Managing Symptoms Is Key for Patients With Metastatic Cancer Who Continue to Work

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Patients with metastatic cancer who continue to work may need the income or access to health insurance or simply have the desire to work, yet they face a number of hurdles.
Patients with metastatic cancer who continue to work may need the income or access to health insurance or simply have the desire to work, yet they face a number of hurdles.

Patients with metastatic cancer who continue to work may need the income or access to health insurance or simply have the desire to work. Yet they face a number of hurdles: from being physically unable to complete tasks to having to take time off for treatment to a potentially hostile work environment.

“For patients with metastatic cancer, a great deal of attention is focused on the events surrounding initial diagnosis of disease and the issues surrounding the end-of-life; however, between cancer recurrence and end-of-life, these patients are living their lives day-to-day and there are a number of unique survivorship issues during this time that have been overlooked by researchers,” said Amye J. Tevaarwerk, MD, of the University of Wisconsin-Madison.1

In addition, for many patients, “survival in the metastatic setting is measured in years,” Dr Tevaarwerk, and colleagues wrote in article published in Cancer. “This duration will continue to grow as survival in the metastatic setting improves.”2

They noted that “there is a paucity of literature on factors affecting work with metastatic cancer patients as a distinct population.”

To characterize overall employment patterns in the metastatic setting, Dr Tevaarwerk and colleagues analyzed the Eastern Cooperative Oncology Group (ECOG)- American College of Radiology Imaging Network (ACRIN) Cancer Research Group's Symptoms Outcomes and Practice Patterns (SOAPP) study database, assessing whether cancer type, treatment, and symptoms were associated with either stable employment or a shift to being no longer able to work.

The primary objective of SOAPP was to use self-reports from patients with breast, prostate, colon, or lung cancer to describe prevalence and severity of symptoms, along with to what degree they interfered with their lives. Between March 2006 and May 2008, a total of 3123 patients were enrolled from 37 US institutions and 1 site in Peru.

In this secondary analysis, only those who had metastatic disease or were 65 years or younger were included, “because this age represents a significant milestone for retirement,” they noted. Among these 668 participants, the primary cancer sites were breast, 42%; colorectal, 31%; lung, 20%; and prostate, 7%. Most patients (69%) were women; 49% were > 55 to 65 years, 33% were > 45 to 55 years, and 18% were ≤ 45 years.

Of the participants, 236 (35%) worked full- or part-time, while 302 (45%) had stopped working due to their illness. “Overall, 58% reported some change in employment due to illness,” the authors reported; “increased symptom burden was associated with a change to no longer working.”

On multivariate analysis, factors significantly associated with continuing to work included a better performance status and non-Hispanic white ethnicity/race; modifiable factors included hormonal therapy (if an option) and a decrease in symptom interference.

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Based on their data, approximately 33% of patients with metastatic disease will continue to try working. Better symptom control may help patients reach their goal of working, and further research is needed to understand what other resources could be beneficial to this patient population.1

“As the number of patients living and working despite metastatic cancer increases, the importance of developing and applying interventions to promote the ability to work will become increasingly imperative,” they concluded.

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