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Study identifies patients' reasons for quitting jobs after treatment for head and neck cancer

The JAMA Network Journals

After treatment, 38.1 percent of patients with head and neck cancer who were employed at the time of cancer diagnosis reported discontinuing work because of their cancer and treatment, according to a report in the May issue of Archives of Otolaryngology-Head & Neck Surgery, one of the JAMA/Archives journals.

"Although most cancer survivors who are of working age who want to return to work are able to do so, cancer survivors experience significantly more work-related problems owing to missed work days than the general population, and the economic consequences for those who are disabled following cancer treatment are a substantial societal burden," the authors note. Those with head and neck cancer have the third highest rate of discontinuing employment because of their illness when compared to patients with other types of cancer.

Andrea E. Buckwalter, B.S., of the University of Iowa, Iowa City, and colleagues analyzed 666 patients with head and neck cancer who were treated from 1998 to 2004. The patients provided information about their employment status at the time of diagnosis and then at three, six, nine and 12 months after. Those who discontinued employment also rated the importance of five factors (eating, speech, appearance, pain or discomfort and fatigue) in their decision to stop working. The factors were scored on a five-point scale with five being the most important and one being the least important.

Of the 666 patients, 440 were men and 431 were younger than 65 years. Before treatment, 239 (35.9 percent) were employed, 337 (50.6 percent) were not employed and 23 (3.5 percent) were never employed. Of those who were employed at the time of cancer diagnosis, 91 (38.1 percent) [68 men and 23 women] discontinued work because of their cancer and treatment and 37 (40.7 percent) of those who had left their jobs returned to work within the first year. A higher percentage of patients who discontinued employment had advanced-stage disease (78 percent) and were treated with multimodality therapy such as surgery, radiation therapy and chemotherapy, (64 percent), compared with those who continued to work.

"Fatigue had the highest percentage (58.5 percent) of 4 or 5 ratings, followed by speech (51.2 percent), eating (45.1 percent), pain or discomfort (37.8 percent) and appearance (17.1 percent)," the authors write. Among those who returned to work, there were no significant differences in the ranking of factors, but there was a significantly higher number of patients who did not return to work who reported speech and eating as important factors in their decision to discontinue work. Women rated speech, appearance and pain as more important factors in quitting their jobs than men. Appearance was of relatively little importance for both men and women.

"This study demonstrates that fatigue is a parameter that will likely assume a greater importance in head and neck cancer outcome evaluation," the authors conclude. "Identification of the patient-reported factors associated with the decision to discontinue employment is a first step in providing more useful information about employment to patients and identifying interventions to minimize the disability following treatment for head and neck cancer."

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(Arch Otolaryngol Head Neck Surg. 2007;133:464-470. Available pre-embargo to the media at www.jamamedia.org.)

Editor's Note: This study was supported by a grant from National Institutes of Health through the Office of Cancer Survivorship. Dr. Smith has an unrestricted educational/research grant from KLS Martin. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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