Risk factors for return to work in colorectal cancer survivors

Abstract

Background: The increasing incidence of colorectal cancer among individuals in the productive age-group has adversely affected the labor force and increased healthcare expenses in recent years. Return to work (RTW) is an important issue for these patients. In this study, we explored the factors that influence RTW and investigated the influence of RTW on survival outcomes of patients with colorectal cancer.

Methods: Data of individuals (N = 4408) in active employment who were diagnosed with colorectal cancer between 2004 and 2010 were derived from 2 nationwide databases. Subjects were categorized into 2 groups according to their employment status at 5-year follow-up. Logistic regression analysis was performed to identify the factors associated with RTW. Survivors were further followed up for another 8 years. Propensity score matching was applied to ensure comparability between the two groups, and survival analysis was performed using the Kaplan-Meier method.

Results: In multivariable regression analysis for 5-year RTW with different characteristics, older age (OR: 0.57 [95% CI, 0.48-0.69]; p < 0.001), treatment with radiotherapy (OR: 0.69 [95% CI, 0.57-0.83]; p < 0.001), higher income (OR: 0.39 [95% CI, 0.32-0.47]; p < 0.001), medium company size (OR: 0.78 [95% CI, 0.63-0.97]; p = 0.022), and advanced pathological staging (stage I, OR: 16.20 [95% CI, 12.48-21.03]; stage II, OR: 13.12 [95% CI, 10.43-16.50]; stage III, OR: 7.68 [95% CI, 6.17-9.56]; p < 0.001 for all) revealed negative correlations with RTW. In Cox proportional hazard regression for RTW and all-cause mortality, HR was 1.11 (95% CI, 0.80-1.54; p = 0.543) in fully adjusted model.

Conclusion: Older age, treatment with radiotherapy, higher income, medium company size, and advanced pathological stage showed negative correlations with RTW. However, we observed no significant association between employment and all-cause mortality. Further studies should include participants from different countries, ethnic groups, and patients with other cancers.

Keywords: colorectal cancer; prognostic factor; retrospective cohort study; return to work.

FIGURE 1

Flowchart of the study protocol

FIGURE 2

Kaplan–Meier curve for all‐cause mortality