Predictors of unemployment status in people with relapsing multiple sclerosis: a single center experience

Background: Multiple sclerosis (MS) is the most common cause of nontraumatic chronic neurological disability affecting young adults during their crucial employment years. Objectives: To evaluate patients and disease related factors associated to unemployment in a cohort of relapsing–remitting (RR) MS patients. Methods: We included RRMS patients with a follow-up of at least 1 year. We collected data about years of school education and employment status. Patients underwent a neuropsychological evaluation using the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS). Demographic and clinical predictors of unemployment were assessed through a multivariable stepwise logistic regression model. Results: We evaluated 260 consecutive RRMS patients. Employed patients were less frequently female (68.4% vs 83.3%, p = 0.006), less disabled (median Expanded Disability Status Scale (EDSS) score: 2.0 (0–7.0) vs 2.5 (0–7.5), p < 0.001), with more years of school education (mean ± standard deviation (SD), years: 13.74 ± 0.30 vs 10.86 ± 3.47, p < 0.001). Female sex and a higher EDSS score resulted associated with a greater risk of unemployment (OR 3.510, 95% CI 1.654–7.448, p = 0.001; OR 1.366, 95% CI 1.074–1.737, p = 0.011, respectively), whereas a greater number of years of schooling and current disease-modifying therapy exposure resulted protective factors (OR 0.788, 95% CI 0.723–0.858, p < 0,001; OR 0.414, 95% CI 0.217–0.790, p = 0.008, respectively). Conclusions: Understanding work is pervasively influenced by consequences of MS, we confirmed the impact of demographic, physical, and cognitive factors on employment status in RRMS patients

Tamoxifen in treatment of hepatocellular carcinoma: a randomised controlled trial

Background Results from small randomised trials on tamoxifen in the treatment of hepatocellular carcinoma (HCC) are conflicting, We studied whether the addition of tamoxifen to best supportive care prolongs survival of patients with HCC. Methods Patients with any stage of HCC were eligible, irrespective of locoregional treatment. Randomisation was centralised, with a minimisation procedure accounting for centre, evidence of disease, and time from diagnosis. Patients were randomly allocated best supportive care alone or in addition to tamoxifen, Tamoxifen was given orally, 40 mg per day, from randomisation until death. Results 496 patients from 30 institutions were randomly allocated treatment from January, 1995, to January, 1997. Information was available for 477 patients. By Sept 15, 1997, 119 (50%) of 240 and 130 (55%) of 237 patients had died in the control and tamoxifen arms, respectively. Median survival was 16 months and 15 months (p=0.54), respectively, No differences were found within subgroups defined by prognostic variables. Relative hazard of death for patients receiving tamoxifen was 1.07 (95% CI 0.83-1.39). Interpretation Our findings show that tamoxifen is not effective in prolonging survival of patients with HCC

RELATIONSHIP OF COGNITIVE PERFORMANCES AND EMPLOYMENT STATUS IN PEOPLE WITH RELAPSING MULTIPLE SCLEROSIS

Background: Multiple sclerosis (MS) is thè most frequent neurologic disorders in young adults, which may detrimentally affect employment. It is important to identify people with MS who may be at risk of unemployment in order to put in place appropriate management strategies. Objectives: to evaluate clinical factors associated to a higher risk of unemployment in people with relapsing MS (RRMS). Methods: Consecutive RRMS patients attending the scheduled follow-up visit at our outpatient MS clinic were enrolled. Clinical characteristics including the EDSS score were recorded. Data were obtained on employment status. Cognitive functioning was assessed using the brief international cognitive assessment for MS (BICAMS). The presence of fatigue and of depressive symptoms was assessed us¬ing the Modified Fatigue Impact Scale (MFIS) and the Beck Depression Inventory (BDI-II), respectively. Patients with at least one cog¬nitive impaired test out of the three cognitive tests which composed the BICAMS were classified as cognitively impaired. Demographic and clinical predictors of unemployment were assessed through a multivariate logistic regression model, including as covariates age, sex, disease duration, EDSS score, MFSI score, BDI-II score, cognitive impairment status. Results: As of May 2019, 200 RRMS patients have been enrolled, 88 (44%) were unemployed at the time of the evaluation. The male/ female ratio, the mean (standard deviation - SD) age and the mean (SD) disease duration did not differ (p=n.s.) between employed and unemployed patients [32/80 vs 21/67; 41.4 (10.2) vs 41.0 (13.1) years and 11.9 (8.7) vs 12.2 (9.0) years, respectively], Unemployed RRMS patients were signifìcantly more disabled [median (range) EDSS score: 2.5 (0-7.5) vs 2.0 (0-6), p<0.0001], more frequently cognitively im¬paired (64/24 vs 51/61, p<0.0001) than employed patients. Moreover, unemployed patients reported signifìcantly higher scores at BDI-II and MFIS than patients still at work [BDI-II: 10.6 (7.5) vs 8.6 (8.3), p=0.026; MFIS: 32,7 (20) vs 23.7 (20.3), p=0.002], The multivariate logistic regression model revealed that the only significant predictors of unemployment status were the presence of cognitive impairment in at least one BICAMS test [Odds Ratio (OR) (95% Confidence Interval) (CI): 2.602 (1.349-5.018), p=0.004] and a higher EDSS score [OR 95% CI: 1.520 (1.146-2.015), p=0.004], Conclusions: Our results confirmed the impact of cognitive and physical disabilities on employment status in RRMS patients. Moreo¬ver, our data stress the importance of routinely evaluate cognitive functions in order to minimize their impact on social and working abilities in RRMS patients