Time to act: the challenges of working during and after cancer, initiatives in research and practice

Time to act: the challenges of working during and after cancer, initiatives in research and practic

Rehabilitation and return to work after cancer — instruments and practices

The ‘Rehabilitation and return to work after cancer — instruments and practices’ project provides an insight into the issues surrounding rehabilitation and return to work (RTW) after a cancer diagnosis and the problems encountered by workers affected by cancer and their employers. Furthermore, the report presents recommendations for instruments, practices, policies and interventions to successfully support the RTW of workers affected by cancer. Each year, an estimated 3.4 million new cases of cancer are diagnosed in Europe. About half of the people diagnosed with cancer are of working age. Although cancer occurrence differs from one region to another in Europe, the most frequent forms of cancer are breast, colorectal, prostate and lung cancer. These types of cancer were estimated to account for over half of the overall burden of cancer in Europe in 2012. The impact of cancer on a person’s daily life is immediate and striking. The diagnosis usually results in long periods of sickness absence because of medical treatments and functional restrictions. Although, in general, cancer management has improved over the past three decades and the overall number of people who survive cancer is increasing, many cancer survivors still face long-term symptoms and impairments after their treatment ends, such as fatigue. These symptoms and impairments can affect the workability of cancer survivors, making it more difficult to remain in or re-enter the job market. Research shows that most cancer survivors are able to remain in or return to work, but that overall the risk of unemployment among cancer survivors is 1.4 times higher than among people who have never been diagnosed with cancer. Optimising the rehabilitation and RTW of workers affected by cancer is therefore important to both improve the well-being of this vulnerable group and reduce the societal and financial impacts of cancer on European enterprises and society at large. Instruments, practices, policies and interventions aimed at the promotion of rehabilitation and RTW are clearly important. This ‘Rehabilitation and return to work after cancer — instruments and practices’ project reports on the emerging issue of rehabilitation and RTW after cancer and provides national examples of successful instruments, practices, policies and interventions to prevent long-term sickness absences and unemployment. The project is divided into the following main tasks: a literature review on rehabilitation and RTW after a cancer diagnosis; detailed descriptions of instruments, practices, policies and interventions to support rehabilitation and RTW after a cancer diagnosis; company case studies; qualitative research with experts and intermediaries; support for the EU-OSHA stakeholder seminar

Marital status associated with ovarian cancer stage, treatment and outcomes?

<p><strong>Background</strong></p> <p>Ovarian cancer is the 4th most common cancer in women in Ireland and their mortality rates are second highest in Europe. There is growing evidence, across a range of cancer sites, that married cancer patients have better survival. It is unlikely that marriage elicits biological changes in cancer cells, but there are societal factors which could lead to earlier diagnosis, greater treatment utilisation and improved quality of follow-up for married patients within the health system. We investigated associations between marital status and stage, treatment receipt and survival in ovarian cancer.</p> <p><strong>Methods</strong></p> <p>Women, aged ≥20, diagnosed with primary malignant ovarian cancer (IDC10-C56) during 1994-2010 were identified from National Cancer Registry Ireland. Data extracted was: marital status, stage, treatment received in the first year, date and cause of death, age, smoking status, occupation, region and area deprivation score. Logistic regression was used to estimate adjusted effects of marital status on tumour stage (1-3 vs 4). Effect on treatment uptake was evaluated adjusting for socio-demographic characteristics, stage and grade. Associations between marital status and survival were evaluated using Cox regression, at baseline and beyond a 6-month landmark, adjusting for treatment.</p> <p><strong>Results</strong></p> <p>The median age of 5022 included women was 64 (range 23-97, IQR 21); 54% were married at diagnosis; 50% were non-smokers; 41% identified as housewives; 30% had stage 4 disease. Married women were younger, more likely to be a housewife and lived in less deprived areas. Marriage reduced the odds of stage 4 disease (crude OR=0.88, 95%CI 0.78-1.0), but association disappeared after adjustment for factors above. Overall, 62% of women received cancer-directed surgery. Married women significantly more often had surgery, even after adjusting for covariates (OR=1.47, 95%CI 1.26, 1.70). Married women survived longer (median: 31m vs 15m; adjusted HR=0.88, 95%CI 0.81-0.95) but this effect attenuated when conditional survival beyond 6-months was considered (adjusted HR=0.94, 95%CI 0.85-1.04).</p> <p><strong>Conclusions</strong></p> <p>Among women with ovarian cancer, marriage is not associated with stage at diagnosis but does increase the odds of having treatment. Associations between marital status and survival are restricted to the initial follow-up period.</p> <p><strong>Acknowledgements</strong></p> <p>National Cancer Registry receives Department of Health funding.</p

Social and emotional impact of financial burden of cancer.

<p>Social and emotional impact of financial burden of cancer.</p

Characteristics of patients interviewed.

<p>Characteristics of patients interviewed.</p

Financial adjustments.

<p>Financial adjustments.</p

Factors increasing financial vulnerability.

