VUmc Basispresentatie Predictive Factors of Fatigue and Work Ability in Cancer Survivors Beyond Two Years of Sick Leave Peter van Muijen, Saskia F.A. Duijts, Karin Bonefaas-Groenewoud, Johannes R. Anema, Allard J. van der Beek Eumass 2016, Ljubljana Slovenia

VUmc Basispresentatie Disclosure sheet: no conflicts of interest. Funding: Research Center for Insurance Medicine. P. van Muijen is employed by UWV. Eumass 2016, Ljubljana Slovenia

VUmc Basispresentatie Background Figures Europe (2012): incidence of cancer in the adult population Men: 1.804.691 Women: 1.599.237 Netherlands (2015): increase of incidence up to 104.988 Growing number of cancer survivors in working population Netherlands (2015): 38.812 (20-64 yrs) Average 73% able to return to work (RTW) within 18 months sick leave (Mehnert, 2011)

Background Cancer survivors and work ability VUmc Basispresentatie Background Cancer survivors and work ability Cancer survivors are at risk of work disability, due to the disease, side-effects, physical and cognitive impairments Positive effect of RTW on health and well-being Social connections Support self esteem Help to overcome negative side-effects Positive financial consequences Societal impact of RTW in reducing - loss of productivity - costs of sick-leave

VUmc Basispresentatie Background Level of work disability Assessment by Dutch Social Security Agency (SSA) Related to wage loss and abilities Four categories related to wage loss: <35% 35-80% 80-100% Benefit Act fully & durable work disability 2013: over 4200 cancer survivors applied for a disability benefit

VUmc Basispresentatie Background Assessment The assessment of functional abilities in cancer survivors is complex Identification of predictors of fatigue and work ability in cancer survivors may help to: - offer adequate support in a RTW trajectory - support an IP to assess functional abilities, plan reassessment Medical factors Non-medical factors Disease Legislation Treatment Environment Side-effects Workers’ perception

VUmc Basispresentatie Aim To identify prognostic factors related to fatigue and work ability in cancer survivors on long-term sick leave To develop a model to predict future work ability in cancer survivors Considering: Fatigue is very prevalent in cancer survivors, and may last even after treatment has finished successfully Work ability relates to vocational rehabilitation and RTW, that we think should be supported

VUmc Basispresentatie Methods Design: prospective cohort study, baseline measurement at two year sick-leave term, follow-up one year later. Study population: employed workers diagnosed with cancer, who applied for work disability benefit (inclusion july 2011- february 2012) 13,023 claims 1307 diagnosis cancer included N = 336 (with data at baseline and at 1 year follow-up) Variables Dependent: Fatigue (FACT-F), Work ability (WAI) Independent: socio-demographics, health- & work-related factors, questionnaire data, SSA data. Univariate and multivariate analysis (linear regression)

VUmc Basispresentatie Methods Work Ability Single question + answer Also applicable in unemployed workers Correlates well with RTW/vocational rehabilitation efforts Often used and validated Scoring: ≤2 poor 3-6 poor-average 7-8 average-good 9-10 good-excellent

VUmc Basispresentatie Methods Fatigue / FACT-F Questionnaire, 13 items Often used and validated Scoring range 0-52, higher score means less fatigue

VUmc Basispresentatie Results Model for fatigue

VUmc Basispresentatie Results Model for work ability

Discussion Interpretation of results VUmc Basispresentatie Discussion Interpretation of results Chemotherapy was associated with decrease of fatigue and increase of work ability More physical complaints were associated with increase of fatigue and decrease of work ability Likely explanation: selection bias in the cohort considering 75% of respondents received chemotherapy sick listed workers not receiving chemotherapy and with better scores on fatigue had already RTW

VUmc Basispresentatie Discussion Practical implications Prediction tool for work ability: Predicted value= 2.43 + (X1 * -0.64 ) + (X2 * 0.8) + (X3 * 0.48) + (X4 * -0.05) + (X5 * 0.02) + (X6 * 0.43) + (X7 * -0.61) Predicts work ability 1 year after assessment of the work disability claim Outcome may support planning a reassessment May help to decide on starting a vocational trajectory

Thank you for your attention! VUmc Basispresentatie Thank you for your attention! Questions? Contact: Peter van Muijen, MD Insurance physician / junior researcher Department of Public and Occupational Health EMGO+ Institute, VU University Medical Center Email: p.vanmuijen@vumc.nl