Work Disability After Robot-assisted or Open Radical Prostatectomy: A Nationwide, Population-based Study. Employment and sick leave in patients with prostate cancer before, during and after radiotherapy Physical activity before radical prostatectomy reduces sick leave after surgery - results from a prospective, non-randomized controlled clinical trial (LAPPRO) The burden of out-of-pocket and indirect costs of prostate cancer. Quality‐of‐life outcomes for men treated with cryosurgery for localized prostate carcinoma Return to work and sick leave after radical prostatectomy: A prospective clinical study Preoperative biofeedback assisted behavioral training to decrease post-prostatectomy incontinence: a randomized, controlled trial. Cancer and the risk for taking early retirement pension: A Danish cohort study Employment outcomes of men treated for prostate cancer. Improving quality of life in men with prostate cancer: a randomized controlled trial of group education interventions. Burden of illness in cancer survivors: findings from a population-based national sample. Influence of radical prostatectomy for prostate cancer on work status and working life 3 years after surgery
BACKGROUND Robot-assisted radical prostatectomy ( RARP ) has been associated with reduced bleeding and shorter hospital stays than open retropubic radical prostatectomy ( RRP ) , but it is unclear whether these differences translate into shorter absence from work . OBJECTIVE To investigate short- and long-term rates of work disability following RARP and RRP . DESIGN , SETTING , AND PARTICIPANTS We conducted a nationwide population -based cohort study of 2571 men of working age treated with RARP or RRP between 2007 and 2009 identified in the National Prostate Cancer Register of Sweden . Information about physician-certified sick leave and disability pension was retrieved from the Swedish Social Insurance Agency through 2012 . OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We used Cox regression to calculate time to return to work ( RTW , or duration of sick leave ) after surgery and used generalised estimating equations to analyse days lost from work ( because of sick leave and disability pension ) after RTW . RESULTS AND LIMITATIONS Men treated with RARP returned to work after a median of 35 d , whereas the corresponding time for RRP was 48 d ( p<0.001 ) . The difference was seen early ; within the first month , men treated with RARP returned to work nearly four times faster than men treated with RRP ( adjusted relative RTW rate 3.76 ; 95 % confidence interval [ CI ] , 3.04 - 4.66 ) . During a median of 3.6 yr after return to work , men treated with RARP lost fewer days from work per person-year than men treated with RRP-12 d versus 15 d-but the association was not statistically significant ( p=0.10 ) . The adjusted rate ratio was 1.08 ( 95 % CI , 0.82 - 1.42 ) . One limitation is the nonr and omised design of this study . CONCLUSIONS RARP was associated with a faster RTW compared with RRP , but the surgical method did not influence long-term rates of work disability in terms of days lost from work after RTW . PATIENT SUMMARY We compared disease-related absence from work between two surgical methods for the removal of the prostate . Robot-assisted surgery was associated with a faster return to work compared with open surgery but did not influence absence from work in a long-term perspective Abstract Objective . The aim of this study was to determine employment outcomes after radiotherapy ( RT ) for prostate cancer ( PCa ) . Material s and methods . The Danish DREAM data base contains information about social benefits paid to Danish citizens . Data are recorded prospect ively every week . From the data base , it is possible to assess whether a patient is working , on sick leave or retired at a certain time . Data on 417 Danish citizens treated with RT for PCa at Rigshospitalet , Copenhagen , between 1 January 2005 and 1 May 2010 were obtained from the data base . The data were collected during a 2 year period from 1 year before RT to 1 year after RT . Results . Among patients of working age , 75 % were still available for work 1 year after RT . The degree of sick leave increased almost continuously in the year before the start of RT and reached a maximum of 56 % during RT . After RT it gradually declined . There was no significant difference between the number of patients on sick leave 1 year after RT compared to 1 year before RT ( p = 0.23 ) . Patients spent a significantly higher number of weeks on sick leave in the year after the start of RT compared to the year before RT ( p = 0.001 ) . Conclusion . Except for a transient increase in sick leave during treatment , RT did not seem to affect the working lives of patients with PCa significantly Background Studies have reported that early physical rehabilitation after surgical procedures is associated with improved outcome measured as shorter hospital stay and enhanced recovery . The aim of this study was to explore the relationship between the preoperative physical activity level and subsequent postoperative complications , sick-leave and hospital stay after radical prostatectomy for prostate cancer in the setting of the LAPPRO trial ( LAParoscopic Prostatectomy Robot Open ) . Methods LAPPRO is a prospect i ve controlled trial , comparing robot-assisted laparoscopic and open surgery for localized prostate cancer between 2008 and 2011 . 