<p>Factors increasing financial vulnerability.</p

Effect of drug class on association of beta-blocker with ovarian cancer survival

<p><strong>Background:</strong> There is evidence in breast, colorectal and prostate cancer that patients who use beta-blocker (BB) medication have better cancer outcomes. There is conflicting evidence of similar benefits in ovarian tumours. We investigated whether type of drug effected association between BB use and survival within Irish ovarian cancer patients.</p> <p><strong>Method:</strong> Women diagnosed with invasive ovarian cancer (ICD code: C56) between 2001-2011 were identified from the National Cancer Registry Ireland. Those with continuous eligibility for a (means-tested) medical card in the year immediately prior to diagnosis were identified and linked to pharmacy claim records. Any BB exposure (WHO ATC: C07) in the year prior to diagnosis was determined. Associations between exposure and ovarian cause-specific survival (OvCSS) and all other causes was estimated using Cox regression (until follow-up 31/12/2012) adjusted for age, smoking, marital status, diagnosis year, urban/rural residence, deprivation, stage, grade, and surgery at diagnosis. Adjusted hazard ratios (AHR) and 95% CI are presented. Class of medication was a pre-planned subgroup and patients were classified as having exposure to: selective, non-selective, neither (reference category) or both.</p> <p><strong>Results:</strong> Of 3097 invasive ovarian cancers diagnosed 2001-2011, 1823 (59%) had a medical card for at least one year prior to diagnosis. Of these, 432 (24%) had some BB exposure in that year. 78% of women in the cohort had died by 31/12/2012 (median follow-up 5.8 years). Pre-diagnostic use was not associated with improved OvCCS (AHR=1.08, 95%CI 0.93,1.23) or other-cause survival. Exposure to selective drugs (AHR=1.11, 95%CI 0.95,1.30) was not significantly different to that of non-selective drugs (AHR=0.88, 95%CI 0.56,1.38), drug class interaction p=0.55.</p> <p><strong>Conclusions:</strong> In this large study of beta-blocker use in ovarian cancer, we observed no modification of association by drug class on cancer-specific survival.</p

Associations between pre- and post-diagnostic use of beta-blockers and ovarian cancer survival

<p><strong>Background</strong>: There is evidence in breast, colorectal and prostate cancer that patients who use beta-blocker (BB) medication have better cancer outcomes. There is some evidence of similar benefits in ovarian tumours. We investigated whether BB use was associated with improved survival within Irish ovarian cancer patients.</p> <p><strong>Method</strong>: Women diagnosed with invasive ovarian cancer (ICD code: C56) between 2001–2011 were identified from the National Cancer Registry Ireland. Those with continuous eligibility for a (means-tested) medical card in the year immediately prior to diagnosis were identified and linked to community prescription records. Any BB exposure (WHO ATC: C07) in the year prior to diagnosis was determined. Associations between exposure and ovarian cause-specific survival (OvCSS) and other causes until follow-up 31/12/2012 was estimated using Cox regression adjusted for: age, smoking, marital status, diagnosis year, urban/rural residence,deprivation, stage, grade, and surgery at diagnosis. Secondary analysis accounting for competing risks was conducted. Time-varying regression with ever/never status (6 month lag) was used to evaluate post-diagnostic BB use.</p> <p><strong>Results</strong>: Of 3097 invasive ovarian cancers diagnosed 2001–2011, 1823 (59%) had a medical card for at least one year prior to diagnosis. Of these, 432 (24%) had some BB exposure in that year. 78% of women in the cohort had died by 31/12/2012 (median follow-up 5.8 years). Pre-diagnostic use was not associated with improved OvCCS (AHR = 1.08, 95% CI 0.93,1.23) or other-cause survival (AHR = 1.39, 95% CI 0.92,2.09). Results were similar adjusting for competing risks. Post-diagnostic BB use was associated improved OvCSS (AHR = 0.80, 95% CI 0.65, 0.99) but not other-cause survival(AHR = 1.61, 95% CI 0.85, 3.03).</p> <p><strong>Conclusions</strong>: In this, one of the largest ever studies of beta-blocker use in ovarian cancer, we observed a post- (but not pre-) diagnostic association between exposure and cancer-specific survival.This analysis is being replicated in Northern Ireland and English populations.</p> <p><strong>Acknowledgements</strong>: Project funding, Health Research Board; Registry funding, Department of Health.</p

Do ovarian cancer patients using statins have better outcomes?

<p><strong>Background:</strong> There is evidence in breast, colorectal and prostate cancer that patients who use statins have better cancer outcomes. There is biological evidence of similar benefits in ovarian tumour cells. We investigated whether stain use was associated with survival in ovarian cancer patients in Ireland.</p> <p><strong>Methods:</strong> Women diagnosed with invasive ovarian cancer (C56) between 2001-2011 were identified from the National Cancer Registry. Those with at least one year medical card history (means tested) pre-diagnosis were identified and linked to community prescription records. Any statin use (ATC code: C10AA,C10B) in the year prior to diagnosis was determined. Association between statin use and cause-specific survival (end of follow-up: 31/12/2012) was estimated using Cox regression (adjusted for: age, smoking, marital status, year of diagnosis, urban/rural, local area deprivation, stage, grade, surgery at diagnosis). Secondary analysis accounting for competing risk was conducted.</p> <p><strong>Results:</strong> Of 3097 invasive ovarian cancers diagnosed 2001-2011, 1823 (59%) had had a medical card history for at least one year prior to diagnosis and, of these, 490 (27%) had some exposure to statin in the year prior to diagnosis. 78% of women in the cohort had died by 31/12/2012 (median follow-up=5.8years). Pre-diagnostic statin use was not associated with ovarian cancer-specific survival (HR=1.06, 95%CI 0.92, 1.23) but was associated with better survival for other causes (HR=0.57, 95%CI 0.36, 0.93). When adjusting for competing risks, statin use was significantly associated with increased risk of ovarian cancer-specific death (HR=1.20, 95%CI 1.03, 1.40, p=0.02).</p> <p><strong>Conclusion:</strong> In this, the largest ever study of statin use in ovarian cancer, we observed an association between pre-diagnostic statin use and cancer survival when adjusting for competing risks. Further work is being conducted to verify these results in United Kingdom populations. Research is needed to better understand the mechanisms by which prediagnosis statin use might influence cancer survival.</p> <p> </p