Pattern of employment and associated factors in long-term lymphoma survivors 10 years after high-dose chemotherapy with autologous stem cell transplantation

Figures & data

Figure 1. Flowchart of the study.

Figure 2. Proportions of employed patients over time according to sex and total sample (N = 312)*.

*The difference between men and women are p < 0.007 before and after HDT-ASCT and at survey. HDT-ASCT: high-dose chemotherapy with autologous stem cell transplantation.

Table 1. Patterns of employment (E) and not-employment (N) over time (N=312).

Patterns of employment	At diagnosis	Before HDT-ASCT*	After HDT-ASCT*	At survey	Total N (%)
1	E	E	E	E	148 (47)
2	E	E	E	N	48 (15)
3	E	E	N	N	33 (11)
4	E	N	N	N	18 (6)
5	N	N	N	N	16 (5)
6	E	N	E	N	11 (4)
7	N	N	E	E	11 (4)
8	N	E	E	E	8 (2)
9	E	N	E	N	7 (2)
10	N	N	E	N	6 (2)
11	N	U	E	E	1 (0.6)
12	N	E	E	N	1 (0.6)
13	N	N	N	E	1 (0.6)

Table 2. Demographic and disease characteristics of the sample according to work status at follow-up survey (N = 281).

Variables	Employed (N = 179) N (%)	Not-employed (N = 102) N (%)	p-Value	Total (N = 281) N (%)
Males	122 (68)	46 (45)	<0.001	168 (60)
Females	57 (32)	56 (55)		113 (40)
Not in paired relationship	49 (27)	27 (26)	0.85	76 (27)
High level of education	92 (58)	36 (36)	0.010	128 (46)
Higher annual family income	104 (58)	23 (24)	<0.001	127 (46)
Treatment periods			0.61
1987–1995	24 (13)	17 (17)		41 (15)
1996–2002	54 (30)	26 (25)		80 (28)
2003–2008	101 (56)	59 (58)		160 (57)
Lymphoma stages (Ann Arbor)			0.24
I–II	60 (33)	27 (27)		87 (31)
III–IV	119 (67)	74 (73)		193 (69)
Relapse after HDT-ASCT	37 (21)	23 (22)	0.71	60 (21)
Allogeneic stem cell transplantation	12 (7)	7 (7)	0.96	19 (7)
Treatment lines before HDT-ASCT
One	56 (31)	26 (26)	0.39	82 (29)
Two	99 (55)	57 (58)		156 (56)
Three or more	24 (14)	19 (19)		43 (15)
Type of lymphoma			0.16
Hodgkin lymphoma	47 (26)	23 (22)		70 (25)
Aggressive NHL	117 (65)	63 (62)		180 (64)
Indolent NHL	15 (9)	16 (16)		31 (11)
Second cancer	7 (4)	8 (8)	0.16	15 (5)
≥1 comorbid somatic disease	96 (54)	71 (70)	0.009*	167 (59)
Poor physical work ability	19 (11)	54 (59)	<0.001*	73 (27)
Poor mental work ability	10 (6)	28 (33)	<0.001*	38 (15)
Work changes due to lymphoma	23 (13)	24 (24)	0.047*	47 (17)
	Mean (SD)	Mean (SD)		Mean (SD)
Age at diagnosis, years	37.8 (12.6)	43.4 (13.2)	0.001	39.8 (13.1)
Age at HDT-ASCT, years	40.7 (12.7)	46.0 (13.3)	0.001	42.6 (13.1)
Age at survey, years	50.4 (11.1)	55.6 (12.5)	<0.001	52.3 (11.7)
Time diagnosis – survey, years	12.6 (6.4)	12.3 (5.9)	0.69	12.5 (6.2)
Time HDT-ASCT – survey, years	9.7 (5.3)	9.6 (5.2)	0.82*	9.7 (5.3)
Work ability at diagnosis	9.2 (1.8)	7.3 (3.5)	<0.001*	8.7 (2.5)
Work ability at survey	7.3 (2.5)	3.6 (3.2)	<0.001*	5.3 (3.2)
Change of work ability	2.0 (2.9)	4.1 (4.3)	<0.001*	2.7 (3.5)

*Adjusted for age at survey, sex, and level of education.

