Early retirement in cancer patients with or without comorbid mental health conditions: a prospective cohort study

Risk as a pattern over time: Delineation of time-dependent risk factors in biological, psychological, and social variables in cancer patients

BACKGROUND

Survival in cancer patients is associated with a multitude of biological, social, and psychological factors. Although it is well established that all these factors add to overall mortality, it is not well understood how the predictive power of these parameters changes in a comprehensive model and over time.

METHODS

Patients who attended the authors' outpatient clinic were invited to participate. The authors followed 5180 mixed cancer patients (51.1% female; mean age, 59.1 years [SD = 13.8]) for up to 16 years and analyzed biological (age, sex, cancer site, anemia), psychological (anxiety, depression), and social variables (marital status, education, employment status) potentially predicting overall survival in a Cox proportional hazards model.

RESULTS

The median survival time for the entire sample was 4.3 years (95% confidence interval, 4.0-4.7). The overall survival probabilities for 1 and 10 years were 76.8% and 38.0%, respectively. Following an empirical approach, the authors split the time interval into five periods: acute, subacute, short-term, medium-term, and long-term. A complex pattern of variables predicted overall survival differently in the five periods. Biological parameters were important throughout most of the time, social parameters were either time-independent predictors or tended to be more important in the longer term. Of the psychological parameters, only depression was a significant predictor and lost its predictive power in the long-term.

CONCLUSIONS

The findings of this study allow the development of comprehensive patient-specific models of risk and resilience factors addressing biopsychosocial needs of cancer patients, paving the way for a personalized treatment plan that goes beyond biomedical cancer care.

Financial difficulties in breast cancer survivors with and without migration background in Germany-results from the prospective multicentre cohort study BRENDA II

Purpose

We aimed to explore the trajectory of financial difficulties among breast cancer survivors in the German health system and its association with migration background.

Methods

In a multicentre prospective study, breast cancer survivors were approached four times (before surgery, before and after adjuvant therapy, five years after surgery) and asked about their migration history and financial difficulties.

Migrants were defined as born/resided outside Germany or having citizenship/nationality other than German. Financial difficulties were ascertained with the financial difficulties item of the European Organisation for Research and Treatment of Cancer Core Instrument (EORTC QLQ-C30) at each time-point (cut-off > 17). Financial difficulties were classified in trajectories: always (every time-point), never (no time-point), initial (first, not fourth), delayed (only fourth), and acquired (second and/or third, not first).

A logistic regression was conducted with the trajectories of financial difficulties as outcome and migration background as exposure. Age, trends in partnership status, and educational level were considered as confounders.

Results

Of the 363 participants included, 49% reported financial difficulties at at least one time-point.

Financial difficulties were reported always by 7% of the participants, initially by 5%, delayed by 10%, and acquired by 21%.

Migrants were almost four times more likely to report delayed (odds ratio [OR] = 3.7; 95% confidence interval [CI] 1.3, 10.5) or acquired (OR = 3.6; 95% CI 1.6, 8.4) financial difficulties compared to non-migrant participants.

Conclusion

Survivors with a migration background are more likely to suffer from financial difficulties, especially in later stages of the follow-up. A linguistically/culturally competent active enquiry about financial difficulties and information material regarding supporting services/insurances should be considered.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00520-022-07074-7.

Adjustment disorder in cancer patients after treatment: prevalence and acceptance of psychological treatment

Purpose

To investigate the prevalence of adjustment disorder (AD) among cancer patients and the acceptance of psychological treatment, in relation to sociodemographic, clinical, and psychological factors.

Methods

Breast, prostate, and head and neck cancer patients of all stages and treatment modalities (N = 200) participated in this observational study. Patients completed the Hospital Anxiety and Depression Scale, Checklist Individual Strength, Distress Thermometer and problem list. Patients with increased risk on AD based on these questionnaires were scheduled for a diagnostic interview. Patients diagnosed with AD were invited to participate in a randomized controlled trial on the cost-effectiveness of psychological treatment. Participation in this trial was used as a proxy of acceptance of psychological treatment. Logistic regression analyses were used to investigate associated factors.

Results

The overall prevalence of AD was estimated at 13.1%. Sensitivity analyses showed prevalence rates of AD of 11.5%, 15.0%, and 23.5%. Acceptance of psychological treatment was estimated at 65%. AD was associated both with being employed (OR = 3.3, CI = 1.3–8.4) and having a shorter time since diagnosis (OR = 0.3, CI = 0.1–0.8).

