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Original Article
May 2007

Patient-Reported Factors Associated With Discontinuing Employment Following Head and Neck Cancer Treatment

Author Affiliations

Author Affiliations: Department of Otolaryngology–Head and Neck Surgery, College of Medicine (Ms Buckwalter and Drs Karnell, Smith, and Funk), and Department of Psychology (Dr Christensen), The University of Iowa, Iowa City.

Arch Otolaryngol Head Neck Surg. 2007;133(5):464-470. doi:10.1001/archotol.133.5.464

Objective  To evaluate patients' reported reasons for discontinuing employment following treatment for head and neck cancer (HNC). Discontinuing employment is a serious problem for patients with HNC and has an impact on many aspects of their lives.

Design  Prospective, observational outcomes study.

Setting  Tertiary care institution.

Patients  A total of 666 patients with carcinomas of the head and neck who were treated from January 1, 1998, to October 31, 2004.

Interventions  Patients provided information about the status of their employment at the time of diagnosis and then at 3, 6, 9, and 12 months after diagnosis. Patients who discontinued employment after treatment rated the importance of 5 factors (eating, speech, appearance, pain or discomfort, and fatigue) in that decision.

Main Outcome Measures  The 5 factors were scored on a 5-point Likert scale (5 being most important) as to their importance in the decision to discontinue work. The relationships of patient, disease, and treatment variables to employment status were evaluated.

Results  Of the 666 patients, 239 were employed at the time of their diagnosis. After treatment, 91 (38.1%) of the 239 reported discontinuing work because of their cancer and treatment. Eighty-two (90.1%) of these 91 patients rated each of the 5 factors. Fatigue had the highest percentage (58.5%) of 4 or 5 ratings, followed by speech (51.2%), eating (45.1%), pain or discomfort (37.8%), and appearance (17.1%). Thirty-seven (40.7%) of the 91 patients who discontinued work returned to work within 1 year of treatment.

Conclusion  Identification of the factors associated with the decision to discontinue work is a first step in providing focused solutions to minimize disability.