Return to work following diagnosis of low-grade glioma: A nationwide matched cohort study

Abstract

Objective: Return-to-work (RTW) following diagnosis of infiltrative low-grade gliomas is unknown.

Methods: Swedish patients with histopathologic verified WHO grade II diffuse glioma diagnosed between 2005 and 2015 were included. Data were acquired from several Swedish registries. A total of 381 patients aged 18-60 were eligible. A matched control population (n = 1,900) was acquired. Individual data on sick leave, compensations, comorbidity, and treatments assigned were assessed. Predictors were explored using multivariable logistic regression.

Results: One year before surgery/index date, 88% of cases were working, compared to 91% of controls. The proportion of controls working remained constant, while patients had a rapid increase in sick leave approximately 6 months prior to surgery. After 1 and 2 years, respectively, 52% and 63% of the patients were working. Predictors for no RTW after 1 year were previous sick leave (odds ratio [OR] 0.92, 95% confidence interval [CI] 0.88-0.96, p < 0.001), older age (OR 0.96, 95% CI 0.94-0.99, p = 0.005), and lower functional level (OR 0.64 95% CI, 0.45-0.91 p = 0.01). Patients receiving adjuvant treatment were less likely to RTW within the first year. At 2 years, biopsy (as opposed to resection), female sex, and comorbidity were also unfavorable, while age and adjuvant treatment were no longer significant.

Conclusions: Approximately half of patients RTW within the first year. Lower functional status, previous sick leave, older age, and adjuvant treatment were risk factors for no RTW at 1 year after surgery. Female sex, comorbidity, and biopsy only were also unfavorable for RTW at 2 years.

Figure 1. Flow chart of patient selection

LGG = low-grade glioma.

Figure 2. Sick leave compensation over time (12 months after index date)

(A) Patients with low-grade glioma (n = 381) and (B) controls (n = 1,900) without sick leave compensation (green), with partial compensation (yellow), and with full compensation (red) 1 year prior to and 1 year following the index date (date of primary surgery) (n = 381). The dark gray stack at the bottom represents deceased patients.

Figure 3. Sick leave compensation over time (24 months after index date)

Patients with low-grade glioma without sick leave compensation (green), with partial compensation (yellow), and with full compensation (red) 1 year prior to and 2 years following the index date (date of primary surgery), including only patients with 2 years follow-up data available (n = 343). The dark gray stack at the bottom represents deceased patients.

Figure 4. Sick leave compensation over time in relation to age

(A) Patients aged 18–39 years. (B) Patients aged 40+ years.

Figure 5. Sick leave compensation over time in relation to treatment combinations

(A) Patients with resective surgery receiving adjuvant treatment. (B) Patients with resective surgery without adjuvant treatment. (C) Patients with biopsy receiving adjuvant treatment. (D) Patients with biopsy without adjuvant treatment.