The impact of follicular (FL) and other indolent non-Hodgkin's lymphomas (NHL) on work productivity-a preliminary analysis
Matthew C. Cheung 1 2 5, Kevin R. Imrie 1 2 5, Jessica Friedlich 1, Rena Buckstein 1 2, Nina Lathia 3, Nicole Mittmann 4 5
1Hematology/Oncology, Sunnybrook Health Sciences Centre, Toronto, Ont., Canada
2Department of Medicine, University of Toronto, Toronto, Ont., Canada
3Faculty of Pharmacy, University of Toronto, Toronto, Ont., Canada
4Health Outcomes and Pharmacoeconomics Research Centre, Division of Clinical Pharmacology, Sunnybrook Health Sciences Centre, Toronto, Ont., Canada
5Working Group on Economic Analysis, National Cancer Institute of Canada, Kingston, Ont., Canada
Introduction: Although much is known about the efficacy, toxicity, and direct costs of treatment for follicular lymphoma (FL), there is no data assessing the impact of this diagnosis on the work productivity of affected individuals.
Methods: We conducted a cross-sectional survey study of consecutive patients attending a malignant haematology clinic at a large multi-disciplinary cancer centre. Patients with a diagnosis of FL or other indolent non-Hodgkin's lymphoma completed questionnaires assessing health status, work productivity, and activity impairment.
Results: Eighty-four patients completed the survey study (95% response). Patients who continued to work reported a minimal impact on their work productivity (10%±standard deviation SD 20; 0%=no effect and 100%=complete impairment of activity) and on their daily activities (13%±SD 25) attributable to their cancer. Prior to lymphoma diagnosis, over 71% of patients were working while 14% were retired. At the time of survey administration, only 41% of patients were still able to work with a significant proportion of patients having transitioned to retirement (36%), sick leave (10%), or unemployment (4%). On multivariate analysis, significant activity impairment (daily activity impairment>50%) was predicted by poor self-rated health status (OR 32.1; 95% CI: 5.9-174.2; p<0.0001) and active chemotherapy treatment (OR 14.5; 95% CI: 0.91-230.9; p=0.059).
Conclusions: Although few patients with indolent lymphoma identified significant impairment in productivity, many were unable to continue employment following diagnosis, needed to miss days from work, or imposed a significant burden on caregivers. The greatest impact on activity is apparent in patients who rate their health status as poor and in those who are currently receiving systemic therapy.