Unemployment Risk and Decreased Income Two and Four Years After Thyroid Cancer Diagnosis: A Population-Based Study

The challenges of returning to work for differentiated thyroid cancer survivors in china: a qualitative study

PURPOSE

Although thyroid cancer survivors have a good prognosis and the survival rate of differentiated thyroid cancer is close to 100%, treatment and its side effects seriously affect the quality of life of patients, especially rehabilitation at work. The purpose of this study was to explore the challenges faced by differentiated thyroid cancer survivors in returning to work and maintaining employment.

METHODS

A purposive sample of differentiated thyroid cancer patients who had undergone surgical treatment and were followed up at the outpatient departments of thyroid surgery wards of two tertiary care hospitals in Jiangsu Province, China, between January and March 2023, were subjected to semi-structured interviews. An inductive content analysis was conducted to identify themes.

RESULTS

A total of 27 participants, aged 23-56 years, were interviewed. Three themes and eight subthemes were identified: pressure perception including social pressure in the workplace, regular appointments conflict with work schedules, and dilemma of career development; the challenges of self-adjustment including physical disorder, unable to adapt to the pace of work, and unstable mood affects working condition; and lack of social support including lack of access to information or support groups, lack of sympathy and understanding from employers, and lack of professional support.

CONCLUSIONS

Our study identified that our participants with differentiated thyroid cancer patients face challenges in trying to return to work or maintain employment within the confines of their disease. Multilevel interventions, ranging from employer and co-worker understanding to information, psychological and other support from health care professionals, can facilitate the process of returning to work and help patients reconcile illness and work.

Unemployment Status Subsequent to Cancer Diagnosis and Therapies: A Systematic Review and Meta-Analysis

The purpose of our study is to examine whether cancer and treatments are associated with job loss or changes in employment status. Eight prospective studies were included in the systematic review and meta-analysis, with a population aged 18-65 years, analyzing treatment regimen and psychophysical and social status in post-cancer follow-up of at least 2 years. In the meta-analysis, a comparison was made between recovered unemployed cases and cases from a standard reference population. Results are summarized graphically using a forest plot. We showed that cancer and subsequent treatment are risk factors for unemployment with an overall relative risk of 7.24 (lnRR: 1.98, 95% CI: 1.32-2.63) or for change in employment status. Individuals undergoing chemotherapy and/or radiation treatment and those with brain and colorectal cancers are more likely to develop disabilities that negatively affect the risk of unemployment. Finally, variables such as low level education, female sex, older age, and being overweight before starting therapy are associated with higher risk of unemployment. In the future, it will be necessary for people with cancer to have access to specific health, social welfare, and employment support programs. In addition, it is desirable that they become more involved in their choice of therapeutic treatment.

The Impact of Thyroid Diseases on the Working Life of Patients: A Systematic Review

Thyroid diseases are characterized by a wide range of physical and mental symptoms that can affect biological function, emotional and social life of patients. However, their impact on work functioning is not yet fully understood. Therefore, this review aims to address the way in which thyroid diseases can affect occupational outcomes, i.e., the employment rate, sick leave, working capacity and work income of patients. A systematic review of Pubmed, Scopus and ISI Web of Knowledge databases has been performed. Although it is not possible to extrapolate precise data for benign pathologies, about a third of the survivors of thyroid cancer could be unemployed. Hyperthyroid and hypothyroid patients presented a greater risk of long-term sick leave than controls, depending on the severity of the disease. Hyperthyroidism impaired working ability in about a third of affected patients, particularly in cases complicated by orbitopathy with diplopia. A possible influence of thyroid diseases on various occupational outcomes emerged from our review, however further research seems necessary to understand the relationship between work problems, specific pathological characteristics over time and risk factors in the workplace. This may support a comprehensive, interdisciplinary management of thyroid disorders, with benefits for patients’ personal, social and professional life.

