Important factors associated with sick leave after allogeneic haematopoietic stem cell transplantation—a 1-year prospective study

Abstract

Purpose This study examines sick leave (SL) and factors associated with full-time SL 1 year after allogeneic haematopoietic stem cell transplantation (allo-HSCT) in patients of working age from 2009 to 2016 (n = 122). Methods Questionnaire data were collected on admission to the allo-HSCT unit, at 7 months and 1 year after allo-HSCT. Associations between factors and SL were analysed using logistic regression analyses. Results One year after allo-HSCT, 76% of participants were on SL, with 36% on full-time SL. In univariable analyses, chronic graft-versus-host-disease (cGvHD) (OR 3.07; 95% CI 1.34–7.07; p = 0.01), having symptoms of depression at 7 months (OR 4.81; 95% CI 1.69–13.69; p = 0.00) and low levels of vocational satisfaction at 7 months after treatment (OR 3.27; 95% CI 1.27–8.41; p = 0.01) were associated with full-time SL 1 year after allo-HSCT. cGvHD (OR 3.43; 95% CI 1.35–8.73; p = 0.01) and having symptoms of depression at 7 months after allo-HSCT (OR 3.37; 95% CI 1.2–11.58; p = 0.02) remained significant in multivariable analysis. Conclusion The majority of allo-HSCT survivors were on SL 1 year after treatment, and cGvHD, low vocational satisfaction and depressive symptoms were associated with full-time SL 1 year after allo-HSCT. Implications for Cancer Survivors Healthcare professionals need to be observant of and manage the consequences of cGvHD and patients’ symptoms of depression in order to support them appropriately in their return-to-work process.

Symptom Burden and Recovery in the First Year After Allogeneic Hematopoietic Stem Cell Transplantation

“…This is consistent with previous research showing that health-related issues can delay a return to work, 21–24 with physical recovery occurring earlier than work recovery 22 . The ability to return to work is a sign of recovery for many allo-HSCT patients as it is perceived as a chance to return to normality, 42–44 but because of the severity of the treatment and subsequent adverse effects, most allo-HSCT survivors are on sick leave for long periods, with research showing that 1 year after allo-HSCT, 76% are still on either part- or full-time sick leave, 23 and 8 years after allo-HSCT, only 57% of survivors were back in full-time work or equivalent 24 . Early diagnosis of cGvHD together with treatment, evaluation, and the use of supportive care can alleviate complications and long-term conditions, 45 which may result in an improved work recovery for patients.…”

“…Results also revealed that the prevalence of cGvHD at some point during the first year after allo-HSCT is associated with full-time sick leave 1 year after treatment. This is consistent with previous research showing that health-related issues can delay a return to work, 21–24 with physical recovery occurring earlier than work recovery 22 . The ability to return to work is a sign of recovery for many allo-HSCT patients as it is perceived as a chance to return to normality, 42–44 but because of the severity of the treatment and subsequent adverse effects, most allo-HSCT survivors are on sick leave for long periods, with research showing that 1 year after allo-HSCT, 76% are still on either part- or full-time sick leave, 23 and 8 years after allo-HSCT, only 57% of survivors were back in full-time work or equivalent 24 .…”

“…19 A medical complication that can result in a lower quality of life is cGvHD, 5,20 and patients suffering from medical complications due to allo-HSCT are also more likely to be on long-term sick leave. [21][22][23] Other risk factors for prolonged sick leave are physical dysfunction, 21 poorer health, 24 and fatigue. 25 In addition, physical activity has been shown to have a positive effect on the physiological, psychological, and psychosocial health of allo-HSCT patients, 26 including a reduction of fatigue 27 and better quality of life.…”

“…Factors that can affect health in allo-HSCT patients are demographics, where, for example, females have been found to be associated with a higher symptom occurrence and lower physical functioning, 17,18 and older age, where patients often report decreased physical well-being 19 . A medical complication that can result in a lower quality of life is cGvHD, 5,20 and patients suffering from medical complications due to allo-HSCT are also more likely to be on long-term sick leave 21–23 . Other risk factors for prolonged sick leave are physical dysfunction, 21 poorer health, 24 and fatigue 25 .…”

Psychosocial and financial issues after hematopoietic cell transplantation

“…18 Chronic GVHD is a major fac tor influ enc ing RTW/sick leave, with one-quar ter of patients with chronic GVHD reporting being "dis abled/unable to work" at a median of 2 years post HCT. 16,19 Lower phys i cal func tion ing, multimorbidity, being female, and the receipt of periph eral blood stem cells for an unre lated HCT are asso ci ated with a lower like lihood of RTW post HCT. [20][21][22] A lack of stan dard guide lines for RTW lead ing to poor com mu ni ca tion between pro vid ers, patients, and employers can be a bar rier to suc cess ful rein te gra tion of patients in the work place after HCT.…”