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: Little is known on the employment situation of long-term Hodgkin lymphoma (HL) survivors despite their young age at diagnosis and the favourable prognosis of the disease.
Methods: A cross-sectional study was conducted in 2009–2011 in 6658 HL patients treated in nine consecutive European randomized trials from 1964 to 2004. 2026 survivors participated. Survivors were matched 1:25 to controls from the European Union Labour Force Survey on age at survey, gender and country of origin. Individual treatment information was obtained from trial records. Employment and socio-demographic characteristics were collected using a Life Situation Questionaire. Logistic regression models were used to estimate associations between disease and treatment characteristics with employment status and work-related attitudes. A two-sided significance level of 0.05 and 95% confidence intervals (CI) were used.
Results: Among the survivors, 49.3% were male, the median age at survey was 47 (range: 25–84) years, and the median time since HL diagnosis was 14 (range: 5–44) years. At employment assessment, a majority of survivors (69.7%, 95% CI: 67.6–71.7%) were working; of these, 68.9% (95% CI: 66.3–71.3%) worked full-time a figure similar to that of controls. The risk of not working was associated with increasing age at diagnosis, increasing age at survey, female gender, lower education level, and (any) relapse treatment. Of those who were at work during treatment, 16.8% (95% CI: 14.5–19.3%) felt their income had subsequently decreased which was attributed to their HL by 65.4% (95% CI: 57.5–72.8). The risk of perceived income decrease due to HL was associated with higher age at diagnosis, female gender, country, and (any) relapse treatment. Among those not at work, 25.1% (95% CI: 20.7–29.8) survivors were disabled compared to 14.5% (95% CI: 13.8–15.3%) of controls. The risk of being disabled was associated with increasing age at survey, country, and (any) relapse treatment.
Conclusions: In this cohort of HL survivors, HL diagnosis and its treatment did not affect the subsequent employment situation. However, increasing age at follow-up, female gender, and treatment given for disease failure are risk factors for unemployment, perceived decrease in income and of being disabled.