Maja V. Maraldo1, Michal Kicinski2, Marleen A. E. van der Kaaij3, Francesco Giusti4, Paul Meijnders5, Berthe M. P. Aleman6, John M. M. Raemaekers7, Elisabeth C. Moser8, Hanneke C. Kluin-Nelemans9, Michele Spina10, Christophe Fermé11, Pauline Brice12, Olivier Casasnovas13, Aspasia Stamatoullas14, Marc André15, Fabien Le Bras16, Catherine Fortpied2, Jan Bogaerts2, Michel Henry-Amar17, Lifang Liu2
1 Department of Oncology, Rigshospitalet, Copenhagen, Denmark, 2 EORTC Headquarters, Brussels, Belgium, 3 Department of Internal Medicine, VU University Medical Centre, Amsterdam, The Netherlands, 4 European Commission, DG Joint Research Centre, Ispra, Italy, 5 Department of Radiation Oncology, Iridium Cancer Network, University of Antwerp, Antwerpen, Belgium, 6 Department of Radiation Oncology, the Netherlands Cancer Institute, Amsterdam, the Netherlands, 7 Department of Hematology, Radboud University Medical Center, Nijmegen, the Netherlands, 8 Department of Radiation Oncology, Champalimaud Cancer Centre, Lisbon, Portugal, 9 Department of Hematology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands, 10 Division of Medical Oncology, National Cancer Institute, Aviano, Italy, 11 Department of Hematology, Gustave Roussy, Villejuif, France, 12 Department of Hematology, Paris Saint-Louis, France, 13 Department of Hematology, Dijon, France, 14 Department of Hematology, Centre Henri Becquerel, Rouen, France, 15 Department of Hematology, CHU UCL NAMUR, Yvoir, Belgium, 16 Unité Hémopathies Lymphoïdes, Hôpital Henri Mondor, Créteil, France, 17 Centre de Traitement des Données du Cancéropôle Nord-Ouest, Centre François Baclesse, Caen, France
Introduction: Studies on the impact of cancer on education or work interruption are lacking in Hodgkin lymphoma (HL). In a survey conducted among 2037 long-term HL survivors enrolled from 1964–2004 in nine EORTC-LYSA trials, the interruption and resumption of education or work was investigated.
Methods: Individuals in training or at work at time of diagnosis were included (n = 1646). Patient and treatment characteristics were issued from trial records. Logistic regression was used to model the risk of education or work interruption; Cox regression was used to study resumption rates. Age, gender, clinical stage, radiotherapy and chemotherapy characteristics, treatment era, education level (only work analyses), and country were considered in the models.
Results: Among individuals in training at time of diagnosis (n = 323), 52% (95% CI: 46%–57%) interrupted their education; however, it was resumed within 24 months by 92% (95% CI: 87–96%). The probability of interruption decreased with time: the more recent the treatment, the lower the risk (OR 0.70 per 10 years, 95% CI 0.49–1.01). Treatment with radiotherapy (Yes/No) was associated with a higher education resumption rate (HR 2.01, 95% CI 1.07–3.78) whereas age, gender, country, stage, radiotherapy field, and chemotherapy were not.
Among survivors working at time of diagnosis (n = 1323), 77% (95% CI: 75–79%) interrupted their work for ≥ 1 month; of those, 86% (95% CI: 84–88%) had resumed work within 24 months. Women were more likely to interrupt their work (OR 1.90, 95% CI 1.44–2.51) and, when interrupted, less likely to resume work (HR 0.70, 95% CI 0.61–0.80). Individuals with a higher education level were less likely to interrupt work (OR 0.68 for university versus no high school degree, 95% CI 0.46–1.03); when interrupted, they were more likely to resume work (HR 1.50, 95% CI 1.21–1.86). Longer duration of chemotherapy (≥24 vs. 8–12 weeks) was associated with lower resumption rates in the first year.
Conclusions: An interruption in education or work is common among HL patients. However, a large majority of those who interrupt their training or work resume it within two years. Female gender and a lower level of education are risk factors for not resuming work after treatment for HL.