Conclusion

Taking sensitivity analysis into account, the prevalence of AD among cancer patients is estimated at 13 to 15%, and is related to being employed and having a shorter time since diagnosis. The majority of cancer patients with AD accept psychological treatment.

Returning to work in lung cancer survivors-a multi-center cross-sectional study in Germany

Purpose

To investigate the work situation of lung cancer survivors and to identify the factors associated with their returning to work.

Methods

Descriptive analysis and logistic regression were used to evaluate study population characteristics and independent factors of subsequently returning to work. To analyze time to return to work, Cox regression was used.

Results

The study sample included 232 lung cancer survivors of working age from 717 enrolled participants in the multi-center cross-sectional LARIS (Quality of Life and Psychosocial Rehabilitation in Lung Cancer Survivors) study. About 67% of the survivors were not employed during the survey. More than 51% of the survivors who were employed before their illness did not return to their work. The survivors who had returned to their careers were younger, associated with higher household income, lower fatigue score, and stable relationship and vocational training. Patients who received social service counseling showed a higher chance of regaining their career.

Conclusions

Lung cancer survivors were found to be associated with a high risk of unemployment and very low professional reintegration after interruption due to illness. More comprehensive studies are needed to support lung cancer survivors and targeting of patients in need of special attention in rehabilitation that would benefit from the findings in the present study.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00520-020-05886-z.

Evaluation of long-term living conditions in patients treated for localised prostate cancer

PURPOSE

To evaluate the evolution of living conditions (LC) in long-term survivors of localised prostate cancer 10 years after treatment compared with those of a same-age control group from the general population.

METHODS

Two hundred and eighty-seven patients diagnosed with prostate cancer in 2001 were selected in 11 French cancer registries. They were matched with controls randomly selected for age and residency. Both patients and controls completed a self-administered LC questionnaire concerning their familial, social and professional life, and general and specific quality of life (QoL) and anxiety and depression questionnaires.

RESULTS

Compared with controls, patients reported more sexual modifications (p < .0001), but without any difference in marital status. Patients' circle of friends was more stable than that of the controls (91% vs. 63%; p < .0001) and patients reported fewer friendship modifications than controls (p < .0006). Their professional and physical activities were also preserved. They reported more anxiolytic intake (p = .002) but did not consult their general practitioner more often. Type of specialist consulted differed in the two groups.

CONCLUSION

Patients treated for localised prostate cancer had the same living conditions as men of the same age. Their social life was satisfying on the whole, albeit they reported more sexual difficulties than their counterparts.

Long-term cervical cancer survivors on disability pension: a subgroup in need of attention from health care providers

PURPOSE

Survivors of cervical cancer have an increased risk for permanently reduced work ability qualifying for disability pension (DP). Few studies describe the social and health situation of long-term survivors of cervical cancer (LSCCs) on DP as a subgroup among LSCCs. The purpose was to investigate the socio-demographic and health status of LSCCs holding DP in a population-based cohort using LSCCs holding paid work as reference.

METHODS

Altogether, 354 LSCCs under 67 years (age of retirement pension in Norway) at survey participated in this study. They responded to a mailed questionnaire containing social, health, and clinical issues.

RESULTS

Among LSCCs 24% held DP at a median of 11 years (range 6-15) after diagnosis versus 12% in the general female population. Compared to LSCCs in paid work, those on DP had significantly higher mean age at survey, short education, more comorbid somatic diseases, poorer self-rated health, higher level of neurotoxic side effects, more chronic fatigue, and higher mean levels of anxiety and depression. Increased age, presence of musculo-skeletal diseases, and increased levels of depression and pain remained significantly associated with DP in multivariate analysis.

CONCLUSIONS

One in four LSCCs held DP which was twice the rate of the general female population. Several somatic and psychological conditions amenable to treatment were significantly associated with holding DP.

IMPLICATIONS FOR CANCER SURVIVORS

LSCCs holding DP should check their health regularly since conditions that can be treated are common, and health care providers should be aware of this opportunity.

Prevalence of adjustment disorder among cancer patients, and the reach, effectiveness, cost-utility and budget impact of tailored psychological treatment: study protocol of a randomized controlled trial

Background

Information on the prevalence of adjustment disorders among cancer patients and the value of psychological interventions in this group of patients is limited. This study investigates the prevalence of adjustment disorders among cancer patients as well as the reach, effectiveness, cost-utility and budget impact of a tailored psychological intervention.