HDT-ASCT, high-dose chemotherapy with autologous stem cell transplantation.

Bold values signify p < 0.05.

Table 3. Fatigue, quality of life, mental problems and lifestyle of the sample according to employment status at follow-up survey (N = 281).

Variables	Employed (N = 179) Mean (SD)	Not-employed (N = 102) Mean (SD)	p-Value*	Total (N = 281) Mean (SD)
Fatigue (FQ)
Physical fatigue	9.4 (4.0)	11.0 (4.5)	0.004	10.0 (4.2)
Mental fatigue	4.4 (1.6)	5.4 (2.1)	<0.001	4.8 (1.9)
Total fatigue	13.8 (5.1)	16.4 (6.2)	<0.001	14.7 (5.6)
HRQoL dimensions (SF-36)
Physical functioning	86.6 (16.0)	74.7 (24.6)	<0.001	82.5 (20.3)
Role physical	71.9 (39.1)	47.7 (43.5)	<0.001	63.3 (42.3)
Bodily pain	73.7 (24.8)	62.9 (28.2)	0.013	70.5 (26.3)
General health	63.7 (26.3)	49.4 (23.8)	<0.001	59.9 (26.3)
Vitality	57.2 (23.4)	45.4 (26.6)	<0.001	53.0 (25.3)
Social functioning	86.0 (20.0)	71.2 (27.0)	<0.001	80.5 (23.9)
Role emotional	82.2 (34.2)	65.5 (43.2)	0.002	76.2 (38.5)
Mental health	80.8 (15.6)	74.1 (17.1)	<0.001	78.4 (16.5)
PCS-36	47.9 (9.9)	41.3 (11.8)	<0.001	45.2 (10.9)
MCS-36	52.5 (9.3)	49.1 (10.5)	0.004	51.3 (9.8)
HADS**
Level of anxiety	4.0 (3.6)	5.3 (4.4)	0.004	4.4 (4.0)
Level of depression	2.8 (3.2)	4.2 (3.5)	0.001	3.3 (3.3)
	N (%)	N (%)		N (%)
Negative affectivity present	51 (29)	44 (45)	0.001	95 (39)
Social inhibition present	60 (34)	46 (47)	0.001	106 (38)
Type D personality present	31 (17)	33 (34)	<0.001	64 (27)
Cognitive problems	33 (18)	31 (31)	0.017	64 (23)

*Adjusted for age at survey, sex and level of education.

HADS, Hospital Anxiety and Depression Scale.

Bold values signify p < 0.05.

Table 4. Logistic regression analyses of independent variables and being currently unemployed (N = 102) with employed (N = 179) as reference.

Variables	Univariate analyses			Multivariable analysis
	OR	95% CI	p	OR	95% CI	p
Age at survey	1.04	1.01–1.07	<0.001	1.04	1.01–1.07	0.015
Female sex	2.61	1.58–4.30	<0.001	2.71	1.34–5.50	0.006
Low education	1.93	1.17–3.14	0.010	1.38	0.70–2.73	0.35
Higher family income	0.22	0.13–0.39	<0.001
Somatic comorbidity	1.98	1.18–3.31	0.009	1.39	0.66–2.93	0.38
Total fatigue	2.56	1.48–4.43	0.001	0.97	0.90–1.06	0.52
Level of anxiety*	2.23	1.22–4.06	0.009
Level of depression	2.62	1.32–5.21	0.006	0.90	0.76–1.06	0.20
Type D personality	2.42	1.37–4.29	0.002	3.48	1.20–10.08	0.021
Cognitive problems	1.99	1.13–3.51	0.018
Physical HRQoL	0.95	0.93–0.97	<0.001	1.04	0.99–1.09	0.12
Mental HRQoL	0.97	0.94–0.99	0.009	1.00	0.95–1.06	1.00
Work ability at diagnosis	0.76	0.67–0.85	<0.001
Work ability at survey	0.66	0.59–0.74	<0.001	0.60	0.50–0.71	<0.001
Change of work	2.09	1.11–3.93	0.023

*The correlation between anxiety and depression was rho = 0.64, and only depression entered the multivariable analysis.

Bold values signify p < 0.05.