Changes in income and employment after diagnosis among patients with multiple myeloma in The Netherlands

Objective: Due to new treatment options, survival rates in multiple myeloma (MM) are improving. Consequently, maintaining work and income is becoming more important for patients and society. Therefore, we aimed to explore the change in income and employment in patients with MM. Methods: Data from the Netherlands Cancer Registry of MM patients diagnosed between 2012 and 2017 were merged with socioeconomic data from Statistics Netherlands. Descriptive statistics were used to analyse total income, income from employment, and accumulated income before and after diagnosis. Results: Income from employment decreased by 45% in MM patients, between 1 year before and 4 years after diagnosis Four years after diagnosis, 35% of the patients were still employed, with an accumulated 5-year productivity loss of €121 million. Higher income loss from employment and job loss was observed in female patients, patients with more extensive disease, or those not treated with autologous stem cell transplant.Conclusion: Loss of (income from) employment among patients with MM was high, causing financial burden on the patient and society. With improving survival in MM, more research and awareness are needed to better assess the importance of income and work for MM patients and society.</p

Changes in income and employment after diagnosis among patients with multiple myeloma in The Netherlands

Objective: Due to new treatment options, survival rates in multiple myeloma (MM) are improving. Consequently, maintaining work and income is becoming more important for patients and society. Therefore, we aimed to explore the change in income and employment in patients with MM. Methods: Data from the Netherlands Cancer Registry of MM patients diagnosed between 2012 and 2017 were merged with socioeconomic data from Statistics Netherlands. Descriptive statistics were used to analyse total income, income from employment, and accumulated income before and after diagnosis. Results: Income from employment decreased by 45% in MM patients, between 1 year before and 4 years after diagnosis Four years after diagnosis, 35% of the patients were still employed, with an accumulated 5-year productivity loss of €121 million. Higher income loss from employment and job loss was observed in female patients, patients with more extensive disease, or those not treated with autologous stem cell transplant.Conclusion: Loss of (income from) employment among patients with MM was high, causing financial burden on the patient and society. With improving survival in MM, more research and awareness are needed to better assess the importance of income and work for MM patients and society.</p

The association between stressful life events and breast cancer risk: A meta-analysis

Breast cancer is the most prevalent cancer in women in Western societies. Studies examining the relationship between stressful life events and breast cancer risk have produced conflicting results. The purpose of this meta-analysis was to identify studies on this relationship, between 1966 and December 2002, to summarize and quantify the association and to explain the inconsistency in previous results. Summary odds ratios and standard errors were calculated, using random effect meta-regression analyses, for the following categories: stressful life events, death of spouse, death of relative or friend, personal health difficulties, nonpersonal health difficulties, change in marital status, change in financial status and change in environmental status. The presence of publication bias has been explored, and sensitivity analyses were performed to identify heterogeneity, using calculation of the percentage of variability due to heterogeneity, meta-regression analyses and stratification. Only the categories stressful life events (OR = 1.77, 95% CI 1.31-2.40), death of spouse (OR = 1.37, 95% CI 1.10-1.71) and death of relative or friend (OR = 1.35, 95% CI 1.09-1.68) showed a statistically significant effect. Publication bias was identified in both stressful life events (p = 0.00) and death of relative or friend (p = 0.02). Sensitivity analyses resulted in the identification of heterogeneity in all categories, except death of spouse. The results of this meta-analysis do not support an overall association between stressful life events and breast cancer risk. Only a modest association could be identified between death of spouse and breast cancer risk

Perspectives on returning to work of multiple myeloma patients: A qualitative interview study

