Predictive factors for prolonged sick leave in breast cancer patients treated with adjuvant therapies: a retrospective registry study

Being able to work during and after breast cancer treatments is important for patients to have a sense of normalcy, financial security, and improved quality of life, and for society due to the economic burden of sick leave. Factors influencing the length of sick leave can be sociodemographic factors, workplace adaptations, recurrences, symptoms, and type of treatment. The aim of this study is to analyse factors associated with prolonged sick leave after adjuvant breast cancer treatments. The population of this registry study consists of 1333 early breast cancer patients diagnosed and treated in Helsinki University Hospital between 2016 and 2018. Data on patient demographics, disease characteristics, treatment, and healthcare resource utilization were obtained from Helsinki University Hospital and data on income level and sick leave were obtained from Kela sickness benefits registry. Prolonged sick leave was determined as the patient accumulating 30 or more reimbursed sick leave days during a 60-day follow-up period after the end of active oncological treatment. Univariate analysis and multivariate analysis were conducted. A total of 26% of the patients in this study were on sick leave for 30 or more days after the active treatments ended. Study findings show that chemotherapy, triple-negative breast cancer, reconstructive surgery, amount of outpatient visits, and income are associated with prolonged sick leave. Independent predictors of prolonged sick leave were treatment line, number of outpatient contacts, reconstruction, and triple-negative breast cancer. Our study shows that prolonged sick leave affects a substantial number of working-age women with early breast cancer. Independent predictors for prolonged sick leave were all treatment-related. Targeted support for treatment-related side-effects already during the treatment period could lead to better recovery and earlier return to work.

能够在乳腺癌治疗期间及治疗结束后继续工作，对于患者获得正常生活感、经济保障以及提升生活质量均具有重要意义，同时也可减轻社会因病假(sick leave)产生的经济负担。影响病假时长的因素可包括社会人口学因素、职场适配措施、疾病复发情况、症状表现以及治疗类型。本研究旨在分析辅助乳腺癌治疗(adjuvant breast cancer treatments)后与长期病假(prolonged sick leave)相关的影响因素。本登记研究(registry study)的研究对象为2016年至2018年间在赫尔辛基大学医院确诊并接受治疗的1333例早期乳腺癌患者。患者人口统计学资料、疾病特征、治疗情况以及医疗资源利用数据均来自赫尔辛基大学医院，而收入水平与病假相关数据则取自Kela病假福利登记库。长期病假被定义为患者在积极抗肿瘤治疗(oncological treatment)结束后的60天随访期内，累计获得30天及以上的报销病假天数(reimbursed sick leave days)。本研究采用单因素分析(univariate analysis)与多因素分析(multivariate analysis)方法。本研究中共有26%的患者在积极抗肿瘤治疗结束后休病假达30天及以上。研究结果显示，化疗、三阴性乳腺癌(triple-negative breast cancer)、重建手术、门诊就诊次数以及收入水平均与长期病假存在关联。长期病假的独立预测因素包括治疗线数、门诊接触次数、乳房重建手术以及三阴性乳腺癌。本研究表明，长期病假对大量处于劳动年龄的早期乳腺癌女性患者造成了影响。长期病假的独立预测因素均与治疗相关。在治疗期间即针对治疗相关不良反应提供针对性支持，有助于改善患者康复状况并使其更早重返工作岗位。