Prospective predictors of return to work in the 5 years after hematopoietic cell transplantation

Work return is an indicator of recovery and functional status for cancer survivors. We investigated whether demographic, medical and functional factors predicted full-time work return following hematopoietic cell transplantation (HCT).

Adults (N = 197), most with hematologic malignancy, completed assessments before their HCT and at intervals over 5 years. Assessments included treatment and demographic factors, and date of return to full-time work. We created binary variables, indicative of major impairment, from the Short Form 36 Health Survey (SF-36) mental (MCS) and physical (PCS) function component scores, dichotomized at 1 SD below population norms ( 40). PCS and MCS were imputed for 16% of the sample. Predictors of work return were analyzed using Cox proportional hazards regression.

Of the 130 patients working full-time at pre-HCT, 88 (68%) were alive and relapse-free at 5 years. Of these, 53 (60%) had returned to full-time and 28 (32%) to part-time work. For the primary analyses at 6 month post-HCT, 14 patients had already died or relapsed and 10 had returned to work. Among the remaining 106 patients, those with PCS >40 returned to work faster (Hazard Ratio (HR) 2.38, 95% Confidence Interval (CI) 1.26-4.49). Female survivors were less likely to return to work than males (HR 0.54, 95% CI 0.29-0.99).

Return to work is a lengthy process for many survivors. Predictors of slower return include physical dysfunction and female gender. Implications for cancer survivors Realistic preparation for time off work is essential to long-term health and finances of cancer survivors.