Objective: Multiple myeloma (MM) is a rare and incurable disease. Because new treatments improved survival rates, return to work (RTW) became more relevant to MM patients of working age. Also, (health care) experts may be confronted with specific obstacles in guiding MM patients' RTW. Therefore, we aimed to qualitatively explore perspectives and experiences of MM patients and (health care) experts regarding RTW and participation at work. Methods: Semi-structured interviews were conducted with patients (N = 9) and (health care) experts (N = 15). Interviews were transcribed verbatim and analysed using thematic analysis. Results: Four themes resulted from the interviews with patients and (health care) experts: (1) severity of diagnosis and treatment impact RTW, (2) step-by-step reintegration facilitates RTW, (3) meaning of work differs between MM patients and experts and (4) lack of tailored counselling by experts. Conclusion: Although MM patients' work ability may be limited due to the severity of diagnosis and side effects from treatment, most patients consider RTW important. Both patients and (health care) experts emphasise the benefits from early work ability assessment (in the hospital setting) and specialised RTW counselling, especially in those with physically demanding jobs

Effectiveness of a preventive coaching intervention for employees at risk for sickness absence due to psychosocial health complaints: Results of a randomized controlled trial

OBJECTIVE: To assess the effectiveness of a preventive coaching intervention on sickness absence due to psychosocial health complaints and on general well being of employees. METHODS: Employees at risk for sickness absence were identified and randomized. The intervention group received the preventive coaching program; the control group received usual care. Primary outcome measure of the trial is sickness absence due to psychosocial health complaints; secondary outcome measures are related to general well being, such as psychological distress, fatigue, and coping. RESULTS: No effect of coaching on self-reported sickness absence due to psychosocial health complaints was found. The intervention group reported statistically significant improved health, declined psychological distress, less burnout, less need for recovery, and an increased satisfaction with life. CONCLUSIONS: This study shows that the coaching intervention primarily has an effect on general well being of employees

Sustained employability and health-related quality of life in cancer survivors up to four years after diagnosis

Background: Most cancer survivors are able to return to work at some point after diagnosis. However, literature on sustained employability and health-related quality of life (HRQoL) is limited. Therefore, the aims of this study were to explore the influence of change in employment status on HRQoL in cancer survivors long term after diagnosis, and to identify predictors of work continuation in occupationally active survivors. Material and methods: We used prospective data (T0 = two years after diagnosis, T1 = one-year follow-up, and T2 = two-year follow-up) from a cohort of cancer survivors that had an employment contract and were of working age at T0 (N = 252, 69.8% female). Groups were formed on the basis of change in employment status: ‘continuously not working’ (19.8%), ‘positive change in employment status’ (5.6%), ‘negative change in employment status’ (14.7%), and ‘continuously working’ (59.9%). ANCOVA was used to explore the relationship between change in employment status and HRQoL at T1. Generalized estimating equations (GEE) were used to identify predictors of work continuation (at T1 and T2) in survivors that were occupationally active at T0 (N = 212). Results: ‘Continuously working’ survivors scored significantly better on the EORTC QLQ-C30 scales: role functioning, fatigue, pain, constipation, global health/QoL and the Summary score, than ‘continuously not working’ survivors, and better on physical, role and emotional functioning, fatigue, financial impact, global health/QoL and the Summary score than survivors with a ‘negative change in employment status’ (effect size range = 0.49–0.74). In occupationally active survivors, a high score on current work ability was associated with work continuation one year later [odds ratio (OR) 1.46; 95% CI 1.11–1.92]. Conclusion: Cancer survivors ‘continuously working’ function better and have a better health and QoL than those who are not able to work. However, in occupationally active cancer survivors, one should monitor those with low self-perceived work ability, because they have an increased risk to discontinue their work

Effectiveness of behavioral techniques and physical exercise on psychosocial functioning and health-related quality of life in breast cancer patients and survivors-a meta-analysis

