Employment disruption and missed workdays after neoadjuvant therapy receipt for high-risk gastrointestinal cancer

Patterns of work loss in patients with gastrointestinal (GI) cancer remain relatively unknown, particularly regarding the effect of neoadjuvant therapy (NAT). We sought to assess employment disruption and missed workdays in patients with esophageal, pancreatic, and rectal cancers with a particular focus on the role of NAT.

Adult patients with esophageal, pancreatic, or rectal cancer were identified from the IBM MarketScan Commercial Claims and Encounters Database (2013-2020). Full- or part-time employed patients were matched to cancer-free individuals with benign GI conditions using entropy balancing. The outcomes included employment disruption within 12 months and number of missed workdays. Multivariate Cox and negative binomial regression models were used to estimate the adjusted hazard ratios (aHRs) and incidence rate ratios (IRRs).

Among 40,008 patients, 2314 (5.8%) were diagnosed with GI cancer. Overall, 333 patients (14.4%) with GI cancer experienced employment disruption compared with 1963 controls (5.2%) (P <.001). Among patients with cancer, 1017 (43.9%) received NAT before surgery. Patients who underwent NAT were mostly male (NAT plus surgery: 67.5% vs upfront surgery: 62.1%) and were less likely to have a Charlson Comorbidity Index of >2 (NAT plus surgery: 3.4% vs upfront surgery: 6.2%) than individuals who underwent upfront surgery (both P <.001). Compared with patients who underwent upfront surgery, patients who received NAT more frequently experienced employment disruption (11.6% vs 17.9%) and missed more workdays (58 vs 76 days, respectively). On multivariate analysis, NAT was associated with greater hazards of employment disruption (aHR, 4.01 [95% CI, 3.44-4.68]) and more missed workdays (IRR, 9.16 [95% CI, 8.65-9.70]).

A GI cancer diagnosis was associated with employment disruption, with a higher incidence of disruption among patients treated with NAT. Tailored occupational and socioeconomic interventions are needed to improve the employment stability of patients with cancer.