1569 patients aged 64 or less with an occupation were included in this sub- study . The Gleason score was < 7 in 52 % of the patients . Demographics and the level of self-assessed preoperative physical activity , length of hospital stay , complications , quality of life , recovery and sick-leave were extracted from clinical record forms and question naires . Multivariable logistic regression , with log-link and logit-link functions , was used to adjust for potential confounding variables . Results The patients were divided into four groups based on their level of activity . As the group with lowest engagement of physical activity was found to be significantly different in base line characteristics from the other groups they were excluded from further analysis . Among patients that were physically active preoperativelly ( n = 1467 ) there was no significant difference between the physical activity-groups regarding hospital stay , recovery or complications . However , in the group with the highest self-assessed level of physical activity , 5 - 7 times per week , 13 % required no sick leave , compared to 6.3 % in the group with a physical activity level of 1 - 2 times per week only ( p < 0.0001 ) . Conclusions In our study of med operated with radical prostatectomy , a high level of physical activity preoperatively was associated with reduced need for sick leave after radical prostatectomy compared to men with lower physical activity . Trial registration The trial is registered at the ISCRTN register . IS RCT N06393679 BACKGROUND Out-of-pocket and indirect ( OPI ) costs play an important role in prostate cancer ( PCa ) outcomes research . We sought to analyze OPI costs of newly diagnosed PCa patients receiving either radical prostatectomy ( RP ) or external beam radiation therapy ( EBRT ) .  METHODS Prospect i ve cohort design was used to recruit 512 newly diagnosed PCa patients from urology clinics of an urban academic hospital and a Veterans Administration medical center . Participants provided demographic information and completed self-reported  generic and prostate-specific Health Related Quality of Life ( HRQoL ) and indirect-cost surveys  at baseline and at 3 , 6 , 12 , and 24 months follow-up . Linear mixed models were applied to study the association between OPI costs , treatment and HRQoL outcomes . Propensity scores adjusted for potential confounders and Bonferroni correction was used to account for multiple testing . RESULTS Total mean OPI costs varied between RP group and EBRT group at 3-month ( $ 5576 vs. $ 2010 ) , 6-month ( $ 1776 vs. $ 2133 ) , 12-month ( $ 757 vs. $ 774 ) , and at 24-month follow-up ( $ 458 vs. $ 871 ) . Linear mixed models indicated that RP was associated with lower medication costs ( OR = 0.61 , CI = 0.48 - 0.89 ) and total OPI costs ( OR = 0.71 , CI = 0.64 - 0.92 ) . Total OPI costs were inversely related to most of the generic HRQoL items . Similarly , prostate-specific HRQoL items of urinary function ( OR = 0.72 ; adjusted-CI = 0.58 - 0.84 ) , bowel function ( OR = 0.96 ; adjusted-CI = 0.78 - 0.98 ) , sexual function ( OR = 0.85 ; adjusted-CI = 0.72 - 0.92 ) , urinary bother ( OR = 0.79 ; adjusted-CI = 0.67 - 0.83 ) , and sexual bother ( OR = 0.88 ; adjusted-CI = 0.76 - 0.93 ) were inversely related to OPI costs . CONCLUSIONS OPI costs of PCa care are substantial and vary across time and treatment Cryosurgery was introduced as an alternative to radiotherapy or radical prostatectomy in the mid‐1960s . Although it met the primary objective of achieving local control , it was largely ab and oned due to a high incidence of complications . Technologic advances in the areas of imaging and urethral warming have renewed interest in this treatment methodology . The aim of the current study was to determine the quality of life of men enrolled in a Phase II clinical trial of cryosurgery for the treatment of localized prostate carcinoma Abstract Background . To evaluate work status at three months after  radical prostatectomy ( RP ) in patients with prostate cancer ( PCa ) in relation to socio-demographics , urinary incontinence and bother , medical complications health-related quality of life ( HRQOL ) and surgical methods . To identify pre-RP available factors that can predict the duration of immediate post-RP sick leave . Material and methods . This prospect i ve question naire-based study included 264 men with PCa < 65 years , who were active in the work force before RP . Urinary incontinence and bother were assessed using the Exp and ed Prostate Cancer Index Composite-50 ( EPIC-50 ) . HRQOL was measured using SF-12 . Medical complications comprised self- reported new morbidities and re-hospitalizations within three months after RP . Patients ’ work status was defined as either “ stable/improved ” or “ declined ” at three months compared to work status at baseline . Duration of immediate post-RP sick leave was considered as prolonged when lasting > 6 weeks . Associations were analyzed using logistic regression analyses . Results . Almost 30 % of the patients had