TABLE 3.

Description of Studies Assessing Multiple or Undefined Cancer Types

Author, Year Country	Target Population; Publication Type	Study Design; Quality Assessment	Treatment Type	Study Objective	Patient Population/Setting	Measures/Methods Used to Assess Productivity	Main Findings
Multiple cancer types (n = 14)
Bradley, 2002 United States62	Patient; full-text	Prospective interview	Not specified	To examine employment patterns of long-term cancer survivors; to better understand the economic late effects of treatment (any treatment for the mentioned cancers) by examining employment decisions and outcomes	253 long-term survivors (58 lung, 53 colorectal, 73 breast, and 69 prostate cancer) selected from Metropolitan Detroit Cancer Surveillance System (MDCSS)	Changes in work status, modified questions from Health and Retirement Study and the Current Population Survey	54.5% reduced work schedule at least once while undergoing treatment. Limitations from cancer and its treatment were most likely for lifting heavy loads (26%) and keeping pace with others (22%). Limitations: Examined long-term survivors and not total cancer population, recall bias.
Passik, 2005 United States71	Patient and caregiver; full-text	Prospective interview	Chemotherapy	To study the impact of chemotherapy-induced cancer patients’ fatigue on their spouses’ quality of life, including their own levels of fatigue, depressive symptoms, activity levels, work absenteeism, and marital adjustment	40 couples with 1 partner with chemotherapy-induced fatigue or anemia; 25 completed assessment at 1 month (most common cancer: 13 breast, 4 ovarian, and 3 prostate)	Changes in responsibilities, changes in work hours, effectiveness at work, missed work; Caregiver-Fatigue Symptom Inventory, Caregiver Strain Index, Zung Self-Rating Depression Scale, Dyadic Adjustment Scale, Activity Level Rating Scale	28% caregivers handling fewer responsibilities at work; 32% reduced their work hours; and 32% felt less effective overall at work. Caregiver strain related to fatigue at baseline, lower likelihood to engage in social activity, and work at 1-month follow-up. $630,000 in total costs due to chemotherapy-related toxicity, with over half of these costs in lost wages. Limitations: Small sample size, short follow-up, greater fatigue among dropouts
Bradley, 2006 United States63	Patient; full-text	Prospective interview	Chemotherapy, hormone therapy, radiation, surgery	To examine the number of days employed patients undergoing treatment for either breast or prostate cancer were absent from their jobs	239 breast cancer and 206 prostate cancer patients selected from Metropolitan Detroit Cancer Surveillance System (MDCSS)	Missed work	Women who received only surgery missed an average of 26.5 days; women who received surgery in combination with radiation or chemotherapy missed 19.0 and 61.6 days. Men missed an average of 27 days overall, and median days missed were 25 for men treated surgically without hormone or radiation therapy. Limitations: Generalizability, recall bias.
Longo, 2006 Canada68	Patient and caregiver; full-text	Prospective survey questionnaire	Chemotherapy, radiation	To determine financial and family resources burden associated with treatment of cancer	282 patients (74 breast, 70 colorectal, 68 lung, and 70 prostate) recruited from 5 cancer clinics in Ontario	Out-of-pocket costs, financial burden, and missed work	Mean monthly out-of-pocket cost was $213, plus $372 related to travel costs. 20% of patients perceived financial burden to be significant or unmanageable. Limitations: Self-reporting bias; data on patients’ lost time from work not verified due to privacy issues
Amir, 2007 United Kingdom61	Patient; full-text	Prospective postal survey questionnaire	Chemotherapy, hormone therapy, radiation, surgery	To explore the association of rate at which cancer patients returned to paid employment after 18 months of diagnosis, with demographic, clinical, and work perception	267 patients (breast 48%, colorectal 14%, prostate 9%) employed and recruited via North Western Cancer Intelligence Service in Manchester	Return to work, sick leave, job satisfaction, and prospects	82% returned to work; 25% worked during their treatment; and 20% not able to return to work. Length of sick leave (OR = 1.68; 95% CI = 1.23-2.28) and absence of surgery (OR = 0.28; 95% CI = 0.08-0.94) were associated with return to work. Those who returned reported work deterioration due to cancer. Limitation: Reliance on general practitioners to include/exclude respondents