Objective: To evaluate the effect of behavioral techniques and physical exercise on psychosocial functioning and health-related quality of life (HRQoL) outcomes in breast cancer patients and survivors. Methods: A meta-analysis was carried out to quantify the effects of behavioral and exercise interventions on fatigue, depression, anxiety, body-image, stress and HRQoL. Summary effect sizes and standard errors were calculated. The presence of publication bias was explored and sensitivity analyses were performed to identify possible sources of heterogeneity. Results: In total, 56 studies were included. Statistically significant results were found for the effect of behavioral techniques on fatigue (ES -0.158; 95% CI -0.233 to -0.082, p<0.001), depression (ES -0.336; 95% CI -0.482 to -0.190, p<0.001), anxiety (ES -0.346; 95% CI -0.538 to -0.154, p<0.001) and stress (ES -0.159; 95% CI -0.310 to -0.009, p=0.038). For the effect of physical exercise interventions, statistically significant results were found on fatigue (ES -0.315; 95% CI -0.532 to -0.098, p=0.004), depression (ES -0.262; 95% CI -0.476 to -0.049, p=0.016), body-image (ES 0.280; 95% CI 0.077 to 0.482, p=0.007) and HRQoL (ES 0.298; 95% CI 0.117 to 0.479, p=0.001). Conclusions: The results indicate that behavioral techniques and physical exercise improve psychosocial functioning and HRQoL in breast cancer patients and survivors. Future research is needed on the effect of physical exercise on stress and the effect of the combined intervention in breast cancer patients

A meta-analysis of observational studies identifies predictors of sickness absence

Objective: About one in every three employees seen by their occupational physician is absent from work because of psychosocial health complaints. To implement preventive measures, it is necessary to identify predictors for this type of sickness absence. Study Design and Setting: A meta-analysis was carried out to quantify the association between predictive factors and psychosocial sickness absence and to assess clinical outcomes and heterogeneity. Eligible for inclusion were prospective studies that examined this association and provided sufficient information to estimate summary odds ratios (SORs). Results: Twenty prospective studies were included. Significant SORs for sick leave >3 days were found for being unmarried, 1.37 (95% confidence interval [CI] = 1.15-1.64), experiencing psychosomatic complaints, 1.79 (95% CI = 1.54-2.07), using medication, 3.13 (95% CI = 1.71-5.72), having a burnout, 2.34 (95% CI = 1.59-3.45), suffering from psychological problems, 1.97 (95% CI = 1.37-2.85), having low job control, 1.28 (95% CI = 1.23-1.33), having low decision latitude, 1.33 (95% CI = 1.16-1.56), and experiencing no fairness at work, 1.30 (95% CI = 1.18-1.45). Conclusion: This study shows that predictors of sickness absence can be identified in a homogeneous manner. The results provide leads to public health interventions to successfully improve psychosocial health and to reduce sickness absence

Cancer survivors’ perspectives and experiences regarding behavioral determinants of return to work and continuation of work

Purpose: Supportive interventions to enhance return to work (RTW) in cancer survivors hardly showed positive effects so far. Behavioral determinants might have to be considered in the development of interventions to achieve sustained employability. This study aimed to explore cancer survivors’ perspectives and experiences regarding behavioral determinants of RTW and continuation of work. Materials and methods: In this qualitative study, semi-structured telephone interviews were held with 28 cancer survivors. All participants were at working age, 1–2 years after diagnosis and employed at time of diagnosis. Thematic content analysis was performed. Results: Work turned out to be a meaningful aspect of cancer survivors’ life, and most participants reported a positive attitude towards their job. Social support to RTW or to continue working was mainly received from family and friends, but pressure to RTW from the occupational physician was also experienced. Changes in expectations regarding work ability from negative to positive during the treatment process were observed. Those who applied active coping mechanisms felt equipped to deal with difficulties regarding work. Conclusions: Behavioral determinants should be taken into account in the development of future interventions to support cancer survivors’ RTW. However, the causal relationship still has to be determined. Implications for rehabilitation Factors influencing occupational motivation among cancer survivors need to be understood in more detail. Previous studies in non-cancer populations have demonstrated that behavioral determinants, such as a positive attitude towards work, high social support and self-efficacy may increase return to work rates or shorten the time to return to work. Addressing behavioral determinants in future development of work-related interventions for cancer survivors is essential in achieving sustained employability