title: Lost workdays in uterine cervical cancer survivors compared to the general population: impact of treatment and relapse.
abstract: The aim of the present study was to examine the risk of lost workdays due to sick leave and disability pension by treatment modality and relapse in a population-based cohort of cervical cancer survivors versus matched comparators.
  
  
  
  We identified 1971 cervical cancer patients aged ≤60 years (median 42) at diagnosis in Sweden 2003-2009 and 9254 population comparators. Information on sociodemographic and clinical characteristics, sick leave, and disability pension was retrieved from nationwide prospective registers. Differences in the annual mean number of lost workdays were calculated by linear regression, and hazard ratios (HRs) of disability pension were calculated by Cox regression analysis, with follow-up through September 2013.
  
  
  
  Cervical cancer patients had more lost workdays annually than comparators up to 8 years following diagnosis. Relapse-free patients had more lost workdays than comparators up to 4 years. Risk of disability pension during follow-up was increased among the relapse-free patients treated with hysterectomy (HR 1.8 [95 % confidence interval (CI) 1.1-2.8]), hysterectomy plus chemotherapy and/or radiotherapy (HR 2.5 [95 % CI 1.2-5.4]), or chemotherapy and/or radiotherapy alone (HR 3.0 [95 % CI 1.3-6.8]), compared with the population. Women treated with fertility-sparing surgery did not have more lost workdays than the population beyond the first year and were not at increased risk of disability pension.
  
  
  
  We observed a long-standing increased risk of lost workdays among cervical cancer patients, overall, as well as among relapse-free patients.
  
  
  
  Extensive but not limited treatment was associated with increased risk of lost workdays, possibly reflecting an association between treatment side effects and work ability.
authors.affiliation: Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden. asa.hallqvist-everhov@ki.se.|Department of Surgery, South Hospital, SE 118 61, Stockholm, Sweden. asa.hallqvist-everhov@ki.se.
authors.forename: Åsa H
authors.initials: ÅH
authors.lastname: Everhov
authors.affiliation: Unit of Clinical Epidemiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Sara
authors.initials: S
authors.lastname: Ekberg
authors.affiliation: Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Angelica Lindén
authors.initials: AL
authors.lastname: Hirschberg
authors.affiliation: Department of Oncology, Sahlgrenska Academy, Gothenburg, Sweden.
authors.forename: Karin
authors.initials: K
authors.lastname: Bergmark
authors.affiliation: Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Angelique Flöter
authors.initials: AF
authors.lastname: Rådestad
authors.affiliation: Unit of Clinical Epidemiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.|Department of Immunology, Genetics and Pathology, Unit of Oncology, Uppsala University, Uppsala, Sweden.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Glimelius
authors.affiliation: Unit of Clinical Epidemiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Karin E
authors.initials: KE
authors.lastname: Smedby
mesh_terms: D000328:Adult; D002908:Chronic Disease; D015331:Cohort Studies; D006233:Persons with Disabilities / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010415:Pensions; D011446:Prospective Studies; D012008:Recurrence; D012042:Registries; D018582:Sick Leave / Q000706:statistics & numerical data*; D017741:Survivors / Q000706:statistics & numerical data*; D013548:Sweden / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy*; D055815:Young Adult
keywords: Chemotherapy; Disability pension; Hysterectomy; Radiotherapy; Sick leave; Uterine cervical cancer