Choi, 2007 South Korea64	Patient; full-text	Prospective longitudinal survey questionnaire	Chemotherapy, radiation, surgery	To study job loss and reemployment in Korean patients with cancer	305 men (stomach 32%, liver 38%, and colorectal 20%) employed and recruited via National Cancer Center Korea	Job loss, reemployment	53% lost job during 24-month follow-up (liver cancer most likely at 63%). At 24 months, 23% had been reemployed, which was more likely for colorectal (31%) and stomach (30%) cancers. Limitations: Generalizability, male patients only
Ohguri, 2009 Japan70	Patient; full-text	Retrospective records analysis	Chemotherapy, radiation, surgery	To evaluate work limitations and attendance rates after employees diagnosed with cancer returned to work from sick leave and to identify related factors for limitations and attendance rates	129 men and 4 women (most common cancer: stomach 24% and colorectal 17%) from employee medical records from a manufacturing company	Limitation in work, changes in hours, and sick leave	Work limitations in 59% of employees upon return, including 27% with alteration of work, 23% with prohibition of shift work, and 41% with prohibition of overtime. Chemotherapy use was correlated with limitations. Decreased attendance related to disease- and treatment-related factors. Limitations: Not all employees were examined before their return to work; small sample size, generalizability
Schwartzberg, 2009 United States72	Patient and staff; full-text	Prospective time motion observational study	Cetuximab or rituximab	To study the impact of infusion reactions on staff time and costs among patients receiving an initial infusion of cetuximab and rituximab	161 patients (71 cetuximab, 90 rituximab) from 27 geographically representative community oncology sites	Time and costs	Total human resource cost accrued through 10 days postadministration was $53.9 (no reaction), $79.9 (mild/moderate), and $210.4 (severe) for cetuximab and $98.7 (no reaction), $110.7 (mild/moderate), and $155.1 (severe) for rituximab. Limitations: No random assignment, time and costs assessed for monoclonal antibody infusions
Song, 2009 United States73	Patient; full-text	Retrospective matched cohort study	Chemotherapy	To examine the impact of chemotherapy-induced neutropenic complications on STD among cancer patients receiving chemotherapy	280 patients with chemotherapy-induced neutropenic complications (breast 29.3%, lung 10.4%, non-Hodgkin’s lymphoma 2.9%, other 57.5%) and 2,154 controls. Patients from the MarketScan CCEA and HPM databases	STD, costs	Patients with complications experienced significantly greater STD leave and indirect costs (3.2 vs. 2.3 days, P = 0.046 and $549 vs. 394, P = 0.050) per month than patients with no neutropenic complications from chemotherapy. Limitations: Claims data availability, indirect cost calculation for caregivers not examined
Tevaarwerk, 2010 United States74	Patient; abstract	Secondary analysis of randomized clinical trial with survey questionnaire	Not specified	To study effect of receiving an increasing number of treatment modalities (e.g., radiotherapy, chemotherapy) as a risk factor for change in employment	1,976 patients (breast cancer 59%) recruited from 7 academic and 32 community medical oncology clinics within trial E2Z02 (ECOG’s SOAPP study)	Change in work status and level	Number of treatment modalities was not a statistically significant predictor for change in employment status. Metastatic disease, age > 45 years, ongoing therapy, and performance status 2-4 was associated with change in employment status and level.
Gudbergsson, 2011 Norway66	Patient; full-text	Prospective postal survey questionnaire	Chemotherapy, hormone therapy, radiation, surgery, other	To conduct a post primary treatment comparative study of cancer patients with short- or long-term leaves	840 patients after primary treatment for the 10 most common invasive types of cancer (breast or gynecological cancer 76%) recruited from 4 hospitals	Sick leave, Work Ability Index	Longer sick leave after primary cancer treatment was associated with lower health status, use of chemotherapy, hormonal therapy and multimodal treatment, and changes in employment due to cancer. Limitations: Sick leave was studied in absolute rather than relative terms.
