Cancer rehabilitation and prehabilitation may reduce disability and early retirement

  • Silver J
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There is no doubt that cancer places an enormous financial burden on individuals and societies throughout the world. Although some patients are symptomatic from their disease at diagnosis, screening tests such as mammography, colono-scopy, and prostate-specific antigen blood studies can detect malignancies even in those who generally feel healthy. Regardless of presentation, therapy protocols frequently include multiple interventions that may be offered sequentially or even simultaneously, increasing both the risk and the severity of treatment-related, short-term and long-term side effects. Therefore, unfortunately, many of these symptomatic and asymptomatic patients then become increasingly ill as they pro-gress through treatment. In the end, it is not only the cancer, but also its treatment, that may cause disability and a subse-quent financial burden. In recent reviews that I wrote with colleagues, we demonstrated that cancer prehabilitation 1 (assessments and interventions that are conducted in anticipation of an upcoming stressor such as surgery or chemother-apy) and rehabilitation 2 can increase function in survivors and may improve employment rates, thereby positively impact-ing both direct and indirect health care costs. 3 Early retirement is an important financial issue that impacts individuals, families, and society, limiting income and depleting accumulated resources. Recent reviews have confirmed that cancer survivors are at a significantly increased risk of early retirement and unemployment. 4,5 For example, a 2013 German study by Noeres et al indicated that, 1 year after primary surgery, female breast cancer survivors were nearly 3 times more likely to have discontinued working than their counterparts in the reference group. 6 Thus, as efforts to lessen the financial impact associated with cancer continue, it has become necessary to understand the root cause(s) leading to cancer-related disability, inability to work, and resultant early retirement. In cancer survivors, early retirement may be related to physical and/or emotional health. Although the impact of physical issues on employment is typically discernable, mental health issues that interfere with work may be less obvious. Certainly the distress, anxiety, and/or depression often associated with an oncology diagnosis and/or treatment may contribute to early retirement, particularly in vulnerable patient populations like those with comorbid mental health conditions. It is important first to identify individuals who may be at risk for early retirement and then to provide appro-priate interventions that support current and future employment. In this issue of Cancer, Singer et al 7 report on their investigation into whether a consecutive sample of German oncol-ogy inpatients were at higher risk of early retirement if they presented with comorbid mental health disorders than those presenting without psychiatric symptoms. The researchers interviewed and assessed 491 patients (age range, 18-55 years) using the Structured Clinical Interview from the Diagnostic and Statistical Manual of Mental Disorders to evaluate comor-bid mental health disorders. Participants were excluded if they had metastatic disease or if they had already retired from work. Patients who consented to participate in the study were interviewed at the beginning of their hospitalization and were followed for 15 months after baseline. In their study, 150 patients (30.6%) were diagnosed with mental health disorders at baseline; and, during the subse-quent 15-month follow-up period, in total, 41 patients (8.4%) retired. Of the participants who had a mental health disor-der, 18 (12%) retired. In contrast, of the participants who did not have a comorbid psychiatric diagnosis, only 23 (7%) retired. The researchers observed that the incidence of early retirement was 9.3 per 100 person-years (py) (95% CI,

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  • Julie K. Silver

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