ASPO Abstracts
LONGITUDINAL ANALYSIS OF THE INDIRECT BURDEN OF PROSTATE CANCER MANAGEMENT ON PAID AND UNPAID WORK: DATA FROM CAPSURE
Category: Cancer Health Disparities
Conference Year: 2021
Abstract Body:
Purpose: Little is known about the impact of prostate cancer (PCa) management on paid work and unpaid responsibilities such as days of work limited, missed, or spent in bed and general health (GH) up to 10 years after treatment.
Methods: We identified men diagnosed with PCa managed with radical prostatectomy (RP), external beam radiation therapy (EBRT), brachytherapy (BT, with or without EBRT), or active surveillance/watchful waiting (AS/WW) in a longitudinal study of 43 primarily community-based US urology practices with data on work type [full-time, part-time, or unpaid (retired, on leave/unemployed, disabled, unspecified)]. Weeks of work missed, SF-36 General Health scores, and number of clinic visits annually were collected via surveys administered prior to treatment and at 1,3,5 and 10 years after treatment. Using multivariate repeated measures modeling we examined the association between management, work type (paid vs unpaid), race, income, and time since treatment with work weeks missed over time and GH after adjustments for clinicodemographics.
Results: 6,673 men were identified. Mean age of 64.4 years (SD 8.3). Most were insured (54% private, 43% Medicare, 3% Veteran's), white (90%, 7% Black, 1% Latino) with low- (60%) or intermediate-risk (32%) disease. Most had paid work (44%) or were retired (45%) and underwent RP (62%, 14% BT, 14% EBRT, 10% AS/WW). Median 5.3 weeks missed in first year (IQR 1.6-12.2) with up to 2.1 weeks missed at all other times. AS/WW (RR 0.62, 95% CI 0.51-0.74) conferred lowest risk of missed weeks [BT (RR 0.70, 95% CI 0.61-0.80), EBRT (RR 0.72, 95% CI 0.62-0.83)] compared to RP. Black patients had lower risk of reporting missed weeks (vs white, RR 0.68, 95% CI 0.55-0.83); work type was not. SF-36 General Health declined across 10 years after treatment after adjustments, with RP and BT having better scores than AS/WW and EBRT.
Conclusions: Nearly one-quarter of men reported missed work weeks due to PCa management, irrespective of work type, up to 10 years after treatment. AS/WW and Black race had the lowest risk although long-term GH declined more than with RP or BT. In carefully selected men with PCa, the long-term impact of management on GH and workshould be considered when counseling about treatment.
Keywords: work burden; prostate cancer; race; treatment