Health-Related Quality of Life After Diagnosis and Treatment of Differentiated Thyroid Cancer and Association With Type of Surgical Treatment

Importance

Concerns around possible overdiagnosis and overtreatment of differentiated thyroid cancer (DTC) have been raised. Issues concerning health-related quality of life (HRQOL) after diagnosis and treatment of DTC are understudied in this patient group.

Objective

To better understand the range of HRQOL outcomes, including possible adverse effects of treatment, associated with diagnosis and treatment of DTC and whether these outcomes vary by type of surgery received.

Design, Setting, and Participants

This content analysis assessed responses to an open-ended question about outcomes and concerns after DTC diagnosis and treatment among patients ascertained from the major postsurgical thyroid cancer treatment center and the population-based Cancer Registry in Queensland, Australia. Participants were aged 18 to 79 years and recently diagnosed with throid cancer. Responses underwent analysis to identify and code emergent themes to describe HRQOL issues and adverse effects of treatment experienced. Quantitative analysis was used to explore whether surgery type was associated with HRQOL issues and/or adverse effects of treatment. Of 1416 eligible patients, 1005 (71.0%) participated. Data were collected from July 1, 2013, through August 31, 2016, and analyzed from January 11 through April 9, 2018.

Main Outcomes and Measures

Issues concerning HRQOL.

Results

The analysis included 1005 patients (72.2% female [n = 726]; mean [SD] age, 52 [14.0 years) with DTC. Most patients were diagnosed with papillary thyroid cancer (889 of 1003 [88.6%]), had tumors smaller than 2 cm in size (564 of 1000 [56.4%]), and received a total thyroidectomy (791 of 1005 [78.7%]). Overall, 775 patients (77.1%) reported HRQOL issues after diagnosis and treatment of DTC. The following 4 main themes emerged from content analysis of patient responses: physical (663 [66.0%]), psychological (187 [18.6%]), lifestyle (82 [8.2%]), and no issue or adverse effect (246 [24.5%]). Patients who had a total thyroidectomy (without neck dissection) were 1.5 times (odds ratio, 1.49; 95% CI, 1.04-2.12) more likely to report an HRQOL issue or an adverse effect of treatment compared with patients who underwent a hemithyroidectomy.

Conclusions and Relevance

According to results of this study, patients diagnosed with DTC report wide-ranging HRQOL issues; these are more prevalent among patients who have total thyroidectomies rather than hemithyroidectomies. For patients with small, localized DTCs, hemithyroidectomy may offer fewer adverse effects of treatment and better HRQOL outcomes than total thyroidectomy. It appears that issues with HRQOL should be considered by patients and physicians when deciding on the best treatment approach after a diagnosis of DTC.

Higher incidence of screening-related cancers in the employed population

Background

Employment may confound the risk of a cancer diagnosis in both directions. We hypothesized that a higher baseline rate of employment among cancer patients may explain the lack of association between a cancer diagnosis and later unemployment in many studies.

Aims

To assess the unemployment rate among cancer patients before diagnosis compared with a matched cancer-free control group.

Methods

Using data from the Israeli National Central Bureau of Statistics 1995 census (persons aged between 15 and 60 years old), the Israeli Tax Authority database and the Israel Cancer Registry, cancer patients (diagnosed between the years 2000 and 2007 and alive at 2011) were compared with matched cancer-free controls.

Results

There were 8797 cancer patients and 26166 cancer-free controls. We found that, in general, cancer was not associated with unemployment 2 years before diagnosis (adjusted odds ratio [OR] = 0.96, 95% confidence interval [CI] 0.90-1.009, P = NS) after adjustment for age, gender, ethnicity, educational years and residential socioeconomic position. However, the diagnoses associated with screening (breast, prostate, colorectal and cervix cancers) were inversely associated with unemployment 2 years before diagnosis (adjusted OR = 0.90, 95% CI 0.84-0.97, P < 0.01).

