title: Affiliation to the work market after curative treatment of head-and-neck cancer: a population-based study from the DAHANCA database.
abstract: OBJECTIVE
  Survivors of squamous cell carcinoma of the head and neck (HNSCC) are more severely affected in regard to affiliation to the work market than other cancer survivors. Few studies have investigated associations between socioeconomic and disease-related factors and work market affiliation after curative treatment of HNSCC. We investigated the factors for early retirement pension due to disability and unemployment in patients who had been available for work one year before diagnosis.
  
  
  METHODS
  In a nationwide, population-based cohort study, data on 2436 HNSCC patients treated curatively in 1992-2008 were obtained from the Danish Head and Neck Cancer Group database and linked to Danish administrative population-based registries to obtain demographic and socioeconomic variables. We used multivariate logistic regression models to assess associations between socioeconomic factors (education, income and cohabitating status), cancer-specific variables such as tumour site and stage, comorbidity, early retirement pension and unemployment, with adjustment for age, gender and year of diagnosis.
  
  
  RESULTS
  Short education [odds ratio (OR) 4.8; 95% confidence interval (CI) 2.2-10.4], low income (OR 3.2; 95% CI 1.8-5.8), living alone (OR 3.0; 95% CI 2.1-4.4) and having a Charlson comorbidity index score of 3 or more (OR 5.9; 95% CI 3.1-11) were significantly associated with early retirement overall and in all site groups. For the subgroup of patients who were employed before diagnosis, the risk pattern was similar. Tumour stage was not associated with early retirement or unemployment.
  
  
  CONCLUSIONS
  Cancer-related factors were less strongly associated with early retirement and unemployment than socioeconomic factors and comorbidity. Clinicians treating HNSCC patients should be aware of the socioeconomic factors related to work market affiliation in order to provide more intensive social support or targeted rehabilitation for this patient group.
authors.affiliation: Survivorship, Danish Cancer Society Research Center, Denmark. trille@cancer.dk
authors.forename: Trille
authors.initials: T
authors.lastname: Kjær
authors.forename: Charlotte Rotbøl
authors.initials: CR
authors.lastname: Bøje
authors.forename: Maja Halgren
authors.initials: MH
authors.lastname: Olsen
authors.forename: Jens
authors.initials: J
authors.lastname: Overgaard
authors.forename: Jørgen
authors.initials: J
authors.lastname: Johansen
authors.forename: Else
authors.initials: E
authors.lastname: Ibfelt
authors.forename: Marianne
authors.initials: M
authors.lastname: Steding-Jessen
authors.forename: Christoffer
authors.initials: C
authors.lastname: Johansen
authors.forename: Susanne O
authors.initials: SO
authors.lastname: Dalton
mesh_terms: D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000534:rehabilitation / Q000628:therapy*; D016208:Databases, Factual; D003718:Denmark / Q000453:epidemiology; D004651:Employment / Q000706:statistics & numerical data*; D005260:Female; D006258:Head and Neck Neoplasms / Q000534:rehabilitation / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries / Q000706:statistics & numerical data; D012074:Remission Induction; D012923:Social Class; D012959:Socioeconomic Factors; D000077195:Squamous Cell Carcinoma of Head and Neck