declined work status three months after RP . Change of physical HRQOL was the only factor remaining significantly associated with declined work status in the multivariate analysis . Half of the patients had prolonged immediate sick leave . Having physically strenuous work was the strongest predictor for this outcome . Conclusions . Long periods of sick leave and reduced workforce participation after RP should be considered potential adverse effects of this treatment PURPOSE We tested the effectiveness of preoperative biofeedback assisted behavioral training for decreasing the duration and severity of incontinence , and improving quality of life in the 6 months following radical prostatectomy . MATERIAL S AND METHODS We performed a prospect i ve , r and omized , controlled trial comparing preoperative behavioral training to usual care . The volunteer sample included 125 men 53 to 68 years old who elected radical prostatectomy for prostate cancer . Patients were stratified according to age and tumor differentiation , and r and omized to 1 preoperative session of biofeedback assisted behavioral training plus daily home exercise or a usual care control condition , consisting of simple postoperative instructions to interrupt the urinary stream . The main outcome measurements were duration of incontinence ( time to continence ) , as derived from bladder diaries , incontinence severity ( the proportion with severe/continual leakage ) , pad use , Incontinence Impact Question naire , psychological distress ( Hopkins Symptom Checklist ) and health related quality of life ( Medical Outcomes Study Short Form Health Survey ) . RESULTS Preoperative behavioral training significantly decreased time to continence ( p = 0.03 ) and the proportion of patients with severe/continual leakage at the 6-month end point ( 5.9 % vs 19.6 % , p = 0.04 ) . There were also significant differences between the groups for self-reported urine loss with coughing ( 22.0 % vs 51.1 % , p = 0.003 ) , sneezing ( 26.0 % vs 48.9 % , p = 0.02 ) and getting up from lying down ( 14.0 % vs 31.9 % , p = 0.04 ) . No differences were found on return to work and usual activities or quality of life measures . CONCLUSIONS Preoperative behavioral training can hasten the recovery of urine control and decrease the severity of incontinence following radical prostatectomy Aims : The purpose of this study was to determine the risk for taking early retirement pension ( ERP )  in cancer survivors who were working at the time of diagnosis . Methods : We conducted a nationwide and population based cohort study including 44,905 persons aged 30—60 years diagnosed with selected cancers in the period 1981—2000 and 211,562 r and omly sample d cancer-free controls . Information on socioeconomic status , demography and physical and psychiatric comorbidity was obtained from Danish administrative registries . Results : We analyzed the risk for ERP  adjusted for known risk factors and found that cancer patients has an excess risk of ERP  compared to cancer-free controls ( RR , 1.60 ; 95 % CI , 1.55—1.65 and RR , 1.55 ; 95 % CI , 1.46—1.65 for women and men , respectively ) . The observed risk factors for taking  ERP  were late age , dissimilated disease , manual job , sickness leave the year before taking ERP  , physical and psychological comorbidity , low education and low income . Three risk categories were identified ( high , medium and low ) by cancer site and we found that in the high risk category , people diagnosed with leukemia , prostate cancer or ovary cancer had a more than two-fold increased risk for ERP  and the risk remained increased with up to 8 years of follow-up . Conclusions : We observed a significantly increased risk for taking early retirement  up to 8 years after the cancer diagnosis and that the magnitude of the risk was dependent of cancer sites BACKGROUND Some organizations recommend prostate cancer screening for men younger than age 65 years , many of whom will be employed when they are diagnosed and treated for prostate cancer . Yet little is known about how prostate cancer and its treatment affect men 's employment status . Consequently , we explored employment outcomes 6 and 12 months after the diagnosis of prostate cancer . METHODS We collected data from a prospect i ve , population -based , longitudinal cohort of 267 men aged 30 - 65 years who had been diagnosed with prostate cancer and compared their likelihood of employment to that of men in two population -based control groups of 283 and 256 men without prostate cancer . The study outcomes were , among all participants , employment status and , among patients with prostate cancer , reasons why they remained employed , reasons why their weekly hours worked changed , and work-related disabilities . We predicted employment using probit regression models . In addition , we tested differences between the sample s with two- sample Wilcoxon rank sum tests and chi-square tests . All statistical tests were two-sided . RESULTS Patients with prostate cancer were 10 percentage points ( 95 % confidence interval [ CI ] = 2.50 to 17.51 percentage points ; P = .009 ) less likely to be working 6 months after their diagnosis than men without prostate cancer . However , at 12 months