Return to work for patients with diffuse large B-cell lymphoma and transformed indolent lymphoma undergoing autologous stem cell transplantation

Abstract

BackgroundAutologous stem cell transplantation (ASCT) is the standard treatment for patients with relapsed diffuse large B-cell lymphoma (DLBCL) or transformed indolent lymphoma (TIL). The treatment is mainly considered for younger patients still available for the work market. In this study, social outcomes after ASCT in terms of return to work (RTW) are described.Patients and methodsInformation from national administrative registers was combined with clinical information on patients, who received ASCT for relapse of DLBCL or TIL between 2000 and 2012. A total of 164 patients were followed until RTW, disability or old-age pension, death, or December 31, 2015, whichever came first. A total of 205 patients were followed with disability pension as the event of interest. Cox models were used to determine cause-specific hazards.ResultsDuring follow-up, 82 (50%) patients returned to work. The rate of returning to work in the first year following ASCT was decreased for patients being on sick leave at the time of relapse (hazard ratio [HR] 0.3 [0.2;0.5]) and increased for patients aged ≥55 years (HR 1.9 [1.1;3.3]). In all, 56 (27%) patients were granted disability pension. Being on sick leave at the time of relapse was positively associated with receiving a disability pension in the first 2 years after ASCT (HR 3.7 [1.8;7.7]).ConclusionPatients on sick leave at the time of relapse have a poorer prognosis regarding RTW and have a higher rate of disability pension. Furthermore, patients >55 are more likely to RTW compared to younger patients. These results indicate an unmet need for focused social rehabilitation.

Care After Lymphoma (CALy) trial: A phase II pilot pragmatic randomised controlled trial of a nurse-led model of survivorship care

“…With improved remission rates, quality of life and well-being can be impacted by long-term and late effects (Leeuwen and Ng, 2017;Sarker et al, 2017). These can include persistent physical effects such as fatigue and cognition impairment (de Lima et al, 2017;Krolak et al, 2017;Leeuwen and Ng, 2017;Linendoll et al, 2016); psychosocial effects such as fear of recurrence, depression, anxiety and distress (Hall et al, 2016;van de Wal et al, 2016); along with practical concerns such as employment and finances (Arboe et al, 2017;Mojs et al, 2017). Survivors also have an increased risk of developing other diseases such as cardiovascular disease (Leeuwen and Ng, 2017) and second cancers (Leeuwen and Ng, 2017;Schaapveld et al, 2015), therefore survivors need an awareness of these potential risks to ensure timely follow-up occurs (Ng et al, 2011).…”

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

“…Interestingly, relapse during the first year after allo-HSCT was not associated with full-time SL 1 year after transplantation. Previous research in autologous HSCT patients has found that relapse of the primary disease was associated with a lower likelihood of RTW in the first year after treatment [11] along with a decreased rate of RTW for patients who were on SL at the time of relapse [33]. The results suggest that those included in this study who relapsed during the first year after allo-HSCT were treated successfully, as they were able to participate in the study at the 1-year follow-up.…”

“…However, a longitudinal study found that of patients who had undergone an autologous HSCT due to relapse after treatment for lymphoma, 30% remained on SL after the first year (part-or full-time SL unknown) (n = 164) [33]. Several studies have examined RTW among HSCT patients and estimates range from 20% to approximately 45% of patients returning to full-time work 1 year after transplantation in research including both autologous and allogeneic participants [10,11,7,33]. Moreover, fewer allogeneic patients RTW within the first year after transplantation compared to autologous patients [11].…”

Living with or beyond lymphoma: A rapid review of the unmet needs of lymphoma survivors

“…Older adults (65–85+ years) were only examined by one study 35 . Chemotherapy was the most common treatment received by participants, with two studies focusing on outcomes relating to stem cell transplantation only 36,54 …”