Faculty Collaboration Database

Return to Work Among Young Adult Survivors of Allogeneic Hematopoietic Cell Transplantation in the United States. Transplant Cell Ther 2021 Aug;27(8):679.e1-679.e8

Date

04/26/2021

Pubmed ID

33895402

Pubmed Central ID

PMC8425287

DOI

10.1016/j.jtct.2021.04.013

Scopus ID

2-s2.0-85107434203 (requires institutional sign-in at Scopus site)   13 Citations

Abstract

Young adult (YA) survivors of allogeneic hematopoietic cell transplantation (HCT) are at risk for late psychosocial challenges, including the inability to return to work post-HCT. Work-related outcomes in this population remain understudied, however. We conducted this study to assess the post-HCT work status of survivors of allogeneic HCT who underwent HCT as YAs and to analyze the patient-, disease-, and HCT-related factors associated with their work status at 1 year post-HCT. Using Center for International Blood and Marrow Transplant Research data, we evaluated the post-HCT work status (full-time, part-time work, unemployed, or medical disability) of 1365 YA HCT survivors who underwent HCT between 2008 and 2015. Percentages of work status categories were reported at 4 time points: 6 months, 1 year, 2 years, and 3 years post-HCT. Percentages of post-HCT work status categories at the 1-year time point were also described in relation to survivors' pre-HCT work status categories. Factors associated with 1-year post-HCT work status (full-time or part-time work) were examined using logistic regression. From 6 months to 3 years post-HCT, the percentage of survivors working full-time increased from 18.3% to 50.7% and the percentage working part-time increased from 6.9% to 10.5%. Of patients in full-time work pre-HCT, 50% were unemployed or on medical disability at 1 year post-HCT. Female sex (odds ratio [OR], 0.55; 95% confidence interval [CI], 0.40 to 0.77), HCT Comorbidity Index score ≥3 (OR, 0.57; 95% CI, 0.39 to 0.82), pre-HCT unemployment (OR, 0.37; 95% CI, 0.24 to 0.56), medical disability (OR, 0.44; 95% CI, 0.28 to 0.70), development of grade III-IV acute graft-versus-host disease (OR, 0.52; 95% CI, 0.34 to 0.80), and relapse within 1 year post-HCT (OR, 0.34; 95% CI, 0.21 to 0.56) were associated with a lower likelihood of employment at 1 year post-HCT. Compared with myeloablative conditioning (MAC) with total body irradiation (TBI), MAC without TBI (OR, 1.71; 95% CI, 1.16 to 2.53) was associated with a greater likelihood of employment at 1 year post-HCT. Graduate school-level education (OR, 2.47; 95% CI, 1.49 to 4.10) was also associated with a greater likelihood of employment at 1 year post-HCT. Although the work status among YA HCT survivors continued to improve over time, a substantial subset became or remained unemployed or on medical disability. These findings underscore the need for effective interventions to support return to work in this population.

Author List

Bhatt NS, Brazauskas R, Salit RB, Syrjala K, Bo-Subait S, Tecca H, Badawy SM, Baker KS, Beitinjaneh A, Bejanyan N, Byrne M, Dias A, Farhadfar N, Freytes CO, Ganguly S, Hashmi S, Hayashi RJ, Hong S, Inamoto Y, Jamani K, Kasow KA, Khera N, Krem MM, Lazarus HM, Lee CJ, Lee S, Majhail NS, Malone AK, Marks DI, Mau LW, Mayo SJ, Muffly LS, Nathan S, Nishihori T, Page KM, Preussler J, Rangarajan HG, Rotz SJ, Salooja N, Savani BN, Schears R, Schechter-Finkelstein T, Schiller G, Shah AJ, Sharma A, Wang T, Wirk B, Battiwalla M, Schoemans H, Hamilton B, Buchbinder D, Phelan R, Shaw B

Authors

Ruta Brazauskas PhD Associate Professor in the Data Science Institute department at Medical College of Wisconsin
Rachel A. Phelan MD, MPH Associate Professor in the Pediatrics department at Medical College of Wisconsin
Bronwen E. Shaw MBChB, PhD Center Director, Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Female
Hematopoietic Stem Cell Transplantation
Humans
Neoplasm Recurrence, Local
Return to Work
Survivors
Transplantation, Homologous
United States
Young Adult