after diagnosis , the likelihood of employment for prostate cancer patients and control subjects was not statistically significantly different ( P = .771 ) . Some patients reported that cancer and its treatment interfered with their ability to perform physical and cognitive tasks at work 12 months after diagnosis . For example , 26 % ( 95 % CI = 18.51 % to 33.87 % ) of men ( 33 patients ) reported that cancer interfered with their ability to perform tasks that involved physical effort . CONCLUSIONS Prostate cancer and its treatment appear to have an impact on employment Men who were recently treated for prostate cancer ( N=250 ) were r and omly assigned to a control group , a group education intervention ( GE ) , or a group education-plus- discussion intervention ( GED ) . Both GE and GED  increased prostate cancer knowledge . In the year postintervention , men in the GED condition were less bothered by sexual problems than men in the control condition , and they were more likely to remain steadily employed ( 93.0 % ) than men in the GE ( 75.6 % ) or control ( 72.5 % ) conditions . Among noncollege graduates , GED and GE result ed in better physical functioning than the control condition , and GED result ed in more positive health behaviors than the control or GE condition . Among college graduates , controls were comparable with the GE and GED groups in physical functioning and positive health behaviors BACKGROUND Population trends in aging and improved cancer survival are likely to result in increased cancer prevalence in the United States , but few estimates of the burden of illness among cancer survivors are currently available . The purpose of this study was to estimate the burden of illness in cancer survivors in a national , population -based sample . METHODS A total of 1823 cancer survivors and 5469 age- , sex- , and educational attainment-matched control subjects were identified from the 2000 National Health Interview Survey . Multiple measures of burden , including utility , a summary measure of health , and days lost from work , were compared using two-sided tests of statistical significance for the two groups overall and for subgroups stratified by tumor site and time since diagnosis . RESULTS Compared with matched control subjects , cancer survivors had poorer outcomes across all burden measures ( P<.01 ) . Cancer survivors had lower utility values ( 0.74 versus 0.80 ; P<.001 ) and higher levels of lost productivity and were more likely to report their health as fair or poor ( 31.0 % versus 17.9 % ; P<.001 ) than matched control subjects . Cancer survivors reported statistically significantly higher burden than did control subjects across tumor sites and across time since diagnosis ( i.e. , within the past year , 2 - 5 years , 6 - 10 years , and > or = 11 years for the majority of measures . CONCLUSIONS Cancer survivors have poorer health outcomes than do similar individuals without cancer across multiple burden measures . These decrements are consistent across tumor sites and are found in patients many years following reported diagnosis . Improved measurement of long-term burden of illness will be important for future prospect i ve research Purpose The purpose of this study is to study the influence of radical prostatectomy ( RP )  for prostate cancer on work status and working life in men 3 years after surgery . Methods In a prospect i ve , question naire-based study on adverse effects after RP , 330 prostate cancer ( PCa ) patients who had been active in the workforce before RP described their work status 3 years after having surgery . We dichotomized their postoperative work status into “ unchanged or increased ” versus “ reduced . ” The participants also reported whether their working life was influenced by the PCa trajectory to no , some , or a great extent . Univariate and multiple logistic regression models were established with sociodemographic and clinical characteristics as independent variables and “ work status ” or “ influence of PCa trajectory on working life ” as dependent variables . Results Twenty-five percent of the participants had retired . Of the remaining participants , approximately 20 % had a reduced work status , which in the multivariate analyses was significantly associated with increasing age . One third of the men still active in the workforce considered the PCa to negatively influence their working life . This was independently associated with bother related to urinary leakage , fatigue , and having undergone additional oncological therapy  ( pelvic radiotherapy and /or hormone treatment ) . Conclusion Though RP does not affect work status in most men , approximately one third of them experience problems in their working life due to adverse effects related to RP and /or additional post-RP anti-cancer therapy . Implication s for Cancer SurvivorsMost PCa survivors can expect to remain in the workforce for at least 3 years after RP , but for some , persistent adverse effects after RP and /or additional anti-cancer treatment negatively affect their working life . Pre-RP counseling of men within the workforce should cover possible post-RP changes concerning work status and working life
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