Mazanec, 2011 United States69	Caregiver; full-text	Cross-sectional correlational study	Not specified	To study health promotion behaviors and work productivity loss in informal caregivers of individuals with advanced stage cancer	70 caregivers (to patients with stages II to IV pancreatic cancer or stages III or IV lung, gastrointestinal, or gynecologic cancer) from Midwestern National Cancer Institute-designated Comprehensive Cancer Center	Caregiver health promotion behaviors, WPAI (adapted from Crohn’s Disease Caregiver), Caregiver Reaction Assessment, and Medical Outcomes Social Support Survey	For absenteeism and presenteeism, the mean percentage of overall work productivity loss due to caregiving was 22.88%. Overall work productivity loss was not significantly correlated with receiving treatment or any other characteristic of the care recipient. Limitations: Convenience sample, generalizability
Cooper, 2013 United Kingdom65	Patient; full-text	Prospective longitudinal survey questionnaire	Chemotherapy, radiation, surgery	To examine the role of clinical, sociodemographic, work and psychological factors in return to work following treatment for breast, gynecological, head and neck, and urological cancers	290 patients (breast 89, gynecological 56, urological 88, head and neck 47) recruited from outpatient department of hospital	Return to work, work values, Illness Perceptions Questionnaire, EORTC QLC-30, Hospital Anxiety and Depression Scale, Fear of Recurrence Scale	Return to work in breast cancer was a median of 30.0 weeks, head and neck cancer (18.3 weeks), gynecological cancer (17.9 weeks), and urological cancer (5.0 weeks). For breast cancer, patients with greater control over the effect of their cancer at work were more likely to return to work sooner. Limitations: Small sample size, lack of gender differences in head and neck patient sample
Hoven, 2013 Sweden67	Caregiver; full-text	Prospective longitudinal telephone interviews	Not specified	To study socioeconomic conditions of parents of children with cancer by means of a longitudinal assessment of work situation, sick leave, and household income	277 caregivers (mothers 139, fathers 138) and 149 children (leukemia 36.2%, central nervous system tumor 20.8%, and other solid tumors 43.0%) recruited from 4 pediatric oncology centers in Sweden	Changes in work status, sick leave, and household income	The greatest period of sick leave was during the child’s treatment phase. Predictors of sick leave longitudinally included being female or a child with more intensive treatment. Limitations: Lack of individual data and comparison group
Cancer type not specified (n = 5)
Ihbe-Heffinger, 2004 Germany79	Patient; full-text	Prospective, multicenter, cost of illness	Chemotherapy	To assess the impact of health care resource utilization of delayed CINV and to estimate costs imputable to CINV	244 patients enrolled from 3 hospitals and 3 office-based facilities in Germany	Direct and indirect costs	53.9% were on sick leave during or after chemotherapy; 33% used health care resources due to CINV. Characteristics associated with high attributable costs imputable to CINV were cisplatin-containing regimen; experience of emesis; and presence of delayed CINV. Limitations: External validity, nonsocietal perspective
Henry, 2008 United States78	Patient and caregiver; full-text	Cross-sectional online/telephone survey questionnaire	Chemotherapy, radiation	To examine the prevalence of chemotherapy or radiotherapy-associated side effects and related treatment burden and correlates of fatigue and missed work days among cancer patients	814 patients receiving chemotherapy and/or radiotherapy derived from Harris Support Care Cancer Interactive’s online chronic illness panel and from a telephone list of physician-diagnosed cancer patients	Missed work, burden of treatment and adverse effects, attitudes toward work (modified work productivity questions from National Health Interview Survey), Functional Assessment of Chronic Illness Therapy	28% reported a clinic visit to treat side effects of this treatment. 43% of patients were employed with an average loss of 26 days due to therapy, and 18 days due to side-effect treatment. Missed work was associated with higher side-effect burden in the regression model. Limitations: Recall bias, self-reporting of side-effect burden
Miedema, 2008 Canada80	Caregiver; full-text	Prospective qualitative interview	Bone marrow transplant, chemotherapy, radiation	To study economic impact on families caring for a child with cancer	28 families in Newfoundland and Labrador, recruited with the assistance of Candle lighters Canada–Newfoundland and Labrador Division (childhood cancer support foundation)	Identification of themes from semistructured interviews	4 major themes emerged: travel expenses for care, loss of income due to reduction/termination, out-of-pocket expenses, and inability to use assistance programs. 61% fathers and 86% mothers changed work hours during treatment. Limitations: Small sample size, questions may not address all concepts associated with work.
Haiderali, 2011 United States25	Patient; full-text	Prospective observational study	Chemotherapy	To prospectively assess the prevalence and burden of CINV	178 patients recruited from 32 oncology specialty care settings in 19 different states	WPAI-Nausea and Vomiting, Functional Living Index-Emesis questionnaire, costs	61.2% reported experiencing CINV. 37.2% of all patients reported reduced daily functioning. Total costs due to CINV were $778.58 per patient from the day of administration through the 5 days following the first cycle of chemotherapy; patients with more severe symptoms typically had higher costs. Limitations: Small size, resource costs extracted from external sources
Blackmon, 2016 United States75	Caregiver; abstract	Retrospective analysis of survey data	Not specified	To study the impact of caregiving on caregivers’ work life and jobs	6,310 respondents from the LIVESTRONG Survey of People Affected by Cancer	Changes in work status and paid time off	41% of survivors reported that caregivers made a work modification: 57% took paid time off, 41% took unpaid time off, 4% switched from full time to part time, and 3% took early retirement.

CINV = chemotherapy-induced nausea and vomiting; EORTC QLQ = European Organization for Research and Treatment of Cancer Quality of Life Questionnaire; STD = short-term disability; WPAI = Work Productivity Activity Impairment.