Duration of sick leave after active surveillance, surgery or radiotherapy for localised prostate cancer: a nationwide cohort study

Abstract

Objectives: To compare the loss of working time due to sick leave by treatment strategy for localised prostate cancer.

Design: Nationwide cohort study.

Setting: Sweden.

Participants: A total of 15 902 working-aged men with localised low or intermediate-risk prostate cancer diagnosed during 2007-2016 from the Prostate Cancer Data Base Sweden, together with 63 464 prostate cancer-free men. Men were followed until 2016.

Primary and secondary outcome measures: Using multistate Markov models, we calculated the proportion of men on work, sick leave, disability pension and death, together with the amount of time spent in each state. All-cause and cause-specific estimates were calculated.

Results: During the first 5 years after diagnosis, men with active surveillance as their primary treatment strategy spent a mean of 17 days (95% CI 15 to 19) on prostate cancer-specific sick leave, as compared with 46 days (95% CI 44 to 48) after radical prostatectomy and 44 days (95% CI 38 to 50) after radiotherapy. The pattern was similar after adjustment for cancer and sociodemographic characteristics. There were no differences between the treatment strategies in terms of days spent on sick leave due to depression, anxiety or stress. Five years after diagnosis, over 90% of men in all treatment strategies were free from sick leave, disability pension receipt and death from any cause.

Conclusions: Men on active surveillance experienced less impact on working life compared with men who received radical prostatectomy or radiotherapy. From a long-term perspective, there were no major differences between treatment strategies. Our findings can inform men diagnosed with localised prostate cancer on how different treatment strategies may affect their working lives.

Keywords: prostatectomy; prostatic neoplasms; radiotherapy; sick leave; watchful waiting.

Figure 1

Probabilities of work, sick leave, disability pension receipt and death by initial treatment strategy and time since diagnosis in men with localised low and intermediate-risk prostate cancer and matched prostate cancer-free men. AS, active surveillance; PCa, prostate cancer; RP, radical prostatectomy; RT, radiotherapy.

Figure 2

Proportion of sick leave spent by men remaining in initial treatment group and by men with secondary treatment by time since diagnosis. ADT, androgen deprivation therapy; AS, active surveillance; RP, radical prostatectomy; RT, radiotherapy.