Patient-reported factors associated with discontinuing employment following head and neck cancer treatment

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.