Background Adverse employment outcomes pose significant challenges for cancer patients, though data patients with gynecologic cancers are sparse. We evaluated the decrease in employment among patients in the year following the diagnosis of a gynecologic cancer compared with population-based controls.
Methods Patients aged 18 to 63 years old, who were diagnosed with cervical, ovarian, endometrial, or vulvar cancer between January 2009 and December 2017, were identified in Truven MarketScan, an insurance claims database of commercially insured patients in the USA. Patients working full- or part-time at diagnosis were matched to population-based controls in a 1:4 ratio via propensity score. Multivariable Cox proportional hazards models were used to evaluate the risk of employment disruption in patients versus controls.
Results We identified 7446 women with gynecologic cancers (191 vulvar, 941 cervical, 1839 ovarian, and 4475 endometrial). Although most continued working following diagnosis, 1579 (21.2%) changed from full- or part-time employment to long-term disability, retirement, or work cessation. In an adjusted model, older age, the presence of comorbidities, and treatment with surgery plus adjuvant therapy versus surgery alone were associated with an increased risk of employment disruption (p<0.0003, p=0.01, and p<0.0001, respectively) among patients with gynecologic cancer. In the propensity-matched cohort, patients with gynecologic cancers had over a threefold increased risk of employment disruption relative to controls (HR 3.67, 95% CI 3.44 to 3.95).
Conclusion Approximately 21% of patients with gynecologic cancer experienced a decrease in employment in the year after diagnosis. These patients had over a threefold increased risk of employment disruption compared with controls.
- cervical cancer
- quality of life (PRO)/palliative care
- uterine cancer
- vulvar and vaginal cancer
- ovarian cancer
Data availability statement
Data may be obtained from a third party and are not publicly available.
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Presented at This study was partially presented at the Society of Gynecologic Oncology virtual annual meeting on women’s cancer, March 19-25, 2021.
Contributors All listed authors contributed to the conception, design, analysis, or interpretation of this study’s data; assisted in manuscript revision; provided approval for publication of this manuscript version; and agree to be accountable to this work. Conceptualization: RN, JAR-H. Data curation: SHG, SF. Formal analysis: SF, RN, JAR-H. Supervision: CL, BDS, LAM, AM, SHG, PTR. Writing - original draft: RN. Writing - review and editing: all authors. Dr. Rauh-Hain is responsible for the overall content as the guarantor.
Funding Supported by The National Institutes of Health’s National Cancer Institute grant (K08CA234333; JARH), a National Cancer Institute Cancer Center Support Grant (P30 CA016672), and a National Institutes of Health T32 grant (5T32 CA101642; RN). The NIH/NCI Cancer Core Support Grant (CA016672) supports the Biostatistics Resource Group at MD Anderson Cancer Center. The T32 training grant (CA101642) supports research training of postdoctoral gynecologic oncology fellows.
Disclaimer The grant providers were not involved in the development of the research hypothesis, study design, data analysis, or manuscript writing.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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