title: Sick leave and disability pension among Swedish testicular cancer survivors according to clinical stage and treatment.
abstract: OBJECTIVE
  To investigate if testicular cancer survivors (TCSs) have a higher incidence of work loss compared with the population, accounting for stage, treatment and relapse.
  
  
  METHODS
  A cohort of 2146 Swedish TCSs diagnosed 1995-2007 (seminoma n = 926, non-seminoma n = 1220) was identified in the SWENOTECA (Swedish-Norwegian Testicular Cancer Group) register, and matched 1:4 to population comparators. Prospectively recorded work loss data (both before and after diagnosis) were obtained from national registers through September 2013. Adjusted relative risks (RR) and 95% confidence intervals (CI) of sick leave and/or disability pension were calculated annually and overall with Poisson- and Cox regression, censoring at relapse. The mean number of annual work days lost was also estimated.
  
  
  RESULTS
  TCSs were at a modestly increased annual risk of work loss up to the third year of follow-up (RR3rd year 1.25, 95% CI 1.08, 1.43), attributed to a more pronounced risk among extensively treated patients (4 chemotherapy courses: RR3rd year 1.60, 95% CI 1.19, 2.15; > 4 courses: RR3rd year 3.70, 95% CI 2.25, 6.11). Patients on surveillance or limited treatment (radiotherapy, 1-3 chemotherapy courses) did not have an increased risk of work loss beyond the first year. TCSs receiving > 4 chemotherapy courses had higher mean number of annual days of work loss up to the 10th year post-diagnosis, and a five-fold risk of disability pension (RR 5.16, 95% CI 2.00, 10.3).
  
  
  CONCLUSIONS
  Extensively treated TCSs, but not those on surveillance or limited treatment, are at increased risk of work loss long-term, not explained by relapse. These patients may benefit from early rehabilitation initiatives.
authors.affiliation: a Department of Oncology-Pathology , Radiumhemmet, Karolinska Institute and University Hospital , Stockholm , Sweden.
authors.forename: Carina
authors.initials: C
authors.lastname: Nord
authors.affiliation: b Department of Clinical Sciences , Division of Oncology and Pathology, Lund University, Skåne University Hospital , Lund , Sweden.
authors.forename: Sven-Erik
authors.initials: SE
authors.lastname: Olofsson
authors.affiliation: c Department of Immunology , Genetics and Pathology, Unit of Oncology, Uppsala University Hospital , Uppsala , Sweden.|e Department of Medicine , Karolinska Institutet, Clinical Epidemiology Unit , Stockholm , Sweden.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Glimelius
authors.affiliation: a Department of Oncology-Pathology , Radiumhemmet, Karolinska Institute and University Hospital , Stockholm , Sweden.
authors.forename: Gabriella Cohn
authors.initials: GC
authors.lastname: Cedermark
authors.affiliation: d Department of Medical Epidemiology and Biostatistics , Karolinska Institute , Stockholm , Sweden.|e Department of Medicine , Karolinska Institutet, Clinical Epidemiology Unit , Stockholm , Sweden.
authors.forename: Sara
authors.initials: S
authors.lastname: Ekberg
authors.affiliation: b Department of Clinical Sciences , Division of Oncology and Pathology, Lund University, Skåne University Hospital , Lund , Sweden.
authors.forename: Eva
authors.initials: E
authors.lastname: Cavallin-Ståhl
authors.affiliation: e Department of Medicine , Karolinska Institutet, Clinical Epidemiology Unit , Stockholm , Sweden.
authors.forename: Martin
authors.initials: M
authors.lastname: Neovius
authors.affiliation: b Department of Clinical Sciences , Division of Oncology and Pathology, Lund University, Skåne University Hospital , Lund , Sweden.
authors.forename: Mats
authors.initials: M
authors.lastname: Jerkeman
authors.affiliation: e Department of Medicine , Karolinska Institutet, Clinical Epidemiology Unit , Stockholm , Sweden.
authors.forename: Karin E
authors.initials: KE
authors.lastname: Smedby
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016022:Case-Control Studies; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D019583:Dose Fractionation, Radiation; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009919:Orchiectomy; D010415:Pensions / Q000706:statistics & numerical data*; D012307:Risk Factors; D018239:Seminoma / Q000556:secondary* / Q000628:therapy*; D018582:Sick Leave / Q000706:statistics & numerical data*; D017741:Survivors / Q000706:statistics & numerical data*; D013548:Sweden; D013736:Testicular Neoplasms / Q000473:pathology* / Q000628:therapy*; D013997:Time Factors; D014478:Unemployment / Q000706:statistics & numerical data; D055815:Young Adult