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Employment situation among long-term Hodgkin lymphoma survivors in Europe: an analysis of patients from nine consecutive EORTC-LYSA trials

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Abstract 

Purpose

Little is known about the employment situation of long-term Hodgkin lymphoma (HL) survivors despite their young age at diagnosis and the favorable prognosis of the disease. In this cross-sectional study, we aim to describe the employment situation in a cohort of long-term HL survivors compared to the general population and investigate the associations with disease characteristics and treatment exposure.

Methods

HL survivors > 25 years (n = 1961) were matched 1:25 to controls (n = 49,025) from the European Union Labour Force Survey. Individual treatment information was obtained from trial records. Employment and socio-demographic characteristics were collected using the Life Situation Questionnaire. Logistic regression models were used to estimate associations between disease and treatment characteristics with employment status and work-related attitudes.

Results

At employment assessment, 69.7% of survivors (95% CI: 67.6–71.7%) were working; of these, 68.9% (95% CI: 66.3–71.3%) worked full-time, a figure comparable to that of controls (p value 0.17). The risk of not working was associated with increasing age at diagnosis, increasing age at survey, female sex, lower educational level, and relapse history. Of those who were at work during treatment, 16.8% (95% CI: 14.5–19.3%) stated their income had subsequently decreased, which was attributed to their HL by 65.4% (95% CI: 57.5–72.8). Among those not at work, 25.1% (95% CI: 20.7–29.8) survivors were disabled compared to only 14.5% (95% CI: 13.8–15.3%) of controls.

Conclusions

In this cohort of HL survivors, employment status was comparable to that of the general population. However, increasing age at follow-up, female sex, lower educational level, and relapse history are risk factors for unemployment, a perceived decrease in income, and disability.

Implications for Cancer Survivors

To further improve follow-up care, special attention should be paid to these vulnerable subgroups.

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Data availability

Access to the data that support the findings of this study (request form) can be found at https://www.eortc.org/data-sharing/. All data sharing takes place in accordance with EORTC’s data sharing policy.

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Acknowledgements

This publication uses data from the European Union Labour Force Survey (Eurostat, European Union). Eurostat has no responsibility for the results and conclusions which are the authors’ only.

Funding

This publication was supported by a donation from the Danish Cancer Society.

Author information

Authors and Affiliations

  1. Department of Oncology, Rigshospitalet, Copenhagen, Denmark

    Sidsel J. Juul & Maja V. Maraldo

  2. Department of Haematology, Rigshospitalet, Copenhagen, Denmark

    Sára Rossetti & Martin Hutchings

  3. EORTC Headquarters, Brussels, Belgium

    Michal Kicinski & Francesco Giusti

  4. Department of Internal Medicine, Amstelland Hospital, Amstelveen, The Netherlands

    Marleen A. E. van der Kaaij

  5. Belgian Cancer Registry, Brussels, Belgium

    Francesco Giusti

  6. Department of Radiation Oncology, Iridium Network, University of Antwerp, Antwerpen, Belgium

    Paul Meijnders

  7. Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands

    Berthe M. P. Aleman

  8. Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands

    John M. M. Raemaekers

  9. Department of Hematology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands

    Hanneke C. Kluin-Nelemans & Wouter J. Plattel

  10. Division of Medical Oncology and Immunerelated Tumors, Centro Di Riferimento Oncologico Di Aviano (CRO), IRCCS, Aviano, Italy

    Michele Spina

  11. Department of Hematology, Gustave Roussy, Villejuif, France

    Christophe Fermé

  12. AP-HP, Hôpital Saint-Louis, Hemato-Oncologie, DMU DHI; Université de Paris, F-75010, Paris, France

    Loïc Renaud

  13. Department of Hematology, CHU Dijon-Bourgogne, Dijon, France

    Olivier Casasnovas

  14. Department of Hematology, Centre Henri Becquerel, Rouen, France

    Aspasia Stamatoullas

  15. Department of Hematology, CHU UCL NAMUR, Yvoir, Belgium

    Marc André

  16. Unité Hémopathies Lymphoïdes, Hôpital Henri Mondor, Créteil, France

    Fabien Le Bras

  17. Centre de Traitement des Données du Cancéropôle Nord-Ouest, Centre François Baclesse, Caen, France

    Michel Henry-Amar

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Contributions

MVDK and MVM are study coordinators. MVDK, BMPA, HCKN, MHA, and PM designed the LSQ questionnaire. MVDK, BMPA, HCKN, MHA, JMMR, PM, MS, CF, OC, AS, MA, and FLB are responsible for acquisition of data and MK for statistical analysis. SJJ drafted the first manuscript with the collaboration of SR. All authors critically reviewed the paper. All authors commented, revised, and approved the final manuscript.

Corresponding author

Correspondence to Sidsel J. Juul.

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Ethics approval

Protocols and informed consent for the H1-H9 trials as well as the LSQ study was approved by local ethical committees in each participating country. The studies were carried out in accordance with the Helsinki Declaration.

Consent to participate

Participants receiving the Life Situation Questionnaire have all consented to their responses being analyzed.

Competing interests

The authors declare no competing interests of relevance to this study.

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Sidsel J. Juul and Sára Rossetti shared first authorship.

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Juul, S.J., Rossetti, S., Kicinski, M. et al. Employment situation among long-term Hodgkin lymphoma survivors in Europe: an analysis of patients from nine consecutive EORTC-LYSA trials. J Cancer Surviv 18, 727–738 (2024). https://doi.org/10.1007/s11764-022-01305-w

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