Conclusions

The results from the current study suggest that a higher baseline rate of employment among cancer patients, mainly those who were diagnosed with screening-associated cancers, explains false negative results in previous studies assessing cancer survivors' work issues.

Early-stage breast cancer and employment participation after 2 years of follow-up: A comparison with age-matched controls

BACKGROUND

Although cancer survivors are more likely to be unemployed than individuals without a cancer history, employment participation after treatment of early-stage breast cancer has not been widely studied to date. The objectives of the current study were to evaluate employment trajectories in a cohort of patients with early-stage breast cancer and age-matched controls from the time of diagnosis to the 2-year follow-up, and identify factors associated with diminished and emerging employment participation.

METHODS

As part of a larger cohort study of 1096 patients with early-stage breast cancer and same-aged women without breast cancer, data from 723 working-age (aged 40-64 years) women (347 patients and 376 controls) were analyzed to evaluate 4 employment trajectories (sustained unemployment, diminished employment, emerging employment, and sustained employment). Multivariable logistic regression models were used to identify factors associated with diminished employment versus sustained employment, and emerging employment versus sustained unemployment.

RESULTS

Lower percentages of patients (71%) compared with controls (79%) reported full-time or part-time employment at enrollment (P<.01). Fatigue was a significant predictor of diminished employment for both patients (odds ratio [OR], 5.71; 95% confidence interval [95% CI], 2.48-13.15) and controls (OR, 2.38; 95% CI, 1.21-4.68). Among patients, African American race (OR, 4.02; 95% CI, 1.57-10.28) and public/uninsured insurance status (OR, 4.76; 95% CI, 1.34-12.38) were found to be associated with diminished employment. Among controls, high social support was associated with emerging employment (OR, 3.12; 95% CI, 1.25-7.79).

CONCLUSIONS

Fatigued patients, African American patients, and publicly insured/uninsured patients with cancer were more likely to experience diminished employment after 2 years of follow-up. Further investigation with longer follow-up is warranted to identify factors associated with these disparities in employment participation after treatment of early-stage breast cancer. Cancer 2018;124:2026-35. © 2018 American Cancer Society.

Effect of Thyroid-Related Symptoms on Long-Term Quality of Life in Patients with Differentiated Thyroid Carcinoma: A Population-Based Study in Sweden

BACKGROUND

Differentiated thyroid cancer (DTC) has a good prognosis but a remaining risk of recurrence, and life-long follow-up as well as medication with levothyroxine may be necessary. The aim of this study was to clarify how thyroid-related symptoms affect health-related quality of life (HRQoL) 14-17 years after diagnosis in Swedish DTC patients.

METHODS

From the all-encompassing population-based Swedish Cancer Registry, 353 patients diagnosed with DTC during 1995-1998 were identified and invited to answer a study-specific questionnaire and the HRQoL questionnaire SF-36 14-17 years after their diagnosis. Subgroups were studied according to thyroid-related symptoms, both symptoms correlated to thyroid disease or levothyroxine treatment and side effects from surgery and radioiodine treatment.

RESULTS

Of the patients with DTC, 279 (79%) answered the questionnaires. In all, only 19 (7%) reported a recurrence. Patients with one single symptom (e.g., fatigue, sleeping disorders, irritability, lower stress resistance, muscle weakness, bodily restlessness, sweating, palpitations, or flushes) had significantly lower HRQoL measured with the SF-36 compared to those without that specific symptom (p < 0.001). Furthermore, those 238 patients with at least one symptom, regardless of which one, had significantly lower HRQoL in all eight SF-36 domains compared to patients that no thyroid symptom (n = 34; p < 0.001). In seven patients, the questionnaires were not complete in terms of the thyroid-related questions. The association between thyroid symptoms and lower HRQoL remained after adjusting for age, sex, comorbidities, education, and menopause.

CONCLUSIONS

DTC patients reporting thyroid symptoms scored lower in HRQoL compared to those with no symptoms >14 years after diagnosis.