Sick leave and disability pension among Swedish testicular cancer survivors according to clinical stage and treatment

Figures & data

Table I. Characteristics of testicular cancer survivors (TCSs) diagnosed in Sweden 2000–2007 (seminoma) or 1995–2007 (non-seminoma), and male population comparators matched to the patients by age and calendar year of diagnosis.

	Testicular cancer survivors	Population comparators	p-value	Testicular cancer survivors
				Seminoma	Non-seminoma
N (%)	2146 (100)	8448 (100)		926 (43)	1220 (57)
Age (years), N (%)
18–30	898 (42)	3541 (42)		203 (22)	695 (57)
31–40	802 (37)	3148 (37)		426 (46)	376 (31)
41–50	310 (14)	1224 (14)		200 (22)	110 (9)
51–60	136 (6)	535 (6)		97 (10)	39 (3)
Median (range)	32 (18–60)	32 (18–60)	1.00	36 (18–60)	29 (18–60)
Calendar period N (%)					A
1995–1998	314 (15)	1241 (15)		0	314 (26)
1999–2002	704 (33)	2778 (33)		304 (33)	400 (33)
2003–2006	896 (42)	3524 (42)		484 (52)	412 (34)
2007	232 (11)	905 (11)	1.00	138 (15)	94 (8)
Education N (%)
≤ 9 years	324 (15)	1229 (15)		123 (13)	201 (16)
10–12 years	1150 (54)	4523 (53)		470 (51)	680 (56)
> 12 years	643 (30)	2591 (31)	0.85	322 (35)	321 (26)
Missing	29 (1)	105 (1)		11 (1)	18 (2)
Unemployment year –1 to 0 N (%)^a	70 (4)	286 (4)	0.83	27 (3)	43 (4)
Sick-leave or disability pension year –2 to –1 N (%)^b	221 (11)	900 (11)	0.63	111 (12)	110 (10)
Clinical stage N (%)^c
CS I	1515 (71)	–		816 (88)	699 (57)
CS II	361 (17)	–		89 (10)	272 (22)
CS III	37 (2)	–		13 (1)	24 (2)
CS IV	186 (9)	–		8 (1)	178 (14)
CS Mk+^d	47 (2)	–		NA	47 (4)
Primary treatment N (%)
No or limited treatment
Surveillance	605 (29)	–		309 (35)	296 (25)
Radiotherapy^e	300 (14)	–		300 (32)	0
Chemotherapy
1 course	621 (29)	–		219 (23)	402 (33)
2–3 courses	118 (6)	–		7 (1)	111 (9)
Extensive treatment
4 courses	384 (18)	–		75 (8)	309 (25)
> 4 courses	102 (5)	–		3 (0.3)	99 (8)
Treatment missing	16 (0.6)	–		13 (1)	3 (0.2)
High dose chemotherapy^f	22 (1)	–		1 (0.1)	21 (2)
Surgery^g	313 (14)	–		6 (0.6)	307 (25)
Follow-up (years) median (range)	10 (2–19)	10 (2–19)		9 (2–14)	12 (2–19)
Relapse N (%)	124 (6)	–		35 (4)	88 (7)
Dead N (%)	33 (1.5)	137 (1.6)		12 (1)	21 (2)

^aUnavailable for subjects aged < 21 years at diagnosis/match date: TCSs n = 70 (Seminoma n = 4, Non-seminoma n = 66, Population comparators n = 280); ^b Unavailable for the years prior to 1994 or for subjects aged < 21 years at diagnosis/match date TCSs n = 105 (Seminoma n = 4, Non-seminoma n = 101), Population comparators n = 418; ^c According to Medical Research Council [13]; ^d Tumor marker positive without macroscopic metastasis; ^e Radiotherapy adjuvantly (n = 288, 20 Gy/10 fractions) or for metastatic disease (n = 12, 27 Gy/15 fractions); ^f High dose chemotherapy with stem cell support given as primary treatment. These patients were also included in the group chemotherapy: > 4 courses; ^g Post-chemotherapy retroperitoneal lymph node dissection and/or other surgery of metastases. These patients are also included in the chemotherapy groups.

Figure 1. Total number of days of sick leave or disability pension from 2 years before, up to maximum 10 years after diagnosis (Dx) among TCSs and comparators (Comp). The numbers at risk and differences in mean annual days between TCSs and comparators, with 95% CI, are displayed below the graphs. Numbers within the bars represent percentages. The 75th percentile (p75) and 90th percentile (p90) are indicated by the lines and refers to the mean annual days of sick-leave or disability pension indicated on the secondary y-axis.

Table II. Relative risk (RR) and 95% confidence intervals (CI) of annual sick-leave or disability pension among TCSs compared with matched population comparators in the 3rd and 5th year after diagnosis. First, patients are grouped by tumor subtype and clinical stage (CS) and second by treatment modality. Follow-up is censored at relapse.