Method

This study consists of two parts. Part 1 is an observational study among a representative group of mixed cancer patients after cancer treatment on the prevalence of adjustment disorder as well as the uptake (i.e. reach) of psychological treatment. In Part 2, patients diagnosed with an adjustment disorder are invited to participate in a randomized controlled trial. Patients will be randomized to the intervention (access to the tailored psychological intervention) or control group (waitlist period of 6 months). The psychological intervention consists of three modules: one module containing psycho-education (3 sessions, all patients) and two additional modules (maximum of 6 sessions per module) provided as continuum, in case needed. Module 2 and 3 can consist of several evidence-based interventions (e.g. group interventions, mindfulness, eHealth) The primary outcome is psychological distress (HADS). Secondary outcomes are mental adjustment to cancer (MAC) and health-related quality of life (EORTC QLQ-C30). To assess the cost-utility and budget impact, quality of life (EQ-5D-5 L) and costs (iMCQ and iPCQ) will be measured. Measures will be completed at baseline and 3 and 6-months after randomization.

Discussion

This study will provide data of the prevalence of adjustment disorders and the reach, effectiveness, cost-utility and budget impact of a tailored psychological intervention.

Trial registration

Netherlands Trial Register identifier: NL7763. Registered on 3 June 2019.

Depression and risk of disability pension: A systematic review and meta-analysis

BACKGROUND AND OBJECTIVE

Depression is a common mental disorder that leads to undesirable consequences. The study of the role of depression in disability pension can provide valuable insights. This study was conducted with the goal of systematic review and meta-analysis of the relationship between depression and disability pension.

METHODS

PubMed, Scopus, PsycInfo, and Google Scholar databases were systematically searched until March 2018. Fifteen prospective cohort studies were selected and included in the meta-analysis. The random-effects method was used to combine the studies. Subgroup analysis was performed, and publication bias was also examined.

RESULTS

Depression was a risk factor for disability pension (pooled risk ratio =1.68 and 95% confidence interval = 1.50-1.88). In men, pooled risk ratio was 1.82 for the effect of depression on the risk of disability pension (95% confidence interval = 1.45-2.28). In women, pooled risk ratio was 1.62 (95% confidence interval = 1.31-2.02). The results showed that there is publication bias.

CONCLUSIONS

Depression is a factor for retirement due to disability. Therefore, the prevention and treatment of depression can reduce socioeconomic and psychological consequences imposed on society.

Impact of Health on Early Retirement and Post-Retirement Income Loss among Survivors of the 11 September 2001 World Trade Center Disaster

The health consequences of the 9/11 World Trade Center (WTC) terrorist attacks are well documented, but few studies have assessed the disaster’s impact on employment among individuals exposed to the disaster. We examined the association between 9/11-related health conditions and early retirement among residents and workers who resided and/or worked near the WTC site on 9/11, and the association between such conditions and post-retirement income loss. The study included 6377 residents and/or area workers who completed the WTC Health Registry longitudinal health surveys in 2003–2004 and 2006–2007, and the 2017–2018 Health and Employment Survey. Logistic regression models were used to examine the associations. We found that 9/11-related health conditions were significantly associated with the likelihood of early retirement. Residents and/or area workers with more physical health conditions, especially when comorbid with posttraumatic stress disorder (PTSD), were more likely to retire before age 60 than those with no conditions. For retirees, having PTSD or PTSD comorbid with any number of physical conditions increased the odds of reporting substantial post-retirement income loss. Disaster-related outcomes can negatively impact aging individuals in the form of early retirement and income loss. Long-term effects of major disasters must continue to be studied.

Early Retirement: A Meta-Analysis of Its Antecedent and Subsequent Correlates

Early or voluntary retirement (ER) can be defined as the full exit from an organizational job or career path of long duration, decided by individuals of a certain age at the mid or late career before mandatory retirement age, with the aim of reducing their attachment to work and closing a process of gradual psychological disengagement from working life. Given the swinging movements that characterize employment policies, the potential effects of ER-both for individuals and society-are still controversial. This meta-analysis examined the relationships between ER and its antecedent and subsequent correlates. Our review of the literature was generated with 151 empirical studies, containing a total number of 706,937 participants, with a wide range of sample sizes (from N = 27 to N = 127,384 participants) and 380 independent effect sizes (ESs), which included 171 independent samples. A negligible ES value for antecedent correlates of early retirement (family pull, job stress, job satisfaction, and income) was obtained (which ranged from r = -0.13 to 0.19), while a fair ES was obtained for workplace timing for retirement, organizational pressures, financial security, and poor physical and mental health, (ranging from r = 0.28 to 0.25). Regarding ER subsequent correlates, poor ESs were obtained, ranging from r = 0.08 to 0.18 for the relationships with subsequent correlates, and fair ESs only for social engagement (r = -0.25). Examination of the potential moderator variables has been conducted. Only a reduced percentage of variability of primary studies has been explained by moderators. Although potential moderator factors were examined, there are several unknown or not measurable factors which contribute to ER and about which there are very little data available. The discussion is aimed to offer theoretical and empirical implications suggestion in order to improve employee's well-being.

