As more organizations recommend screening younger men for prostate cancer, the profile of prostate cancer patients is likely to shift from men older than 65 years to younger men who are more likely to still be in the work force. Treatments for prostate cancer can involve a number of complications, including incontinence, fatigue, or sexual dysfunction, many of which may interfere with work productivity.
To determine the influence of cancer treatment on employment, Cathy J. Bradley, Ph.D., of the Massey Cancer Center at Virginia Commonwealth University in Richmond, and colleagues tracked 267 men with prostate cancer who were employed at the start of the study. They asked the patients about their employment situation 3 months prior to receiving their diagnosis of cancer, and at 6 and 12 months after the diagnosis. They compared the results with those from two control groups of men without prostate cancer selected from U.S. Census population surveys.
The authors found that men with prostate cancer were 10% less likely to be working 6 months after their cancer diagnosis than men without the disease. However, approximately two-thirds of the patients still working said that they continued working out of fear of losing health insurance coverage. The authors note that this fear may have encouraged some who otherwise would have quit to keep working, which may have suppressed unemployment numbers. Additionally, those still working had decreased their weekly hours work by 4 hours on average, and 43% of them attributed their inability to work at their former capacity to cancer treatment-related symptoms.
After 12 months, the gap in employment status disappeared. However, some men with cancer continued to report that treatment-related symptoms interfered with their ability to perform physical and/or cognitive tasks at work.
"Armed with this information, patients can more effectively plan for extended periods of nonemployment with the optimism that they are likely to be able to return to work 1 year after diagnosis," write the authors. "We suggest that the impact of cancer and its treatment on employment be considered alongside clinical and quality-of-life assessments when patients and physicians make prostate cancer treatment decisions," they conclude.
The authors acknowledge several limitations of the study, including the fact that all men surveyed were from the Detroit, Mich., metropolitan area, which may not represent other geographic areas. The study also did not take into account treatment dosages or intensity, or use of rehabilitation services among the cancer patients--all of which could affect work ability.
In an accompanying editorial, James A. Talcott, M.D., of the Center for Outcomes Research at Massachusetts General Hospital in Boston, discusses the implications of the research for helping doctors and patients select a course of treatment. Prostate cancer treatments vary from removing the prostate by surgery, to hormone therapy, to chemotherapy--each of which may be effective but may differ in terms of side effects and medical complications. "It would not be surprising if some men found the likely impact on future employment decisive in choosing a treatment," he writes. Indeed, the study found that men who underwent surgery were more likely to be among the unemployed 6 months after the diagnosis than men receiving other treatments, whereas those who elected hormone therapy were more likely to remain working, although the reasons for this difference were not examined.
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JNCI Journal of the National Cancer Institute