title: Employment status and work-related problems of gastrointestinal cancer patients at diagnosis: a cross-sectional study.
abstract: Objective To assess the employment status of patients with gastrointestinal cancer at diagnosis and to examine work-related problems of employed patients.  Design New, consecutive patients were included at the Gastrointestinal Oncology Center Amsterdam, a one-stop, rapid access diagnostic assessment centre. Patients were interviewed on their employment status by a nurse. If (self-) employed, patients were asked to self-report on work-related problems, perceived distress (0-10), cancer-related problems, fatigue (MFI-20, range 4-20) and work ability (three WAI questions, range 0-10).  Results Of all 333 included new consecutive patients (age range 32-89 years), 95 patients (28%) were (self-) employed at time of diagnosis, 179 (54%) were pensioners, and 59 were not working (18%). For the assessment of work-related problems, 45 (47%) of these 95 employed patients with cancer participated. Their mean age was 56 years, and patients had oesophageal/stomach (49%), colorectal (18%) or hepatic/pancreatic/biliary cancer (33%). Half of the employed patients (49%) were still at work, while 51% were on sick leave. The main reasons for sick leave were stress (35%), (scheduled) operation (26%), fatigue (17%) and pain (13%). Most patients on sick leave (70%) had no contact with their own occupational physician, although the majority (67%) would like to continue to work. Work-related problems were experienced by 73% of working patients. The mean work ability was 5.4, the mean general fatigue score was 11.5, and the mean distress score was 4.7. Employed patients on sick leave reported a lower work ability, more fatigue and higher distress but no more cancer-related problems compared with those still working.  Conclusion A quarter of all patients with gastrointestinal cancer seen at an oncological centre are employed at time of diagnosis, and of these employed patients, 73% experience work-related problems. During diagnosis and treatment, information and support on work-related issues should be offered to patients with cancer as an essential part of high-quality oncological care.
authors.affiliation: Coronel Institute of Occupational Health (Outpatient Clinic People and Work), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: A G E M
authors.initials: AG
authors.lastname: de Boer
authors.forename: D J
authors.initials: DJ
authors.lastname: Bruinvels
authors.forename: K M A J
authors.initials: KM
authors.lastname: Tytgat
authors.forename: A
authors.initials: A
authors.lastname: Schoorlemmer
authors.forename: J H G
authors.initials: JH
authors.lastname: Klinkenbijl
authors.forename: M H W
authors.initials: MH
authors.lastname: Frings-Dresen