The effects of multi-disciplinary psycho-social care on socio-economic problems in cancer patients: a cluster-randomized trial

PURPOSE

We examined whether multi-disciplinary stepped psycho-social care decreases financial problems and improves return-to-work in cancer patients.

METHODS

In a university hospital, wards were randomly allocated to either stepped or standard care. Stepped care comprised screening for financial problems, consultation between doctor and patient, and the provision of social service. Outcomes were financial problems at the time of discharge and return-to-work in patients < 65 years old half a year after baseline. The analysis employed mixed-effect multivariate regression modeling.

RESULTS

Thirteen wards were randomized and 1012 patients participated (n = 570 in stepped care and n = 442 in standard care). Those who reported financial problems at baseline were less likely to have financial problems at discharge when they had received stepped care (odds ratio (OR) 0.2, 95% confidence interval (CI) 0.1, 0.7; p = 0.01). There was no evidence for an effect of stepped care on financial problems in patients without such problems at baseline (OR 1.1, CI 0.5, 2.6; p = 0.82). There were 399 patients < 65 years old who were not retired at baseline. In this group, there was no evidence for an effect of stepped care on being employed half a year after baseline (OR 0.7, CI 0.3, 2.0; p = 0.52).

TRIAL REGISTRATION

NCT01859429 CONCLUSIONS: Financial problems can be avoided more effectively with multi-disciplinary stepped psycho-social care than with standard care in patients who have such problems.

The impact of prior psychiatric medical treatment on return to work after a diagnosis of breast cancer: A registry based study

Purpose: Breast cancer and psychiatric disorders negatively impact work life, both positively associated with unemployment and early retirement. Our purpose was to assess whether being prescribed psychiatric medication, 2-4 yrs prior to a diagnosis of breast cancer, could impact the likelihood of returning to work after cancer therapy. Methods: 16,868 self-supporting women, diagnosed with breast cancer in Denmark from 2000 to 2012, were identified from a population-based clinical database, then cross-referenced to data held for psychiatric medication usage, sociodemographics, and labour-market participation. The association between historic psychiatric medication and return to work was estimated using a modified Poisson regression model. 'Return to work' was defined as being self-supporting one year after diagnosis of breast cancer. Results: 16% of our cohort had used psychiatric medical treatment 2-4 years before their diagnosis. Sixty-three per cent of these individuals had returned to work one year later, compared to 69% of the patient group with no prior history of using psychiatric medication treatments. In the fully adjusted model, prior use of psychiatric medication diminished the likelihood of returning to work one year after cancer diagnosis (RR = 0.91 (0.87-0.94)). High income and older age were positively associated with returning to work; negative correlates included those related to disease severity. Conclusions: Historic use of psychiatric medication provoked a minor, although statistically significant reduction in the resumption of working life one year after a diagnosis of breast cancer. Implications for cancer survivors: Although historic use of psychiatric medication may incur a minor effect on working life, further research is needed on the long-term social consequences for sub-groups.

Workforce unavailability in Parkinson's disease

OBJECTIVES

Individuals with Parkinson's disease (PD) become unavailable in the workforce earlier than comparable members of the general population. This may result in significant social insurance expenses, but as workforce participation can be a source for social interaction and a vital part of the personal identity, there are likely to be personal implications extending far beyond the economic aspects. This study aimed to identify aspects that may contribute to workforce unavailability in people with PD.

MATERIALS & METHODS

This was a cross-sectional registry study using data from the Swedish national quality registry for PD and included persons with PD in Skåne County, Sweden who were younger than 65 years. Variables were selected from the registry based on earlier studies and clinical experience and were tested for association with unavailability in the workforce: first in a series of simple regression analyses and then in a multiple logistic regression analysis.

RESULTS

A total of 99 persons with PD-of whom 59 were available and 40 were unavailable in the workforce-were included in the study. Age (OR per year: 1.47, 95% CI: 1.18-1.85; P < 0.01) and anxiety (OR: 6.81, 95% CI: 1.20-38.67; P = 0.03) were significant contributing factors for unavailability in the workforce.

