Lung cancer survivors and employment: A systematic review
Introduction
For years, lung cancer (LC) has been considered as a severe disease characterised by poor prognosis and short-term survival. Nowadays, promising results of new therapies are broadening the therapeutic perspectives for LC patients. Early detection and more effective treatments have provided a notable improvement of long-term survival rates [1,2]. Immunotherapy, with highly selective humanized monoclonal antibodies, have shown satisfying results in terms of efficiency and low toxicity [3,4]. Despite the severity of the disease, more individuals are now able to resume their normal activities after diagnosis and treatment. As their mental and physical functioning is improving, patients can consider a social and professional rehabilitation. Return to work (RTW) is defined as recovery of the ability to perform work tasks after sick leave. This process is challenging for patients, who may face sequelae of the disease, side effects of their past and current treatments and potentially a psychological trauma after cancer. However, the professional rehabilitation of cancer survivors represents a crucial threshold and should be medically supported [5]. RTW is associated with health-related quality of life of patients [6]. Resuming work helps to regain a sense of normalcy, self-satisfaction and confidence. Moreover, RTW represents a priority for economic reasons, both at the individual and societal scale. LC can be associated with an increased social vulnerability and impoverishment. On a larger scale, LC and its treatments raise challenges in terms of economic sustainability. A clear understanding of the impact of new therapies is crucial in order to determine their cost-efficiency. Thus, the promising efficiency of immunotherapies could allow RTW of LC survivors and reduce indirect costs of the disease and its treatments. This remains to be demonstrated but represents an enthusiastic pathway for the economic sustainability of immunotherapeutic molecules. As LC long-term survivorship represents a recent topic, few studies have addressed the question of employment status and return to work of LC survivors. The aim of this systematic review is to precise the risk of unemployment among LC patients, to examine the economic consequences of unemployment on LC patients and society and to identify a potential impact of the therapeutic evolution on the RTW prognosis of patients.
Section snippets
Protocol
The “Preferred Reported Items for Systematic Reviews and Meta-analyses” (PRISMA) statement was used as a formal guideline [7]. Details are provided in Additional file 1 (S1_Appendix. PRISMA Checklist).
Eligibility criteria
Studies were included if they met the following criteria: (1) inclusion of patients diagnosed with LC (2); assessment of employment status or employment outcomes or work adjustments or RTW (3); inclusion of scientific papers published in peer-reviewed journals (4); inclusion of articles written
Description of included studies
A total of 642 papers were retrieved from the electronic database, including 17 duplicates. Titles and abstracts were analysed and 78 papers were considered relevant for the topic. After assessment of inclusion and non-inclusion criteria, 23 articles were included in the systematic review. Five were longitudinal studies and 18 were cross-sectional studies. The reasons for exclusion are reported in the flow chart (Fig. 1. Flow chart). Details concerning their quality assessment are given in
Summary of evidence
LC survivors are 2–3 times more likely to be unemployed as compared with control groups (patients with no cancer or cancer with less impact on employment) (1120–222,425). Our findings highlight a median duration of sickness absence increased for LC survivors compared to control groups. This increase in sick days (sick leave and disability pension) occurs both pre- and post-diagnosis [17,19,28,29]. The time to partial or full RTW is increased in LC [16,19,28,29] with a median duration varying
Conclusions
The risk of unemployment among LC survivors remains high. With an often delayed RTW compared to other cancers, LC patients are likely to experience economic and social complications. However, the introduction of novel molecularly targeted agents and immunotherapy drugs in the treatment of LC survivors is changing the prognosis of patients in terms of overall survival and quality of live. These promising results may be associated with a better RTW prognosis of patients. Future research should
Compliance with ethical standards
Research involving human participants and/or animals.
Ethics approval and consent to participate
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional committee, national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with humans or animals performed by any of the authors.
Informed consent
No individual participants were included in the study.
Availability of data and material
All data generated or analysed during this study are included in this published article.
Conflict of interest
None declared.
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