RR, relative risk; CS, clinical stage.

*RRs adjusted for education level, sick-leave 1–2 years prior to diagnosis, unemployment > 50% 0–1 years prior to diagnosis and region of residence in Sweden. Patients with relapse were censored 3 months before the event.

^↑p-value>0.01.

^↓p-value>0.001.

Table III. Mean days of sick-leave or disability pension among TCSs and population comparators (Comp) in the 3rd and 5th years after diagnosis. Patients are stratified by no or limited treatment versus extensive treatment, and then further by age, calendar period, educational level and previous sick-leave or disability pension. Follow-up is censored at relapse.

	3rd year				5th year
	TCSs/Comp N	Mean days of sick-leave and disability pension			TCSs/Comp N	Mean days of sick-leave and disability pension
		TCSs	Comp	Difference (95% CI)		TCSs	Comp	Difference (95% CI)
No or limited treatment^a	1545/8293	22	21	1 (–3, 6)	1476/7956	21	19	2 (–2, 6)
Age
18–35	933/5158	16	14	2 (–2, 7)	897/4996	15	12	3 (–2, 7)
36–60	612/3135	32	32	–1 (–8, 7)	579/2960	31	30	1 (–8, 9)
Calendar period
1995–1999	252/1597	20	17	3 (–7, 13)	248/1566	28	19	9 (–3, 20)
2000–2007	1293/6696	22	22	1 (–4, 6)	1228/6390	20	19	1 (–4, 6)
Education
≤ 9 years	206/1198	48	50	–2 (–19, 15)	195/1140	50	45	5 (–13, 23)
10–12 years	831/4477	20	19	1 (–5, 6)	804/4314	18	17	1 (–4, 6)
> 12 years	490/2520	10	6	4 (–1, 9)	460/2411	9	7	2 (–3, 6)
Sick-leave/disability pension year –2 to –1
No	930/5423	8	8	0 (–2, 3)	646/3859	9	9	0 (–3, 3)
Yes	128/675	128	128	0 (–27, 228)	88/457	116	103	13 (–13, 39)
Extensive treatment^b	440/8293	34	21	14 (5, 22) ^↓	429/7956	32	19	13 (4, 22) ^↓
Age
18–35	306/5158	26	14	12 (3, 22) ^↑	302/4996	23	12	11 (2, 21) ^↑
36–60	134/3135	53	32	21 (2, 40) ^↑	127/2960	51	30	21 (2, 40) ^↑
Calendar period
1995–1999	166/1597	41	17	24 (5, 42) ^↑	114/1566	42	19	23 (3, 43) ^↑
2000–2007	324/6696	32	22	10 (0, 20)	315/6390	28	19	9 (–1, 19)
Education
≤ 9 years	92/1198	64	50	14 (–12, 40)	91/1140	56	45	11 (–14, 36)
10–12 years	240/4477	29	19	10 (–1, 21)	231/4314	29	17	11 (0, 23)
> 12 years	101/2520	13	6	7 (–3, 118)	100/2411	11	7	4 (–6, 14)
Sick-leave/disability pension year –2 to –1
No	371/6995	20	8	12 (5, 20) ^↑	362/6717	19	9	10 (3, 18) ^↑
Yes	40/883	174	128	46 (–6, 98)	38/833	158	103	55 (3, 107) ^↑

^aSurveillance/radiotherapy/chemotherapy 1–3 courses.

^bChemotherapy ≥ 4 courses.

^↑p-value>0.05.

^↓p-value>0.01.

Figure 2. Mean annual days of sick-leave or disability pension from 2 years before, up to maximum 10 years after diagnosis (Dx) among TCSs treated with chemotherapy and population comparators. The numbers at risk and differences in mean annual days between TCSs and comparators, with 95% confidence intervals (CI), are displayed below the graph.

Table IV. Hazard ratio (HR) and 95% confidence intervals (CI) of disability pension among testicular cancer survivors (TCSs) compared with matched population comparators. First, patients are grouped by tumor subtype and clinical stage (CS) and second by treatment modality. Follow-up is censored at relapse.

CS, Clinical stage; HR, Hazard ratio.

^aHRs adjusted for education, sick-leave 1–2 years prior to diagnosis, unemployment > 50% 0–1 years prior to diagnosis and region of residence in Sweden. Patients with relapse were censored 3 months before the event. Patients with disability pension before testicular cancer diagnosis where excluded from the analysis.

^↑p-value>0.05.

^↑p-value>0.01.

^↕p-value>0.001.

Peckham MJ, Bagshaw KD, Blandy JP. Prognostic factors in advanced non-seminatous germ-cell testicular tumours: Results of a multicenter study. Report from the Medical Research Council Working Party on Testicular Tumours. Lancet 1985;1:8.

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