CONCLUSIONS

Based on the findings in this exploratory study, anxiety-a potentially modifiable factor-and age may be contributing factors for workforce unavailability in PD. However, prospective studies are warranted to confirm the findings and the causation of the association between anxiety and workforce unavailability needs to be clarified.

Impact of 9/11-related chronic conditions and PTSD comorbidity on early retirement and job loss among World Trade Center disaster rescue and recovery workers

BACKGROUND

The economic impact of the 9/11 terrorist attacks has rarely been studied. We examined the association between 9/11-related chronic health conditions with or without post-traumatic stress disorder (PTSD) and one important aspect of the economic impact, retirement, and job loss before age 60.

METHODS

A total of 7,662 workers who participated in the World Trade Center Health Registry surveys were studied. Logistic regression models examined the association of 9/11-related health and labor force exit.

RESULTS

Workers with chronic conditions were more likely to experience early retirement and job loss, and the association was stronger in the presence of PTSD comorbidity: the odds ratios for reporting early retirement or job loss were increased considerably when chronic conditions were comorbid with PTSD.

CONCLUSIONS

Disaster-related health burden directly impacts premature labor force exit and income. Future evaluation of disaster outcome should include its long-term impact on labor force. Am. J. Ind. Med. 59:731-741, 2016. © 2016 Wiley Periodicals, Inc.

Predictors of early retirement after cancer rehabilitation-a longitudinal study

This longitudinal study was designed to assess patients' desire for early retirement and investigate which cancer-related and psychosocial characteristics are associated with early retirement. We assessed 750 cancer patients at the beginning (t₀ ) and end (t₁ ) of, and 12 months after (t₂ ) inpatient cancer rehabilitation. At t₀ , 22% had a desire to retire early. These patients reported significantly longer sick leave periods, less favourable workplace environments, lower work ability, higher psychological distress and lower quality of life than other patients. At t₂ , 12.5% of patients received temporary or permanent early retirement pensions. Of all patients with a desire for early retirement at t₀ , 43% had returned to work at t₂ . This subgroup had a significantly lower physical quality of life than other patients returning to work. The most influential predictors of early retirement were being on sick leave (OR = 6.50, 95% CI = 1.97-21.47) and a desire for early retirement (OR = 5.61, 95% CI = 2.73-11.52). Inverse predictors of early retirement were cancer remission (OR = 0.23, 95% CI = 0.10-0.53), perceived productivity (OR = 0.38, 95% CI = 0.18-0.83), work satisfaction (OR = 0.36, 95% CI = 0.17-0.77) and mental quality of life (OR = 0.94, 95% CI = 0.91-0.98). This underlines the need for cancer-specific multi-professional rehabilitation and occupational therapy programmes.

Effect of a structured psycho-oncological screening and treatment model on mental health in cancer patients (STEPPED CARE): study protocol for a cluster randomized controlled trial

BACKGROUND

High levels of emotional distress in cancer patients often goes unnoticed in daily clinical routine, resulting in severe undertreatment of mental health problems in this patient group. Screening tools can be used to increase case identification, however, screening alone does not necessarily translate into better mental health for the patient. Doctors play a key role in providing basic emotional support and transferring the patients in need of such specific support to mental health professionals. This study investigates whether a stepped care model, combining screening, doctor consultation and professional psycho-oncological service in a structured way, improves the emotional wellbeing of cancer patients.

METHODS/DESIGN

This study is a cluster randomized trial with two parallel groups (intervention vs. care as usual), set in an academic hospital. Participants are cancer patients, a total of 1,000 at baseline. The intervention consists of stepped psychosocial care. Step one: screening for distress, step two: feedback of screening results to the doctor in charge of the patient and consultation with the patient, and step three: based on a shared patient-doctor decision, either transferal to the consultation liaison (CL) service or not. The outcome will be emotional well-being half a year after baseline, ascertained with the Hospital Anxiety and Depression Scale. Randomization will be done by the cluster randomization of wards.

DISCUSSION

Mental health problems not only cause emotional suffering but also direct and indirect costs. This calls for timely and adequate psychosocial support, especially as we know that such support is effective. However, not every cancer patient can and must be treated by a mental health professional. Allocating limited resources most sensibly and economically is of crucial importance for our healthcare system to ensure the best quality of care to as many patients as possible. It is the hope of the STEPPED CARE trial that this model is both effective and efficient, and that it can be implemented in other hospitals as well, if proven to be effective.

TRIAL REGISTRATION

Clinical Trials Register (Clinicaltrials.gov) identifier: NCT01859429 registration date 17 May 2013.