title: Sick leave and disability pension in Hodgkin lymphoma survivors by stage, treatment, and follow-up time--a population-based comparative study.
abstract: OBJECTIVE
  This study seeks to investigate the long-term public health burden of Hodgkin lymphoma (HL) in terms of work loss following contemporary treatment protocols and associations with established treatment complications and lymphoma relapse.
  
  
  METHODS
  We identified 1,989 Swedish HL patients (1,082 with clinical information) aged 18-60 (median 33) years at diagnosis 1992-2009, and matched 1:4 to population comparators. Sick leave, disability pension (work loss), and comorbidity were retrieved through September 2013. Relative risks (RR) with 95% confidence intervals (CI) were calculated using Poisson regression, and mean lost work days were estimated yearly during follow-up.
  
  
  RESULTS
  The risk of annual work loss was elevated in HL survivors versus comparators up to the 15th year post-diagnosis (RR(5th year) 1.64, 95% CI 1.46-1.84; RR(10th year) 1.33, 95% CI 1.15-1.34; and RR(15th year) 1.30, 95% CI 1.04-1.62). The risk remained elevated up to the 10th year after adjustment for secondary malignancies and cardiovascular disease (RR(10th year) 1.31, 95% CI 1.13-1.52). Advanced-stage patients had more lost days than comparators (mean number(5th year) 66 versus 33, mean difference 34, 95% CI 20-48) as did patients receiving 6-8 chemotherapy courses (62 versus 33, mean difference(5th year) 30, 95 % CI 17-43). Among patients in the first complete remission, a difference was still observed for advanced-stage (51 versus 33, mean difference(5th year) 19, 95% CI 5-34) but not early-stage disease.
  
  
  CONCLUSIONS
  Advanced-stage HL survivors treated with full-dose chemotherapy were at increased risk of work loss, not only explained by relapse, secondary malignancies, or cardiovascular disease.
  
  
  CONCLUSIONS
  The results call for increased awareness and evaluation of reasons for long-term work disability following intensive chemotherapy among young HL survivors.
authors.affiliation: Section of Oncology, Department of Immunology, Genetics and Pathology, University of Uppsala, Uppsala, Sweden.|Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: I
authors.initials: I
authors.lastname: Glimelius
authors.affiliation: Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: S
authors.initials: S
authors.lastname: Ekberg
authors.affiliation: Department of Oncology, Skåne University Hospital, Lund, Sweden.
authors.forename: J
authors.initials: J
authors.lastname: Linderoth
authors.affiliation: Department of Oncology, Skåne University Hospital, Lund, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Jerkeman
authors.affiliation: Health Sciences Practice, Exponent, Inc., Menlo Park, California, and Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: E T
authors.initials: ET
authors.lastname: Chang
authors.affiliation: Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Neovius
authors.affiliation: Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden. karin.ekstrom.smedby@ki.se.
authors.forename: K E
authors.initials: KE
authors.lastname: Smedby
mesh_terms: D000293:Adolescent; D000328:Adult; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D004651:Employment / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006689:Hodgkin Disease / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009367:Neoplasm Staging; D010415:Pensions / Q000706:statistics & numerical data*; D018582:Sick Leave / Q000706:statistics & numerical data*; D017741:Survivors / Q000706:statistics & numerical data*; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D055815:Young Adult
keywords: Cancer survivorship; Chemotherapy; Disability pension; Hodgkin lymphoma; Sick leave; Work loss