Risk factors for return to work in colorectal cancer survivors

Chung-Mao Yuan; Chung-Ching Wang; Wei-Te Wu; Ching-Liang Ho; Wei-Liang Chen

doi:10.1002/cam4.3952

Risk factors for return to work in colorectal cancer survivors

Cancer Med. 2021 Jun;10(12):3938-3951. doi: 10.1002/cam4.3952. Epub 2021 May 14.

Authors

Chung-Mao Yuan^{1

2

3}, Chung-Ching Wang^{3

4}, Wei-Te Wu⁵, Ching-Liang Ho², Wei-Liang Chen^{3

4

6}

Affiliations

¹ Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan.
² Department of Internal Medicine, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, Taipei, Taiwan.
³ Division of Environmental Health and Occupational Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
⁴ Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, Taipei, Taiwan.
⁵ National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan.
⁶ Department of Biochemistry, National Defense Medical Center, Taipei, Taiwan.

Abstract

Background: The increasing incidence of colorectal cancer among individuals in the productive age-group has adversely affected the labor force and increased healthcare expenses in recent years. Return to work (RTW) is an important issue for these patients. In this study, we explored the factors that influence RTW and investigated the influence of RTW on survival outcomes of patients with colorectal cancer.

Methods: Data of individuals (N = 4408) in active employment who were diagnosed with colorectal cancer between 2004 and 2010 were derived from 2 nationwide databases. Subjects were categorized into 2 groups according to their employment status at 5-year follow-up. Logistic regression analysis was performed to identify the factors associated with RTW. Survivors were further followed up for another 8 years. Propensity score matching was applied to ensure comparability between the two groups, and survival analysis was performed using the Kaplan-Meier method.

Results: In multivariable regression analysis for 5-year RTW with different characteristics, older age (OR: 0.57 [95% CI, 0.48-0.69]; p < 0.001), treatment with radiotherapy (OR: 0.69 [95% CI, 0.57-0.83]; p < 0.001), higher income (OR: 0.39 [95% CI, 0.32-0.47]; p < 0.001), medium company size (OR: 0.78 [95% CI, 0.63-0.97]; p = 0.022), and advanced pathological staging (stage I, OR: 16.20 [95% CI, 12.48-21.03]; stage II, OR: 13.12 [95% CI, 10.43-16.50]; stage III, OR: 7.68 [95% CI, 6.17-9.56]; p < 0.001 for all) revealed negative correlations with RTW. In Cox proportional hazard regression for RTW and all-cause mortality, HR was 1.11 (95% CI, 0.80-1.54; p = 0.543) in fully adjusted model.

Conclusion: Older age, treatment with radiotherapy, higher income, medium company size, and advanced pathological stage showed negative correlations with RTW. However, we observed no significant association between employment and all-cause mortality. Further studies should include participants from different countries, ethnic groups, and patients with other cancers.

Keywords: colorectal cancer; prognostic factor; retrospective cohort study; return to work.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Age Factors
Cancer Survivors / statistics & numerical data*
Cause of Death
Colorectal Neoplasms / epidemiology
Colorectal Neoplasms / mortality*
Colorectal Neoplasms / pathology
Colorectal Neoplasms / radiotherapy
Comorbidity
Databases, Factual
Employment / statistics & numerical data*
Epidemiologic Methods
Female
Humans
Income
Male
Middle Aged
Outcome Assessment, Health Care
Return to Work / statistics & numerical data*
Taiwan / epidemiology
Unemployment / statistics & numerical data
Young Adult