Breast and prostate cancer : the impact of diagnosis and treatment on sick leave and work

Treatment for breast or prostate cancer can have negative consequences on working life. In addition to sick leave during treatment, women and men with breast or prostate cancer are at increased risk of permanent absence from work, although data on the underlying reasons for this are sparse. The overall aim of this thesis was to study the impact of breast and prostate cancer and their specific treatments on sick leave and work using population-based Swedish register data.

Studies I and II examined the influence of prostate cancer treatment on sick leave and receipt of disability pension. Two different types of surgery (robot-assisted and open retropubic radical prostatectomy) were studied in men with low-, intermediate- or high-risk prostate cancer, as were the treatment strategies (surgery, radiotherapy, or active surveillance) for men with low- or intermediate-risk prostate cancer. The studies included working-aged men diagnosed with prostate cancer from 2007 onward and matched prostate cancer-free men identified in the Prostate Cancer Data Base Sweden (PCBaSe). In 2,571 men with low-, intermediate- or high-risk prostate cancer (Study I), we found that robot-assisted surgery was associated with an earlier return to work compared with open surgery. Surgery type, however, had no influence on long-term rates of sick leave and disability pension receipt. In 8,699 men with low- or intermediate-risk prostate cancer (Study II), men on active surveillance spent less than half as many days on sick leave due to prostate cancer compared with those treated with primary radical prostatectomy or primary radiotherapy in the first 5 years after diagnosis. At year 5 after diagnosis, there were no major differences in the proportion of men on sick leave, disability pension, and death between treatment strategies.

Studies III and IV were based on working-aged women diagnosed with breast cancer from 1997 onward and matched breast cancer-free women identified in the Breast Cancer Data Base Sweden (BCBaSe). In Study III, we quantified the permanent loss of working time due to breast cancer diagnosis and treatment. Permanent loss was defined as disability pension receipt of at least 75%, early old-age retirement, or death. The study included 19,661 women with breast cancer and 81,303 breast cancer-free women. We estimated that women aged 50 at diagnosis on average lost between 0 years (for in situ and subgroups of stage I breast cancer) and 8 years (for stage IV breast cancer) of their remaining working time due to breast cancer. Study IV examined the underlying causes of sick leave and disability pension receipt after a breast cancer diagnosis. In 16,603 women with stage I to stage III breast cancer, we found that cancer was the most commonly reported cause of sick leave and disability pension receipt, with cancer progression as the strongest determinant. In addition, sick leave and/or disability pension receipt due to lymphedema, fatigue-related conditions, mental disorders, cardiovascular diseases, and inflammatory diseases was more common in women with breast cancer compared with breast cancer-free women.

The results of this thesis show that prostate cancer treatment type has an impact on sick leave and work mainly in the first year of diagnosis. Breast cancer may have a considerable impact on working life, although it is reassuring that many women with early-stage breast cancer are able to remain in the labor market. Disease progression is not the only reason for absence from work in women with breast cancer; our findings suggest that a wide range of physical and physiological conditions underlie the increased risk of permanent absence from work observed in both our studies and others. As a whole, the findings of this thesis can be used to improve the management and rehabilitation of breast and prostate cancer diagnosed in working-aged women and men.

List of scientific papers

I. Plym A, Chiesa F, Voss M, Holmberg L, Johansson E, Stattin P, Lambe M. Work disability after robot-assisted or open radical prostatectomy: A nationwide, population-based study. European Urology. 2016;70(1):64–71.
https://doi.org/10.1016/j.eururo.2015.12.049

II. Plym A, Clements M, Voss M, Holmberg L, Stattin P, Lambe M. Sick leave and disability pension after active surveillance, surgery, or radiotherapy in men with localized prostate cancer in Sweden. [Manuscript]

III. Plym A, Bower H, Fredriksson I, Holmberg L, Lambert PC, Lambe M. Loss in working years after a breast cancer diagnosis. British Journal of Cancer. 2018;118(5):738–743.
https://doi.org/10.1038/bjc.2017.456

IV. Plym A, Johansson ALV, Bower H, Voss M, Holmberg L, Fredriksson I, Lambe M. Causes of sick leave, disability pension, and death following a breast cancer diagnosis in women of working age. [Submitted]