Sick leave and disability pension in Hodgkin lymphoma survivors by stage, treatment, and follow-up time--a population-based comparative study

J Cancer Surviv. 2015 Dec;9(4):599-609. doi: 10.1007/s11764-015-0436-0. Epub 2015 Feb 18.


Purpose: This study seeks to investigate the long-term public health burden of Hodgkin lymphoma (HL) in terms of work loss following contemporary treatment protocols and associations with established treatment complications and lymphoma relapse.

Methods: We identified 1,989 Swedish HL patients (1,082 with clinical information) aged 18-60 (median 33) years at diagnosis 1992-2009, and matched 1:4 to population comparators. Sick leave, disability pension (work loss), and comorbidity were retrieved through September 2013. Relative risks (RR) with 95% confidence intervals (CI) were calculated using Poisson regression, and mean lost work days were estimated yearly during follow-up.

Results: The risk of annual work loss was elevated in HL survivors versus comparators up to the 15th year post-diagnosis (RR(5th year) 1.64, 95% CI 1.46-1.84; RR(10th year) 1.33, 95% CI 1.15-1.34; and RR(15th year) 1.30, 95% CI 1.04-1.62). The risk remained elevated up to the 10th year after adjustment for secondary malignancies and cardiovascular disease (RR(10th year) 1.31, 95% CI 1.13-1.52). Advanced-stage patients had more lost days than comparators (mean number(5th year) 66 versus 33, mean difference 34, 95% CI 20-48) as did patients receiving 6-8 chemotherapy courses (62 versus 33, mean difference(5th year) 30, 95 % CI 17-43). Among patients in the first complete remission, a difference was still observed for advanced-stage (51 versus 33, mean difference(5th year) 19, 95% CI 5-34) but not early-stage disease.

Conclusions: Advanced-stage HL survivors treated with full-dose chemotherapy were at increased risk of work loss, not only explained by relapse, secondary malignancies, or cardiovascular disease.

Implications for cancer survivors: The results call for increased awareness and evaluation of reasons for long-term work disability following intensive chemotherapy among young HL survivors.

Keywords: Cancer survivorship; Chemotherapy; Disability pension; Hodgkin lymphoma; Sick leave; Work loss.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Disabled Persons / statistics & numerical data*
  • Employment / statistics & numerical data
  • Female
  • Follow-Up Studies
  • Hodgkin Disease / epidemiology*
  • Hodgkin Disease / pathology
  • Hodgkin Disease / therapy
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local / epidemiology
  • Neoplasm Staging
  • Pensions / statistics & numerical data*
  • Sick Leave / statistics & numerical data*
  • Survivors / statistics & numerical data*
  • Sweden / epidemiology
  • Time Factors
  • Young Adult