Incidence and predictors of recurrent sick leave in survivors who returned to work after allogeneic hematopoietic cell transplantation

• Published in: Journal of cancer survivorship Vol. 17; no. 3; pp. 781 - 794
• Main Authors: Kurosawa, Saiko, Yamaguchi, Takuhiro, Mori, Ayako, Matsuura, Tomoko, Masuko, Masayoshi, Murata, Makoto, Tashiro, Haruko, Kako, Shinichi, Satake, Atsushi, Hagihara, Maki, Ota, Shuichi, Saito, Takeshi, Kagawa, Kumiko, Matsuo, Yayoi, Itonaga, Hidehiro, Uoshima, Nobuhiko, Yamaguchi, Hiroki, Naito, Kensuke, Takahashi, Miyako, Fukuda, Takahiro
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-06-2023; Springer Nature B.V
• Subjects: Allografts; Cancer Survivors; Cohort Studies; Cord blood; Employee benefits; Employment; Graft-versus-host reaction; Health care; Health Informatics; Health Promotion and Disease Prevention; Hematopoietic Stem Cell Transplantation - adverse effects; Hematopoietic stem cells; Humans; Incidence; Medical personnel; Medicine; Medicine & Public Health; Multivariate analysis; Muscles; Oncology; Patients; Primary Care Medicine; Professionals; Public Health; Quality of Life Research; Regression analysis; Respiratory system; Return to Work; Risk factors; Sick Leave; Signs and symptoms; Stem cell transplantation; Survival; Survivors; Transplantation; Working conditions; Recurrent sick leave; Survivorship; Resignation; Allogeneic hematopoietic cell transplantation; Return to work
• ISSN: 1932-2259; 1932-2267
• DOI: 10.1007/s11764-022-01250-8

Background
Although rather favorable probabilities of return to work have been reported after allogeneic hematopoietic cell transplantation (allo-HCT), survivors often have difficulty continuing to work because of their immunocompromised status and diverse late effects after allo-HCT. We evaluated the incidence of and risk factors for recurrent sick leave in allo-HCT survivors after they initially returned to work.
Methods
We targeted allo-HCT survivors who were employed at diagnosis, aged 20–64 at survey, and survived for ≥ 2 years without relapse. Of the 1904 survivors who were informed of the study, 1148 returned the questionnaire (60%), and 1048 eligible participants were included in the overall analysis. In the present study that considered recurrent sick leave after return to work, we targeted 896 participants who returned to work at least once after allo-HCT. Participants stated if they had recurrent sick leave after returning to work and its reasons, as well as associated patient-, HCT/HCT center–, and work-related factors and clinical events after allo-HCT. A logistic regression analysis was conducted to explore correlated factors for recurrent sick leave.
Results
In survivors who returned to work, 30% required recurrent sick leave. The most frequent causes of recurrent leave were physical issues (72%), and analysis of free descriptions demonstrated that these were mainly associated with graft-versus-host disease, infection, or readmission. Other reasons included work-related issues such as gap between physical and working conditions. Multivariate analysis showed that cord blood transplantation, longer employment duration, and counseling from healthcare professionals were associated with a lower risk of recurrent leave. Readmission, immunosuppressant use, and symptoms involving the respiratory system, gut, and joints and muscles were associated with a higher risk.
Conclusions
Our results drawn from a large cohort study should help healthcare professionals identify and assist at-risk patients. Multi-professional teams that provide continuous support and effective communication with the workplace are necessary to improve long-term outcomes after allo-HCT.
Implications for Cancer Survivors
In order to continue working after the initial return to work, it is important to receive counseling from healthcare professionals and obtain reasonable accommodation from workplace.