tumor malignancy or a lymphoma for which they would receive curative-intent chemotherapy. As reported in previous studies, the factors that influence employment among cancer survivors include sex, education level, severity of symptoms, type of cancer, cancer stage, postoperative complications, type of treatment, job type, and financial factors.2-4 Table 1 in their article shows that the study population was highly heterogeneous with respect to the type of cancer, type of treatment, job type, education level, and household income. The authors clarified these results by using descriptive statistics; however, we believe that the sample size was extremely small and too heterogenous to validate the results with descriptive statistics. Therefore, we believe that the results of this study should be interpreted with caution. As the authors state in their conclusions, we also believe that it is desirable to measure employment, work ability, and work limitations by performing inferential statistics and considering the bias in the results from the trends observed in the data. In addition, cancer stage was included during data collection; however, the results of the data analysis were not reported. We believe that cancer stage is an important factor that affects the outcome and, therefore, must be reported in the results. We highly recommend including it as one of the variables in future analyses. The authors collected information before the initiation of cancer treatment (baseline information) and at subsequent time points (at the end of treatment and at 3, 6, and 12 months). The length of time from the baseline to the end of treatment may vary with the type of cancer and the treatment plan. Therefore, it may be useful to use a regression model that takes the follow-up period into account in future analyses. It is also important to consider that 29% of the patients with cancer (n = 32) were not working at the baseline. In addition, patients with breast cancer accounted for 69% of the patients (n = 77) in this study. Because the type of cancer and the treatment plan affect the results, it may have been easier to interpret the results if the study population had been limited to participants with breast cancer alone or with different types of cancer but similar treatment plans. Finally, 34% of the patients with cancer (n = 111) dropped out of the baseline survey by the completion of the 12-month survey. The reasons that patients with cancer were dropping out may clarify the characteristics of the target population and shed light on other aspects to be considered while future intervention studies are being designed. Therefore, the readers would find it more informative if the study included the reasons that the participants had dropped out. Undoubtedly, it is important to evaluate the effects of curative-intent cancer therapy on employment, work ability, and work limitations, both during and after treatment, to restore the psychological and psychosocial well-being of patients with cancer. The study by Tevaarwerk et al1 provides useful data in this regard. We hope that the authors identify the factors associated with “employment, work ability, and work limitations” and that future intervention studies based on their research protocol are successfully conducted. No specific funding was disclosed. The authors made no disclosures.