title: Socioeconomic effects of and risk factors for disability in long-term survivors of head and neck cancer.
abstract: OBJECTIVE
  To evaluate the socioeconomic effect of and risk factors for work-related disability due to head and neck cancer and its treatment.
  
  
  METHODS
  Cross-sectional analysis of a consecutive series of patients.
  
  
  METHODS
  Tertiary cancer center hospital.
  
  
  METHODS
  Eligible patients had squamous cell carcinoma of the upper aerodigestive tract, were employed or had an active professional career at the time of initial diagnosis, and were disease free for at least 2 years at the time of interview. The survey instruments were a specific questionnaire to evaluate patient socioeconomic status and a Portuguese version of the University of Washington Quality of Life questionnaire.
  
  
  METHODS
  Descriptive analysis of the results and associations between clinical, social, and quality of life variables with work disability.
  
  
  RESULTS
  A total of 301 patients were studied. There were 236 (78.4%) men (median age, 52 years). The tumor sites were the oral cavity in 158 (52.5%), oropharynx in 55 (18.3%), larynx in 78 (25.9%), and hypopharynx in 10 (3.3%). Most patients presented with advanced clinical disease and underwent surgical treatment initially. There were 36 (12.0%) illiterate patients, and only 23 (7.6%) patients had completed college. Ninety-nine patients (32.9%) became unable to work, and 126 (41.9%) reported a significant decrease in household income. Multivariate analysis showed that advanced clinical stage (P = .02), alcohol consumption (P = .02), and low educational level (P = .007) were associated independently with work disability.
  
  
  CONCLUSIONS
  We observed a high rate of work-related disability that led to significant decrease in household income. Several clinical, social, and quality of life variables were associated with this degree of disability. These results could be used to better define who should undergo more intensive rehabilitation aiming to reduce work disability. If intensive rehabilitation is unsuccessful, these patients should receive more comprehensive social support.
authors.affiliation: Head and Neck Surgery and Otorhinolaryngology Department, Hospital do Câncer A.C. Camargo, Rua Professor Antônio Prudente 221, 01509-900 São Paulo, Brazil.
authors.forename: José Guilherme
authors.initials: JG
authors.lastname: Vartanian
authors.forename: André Lopes
authors.initials: AL
authors.lastname: Carvalho
authors.forename: Julia
authors.initials: J
authors.lastname: Toyota
authors.forename: Ivonete S Giacometti
authors.initials: IS
authors.lastname: Kowalski
authors.forename: Luiz Paulo
authors.initials: LP
authors.lastname: Kowalski
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001938:Brazil; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000534:rehabilitation*; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013997:Time Factors