1. 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

2. 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

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

4. 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

5. 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

6. 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

7. 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

8. 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 february 2012)
13,023 claims 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)

9. 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

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

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Results Model for fatigue

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Results Model for work ability

13. 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

14. VUmc Basispresentatie
Discussion Practical implications
Prediction tool for work ability:
Predicted value= (X1 * ) + (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

15. 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