Elsevier

Lung Cancer

Volume 131, May 2019, Pages 31-39
Lung Cancer

Lung cancer survivors and employment: A systematic review

https://doi.org/10.1016/j.lungcan.2019.03.010Get rights and content

Highlights

  • To our knowledge, it is the first study to gather, in a comprehensive manner, employment data on LC patients.

  • Being employed is correlated with a better quality of life regarding physical functioning.

  • On a societal perspective, RTW of LC patients represents a priority as the costs associated with work loss and reduction of productivity have a significant impact.

  • New drug therapies may increase the patients’ chance of resuming their former activities (including working).

  • Therefore, potentially reduce the economic burden they place on healthcare systems.

Abstract

Background

The aim of this systematic review is to identify, in a comprehensive manner, the impact of lung cancer on the employment status of survivors.

Methods

The Preferred Reported Items for Systematic Reviews and Meta-analyses (PRISMA) statement was used as a formal guideline. The systematic review includes scientific papers published between January 2000 and October 2018. The search strategy queried the database MEDLINE. Inclusion criteria comprised: (1) inclusion of patients diagnosed with lung cancer (LC) (2); assessment of employment status or employment outcomes or work adjustments or return to work (3); inclusion of scientific papers published in peer-reviewed journals (4); inclusion of articles written either in English or in French. Literature reviews were not included.

Results

A total of 642 scientific papers were retrieved. Twenty-three articles were included in the systematic review: 5 longitudinal studies and 18 cross-sectional studies. LC survivors are 2–3 times more likely to be unemployed as compared with control groups. Previous studies highlight a median duration of sickness absence increased for LC survivors compared to control groups. The strongest decline in earnings was observed among LC survivors as compared to other cancer types.

Conclusions

LC is associated with a significant impact on employment of patients. The promising results of recent therapeutic strategies could lead to a better social and professional prognosis. A reduction of indirect costs is to be expected.

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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