Work ability and work status changes in long-term Hodgkin lymphoma survivors with focus on late adverse effects

Journal of Cancer Survivorship https://doi.org/10.1007/s11764-023-01432-y Work ability and work status changes in long‑term Hodgkin lymphoma survivors with focus on late adverse effects Alv A. Dahl1,2 · Knut B. Smeland1,2 · Siri Eikeland1,2 · Unn‑Merete Fagerli3 · Hanne S. Bersvendsen4 · Alexander Fosså2,5 · Cecilie E. Kiserud1,2 Received: 23 February 2023 / Accepted: 14 July 2023 © The Author(s) 2023 Abstract Purpose We studied work-related issues in long-term survivors of Hodgkin lymphoma [HLSs] who had undergone treatment according to contemporary stage risk-adapted approaches. At survey, work changes and problems since diagnosis, comparisons of HLSs with low/moderate versus high work ability, associations between work issues, and late adverse effects [LAEs] were examined. Methods This cross-sectional questionnaire-based study included HLSs treated from 1997 to 2006 and alive at the end of 2016. They completed a mailed questionnaire including work and health-related issues. Results Among 518 invited HLSs, 297 (58%) completed the work-related issues, and 48% of them were females. Mean age at survey was 45.9 years, and mean time was 16.7 years since diagnosis. At follow-up, 71% of the HLSs held paid work and 19% were on disability pension. Only 3% of HLSs did not hold paid work at any time after diagnosis. In total, 43% HLSs had low/moderate and 57% high work ability at follow-up. Low/moderate work ability was significantly associated with older age, female sex, more LAEs, disability pension, lower household income, distressed personality, obesity, fatigue, and mental disorders. More LAEs were significantly associated with more work problems. Conclusions Many HLSs manage to stay in the work force. Several health problems and LAEs amenable for interventions are significantly associated with low/moderate work ability and emphasize the importance of focus on these issues in longterm follow-up. Implications for Cancer Survivors HLSs in paid work at diagnosis can be optimistic as to their future participation in work life. Screening and treatment for health problems such as LAEs may improve work ability. Keywords Work ability; Hodgkin lymphoma · Cancer survivors · Late adverse effects Introduction * Alv A. Dahl ; 1 National Advisory Unit for Late Effects after Cancer Therapy, Oslo University Hospital, Oslo, Norway 2 Department of Oncology, Oslo University Hospital, Oslo, Norway 3 Department of Oncology, St Olav’s Hospital, Trondheim, Norway 4 Department of Oncology, University Hospital of Northern Norway, Tromsø, Norway 5 KG Jebsen Center for B‑Cell Malignancies, University of Oslo, Oslo, Norway For adults to be part of the work force is important for income, self-esteem, use of creativity and problem-solving abilities, career development, social status, and relational interactions through collaboration with colleagues. Cancer and its treatment is a well-documented cause of negative work status changes and work problems due to reduced work ability on temporary or permanent basis [1]. Work studies of cancer survivors have concerned sick leave, return to work, changes at work or of profession, reduced work ability, and rates of disability pension [1, 2]. Hodgkin lymphoma (HL) mostly affects young adults, is treated with chemotherapy and radiotherapy, and carries a good prognosis, but includes a relatively high risk for LAEs [3]i. Therefore, work-related issues are of particular interest for HL survivors (HLSs). 13 Vol.:(0123456789) Journal of Cancer Survivorship In studies on work issues in HLSs published between 1987 and 2017, employment rates varied between 52% and 100% [4]. In a sample of HLSs collected from 13 European countries and treated between 1964 and 2004, 70% were working at a median of 14 years after diagnosis [5]. The Scandinavian countries of Denmark, Sweden, and Norway have similar labor markets and health and welfare systems. A register-based study from Denmark [6] reported that 93% of HLSs had returned to work when assessed between five and 12 years after primary treatment. Difficulties returning to work were associated with increasing age, being female, shorter education, and drug treatment for mental health problems, but not with somatic comorbidity. In that cohort of HLSs, 9% held disability pension versus 4% in a normative sample [7], and the relative risk for such pensioning was 2.6 for the whole observation period. Factors associated with disability pensioning were the same as for impaired return to work, but also included somatic comorbidity. A national cohort study from Sweden [8] reported an increased risk of work loss for HLSs up to 15 years after diagnosis. This loss was associated with chemotherapy, advanced stages HL, cardiovascular diseases, and secondary malignancies. Importantly, approximately 70% of the HLSs had early-stage HL in remission, and they did not experience any excess work loss except during the year of diagnosis and 1–2 years thereafter. Among studies addressing the impact of disease- and treatment-related factors including relapse, on work life issues, this study seems to be the first one to include patients treated with ABVD or BEACOPP (for explanation of abbreviations, see “Material and methods”) and limited-field radiotherapy, which are more contemporary treatment strategies, Our Norwegian research group studied post-treatment work patterns in a population-based sample of lymphoma patients treated with high-dose chemotherapy with autologous stem cell transplantation (HDT-ASCT) among whom 25% were HLSs. At a mean of 12.5 years since diagnosis, 58% were employed, and being non-employed was significantly associated with fatigue, mental distress, and type D personality [9]. In contrast to work status categories like holding paid work or being on disability pension, work ability is a dimensional concept. Work ability can be defined as the individual balance between work conditions and human resources defined by health, functional capacity, values, attitudes, and motivation [10]. Work ability was originally rated as seven dimensions by the Work Ability Index (WAI) developed by the Finnish Institute of Occupational Health [11]. Studies have shown that the total WAI score correlates highly with the dimension of “current work ability compared to highest work ability ever” rated on an 11-point Likert scale [12, 13]. Assessment of work ability is useful for at least two reasons: It can be used across professions, and it is independent of current work status. Boelhouwer et al. [14] recently 13 published a systematic review of 36 work ability studies in cancer survivors. In general, they reported few studies assessing long-term work ability, and consistent negative associations between work ability and late adverse effects (LAEs), fatigue, and cognitive complaints among survivors. Three studies reported WAI scores in HLSs, two dimensionally [9, 15] and one as a dichotomy [16]. The current cross-sectional population (...truncated)