LONG-TERM EMPLOYMENT STATUS AND THE ASSOCIATION WITH FATIGUE IN PATIENTS WITH GRADE II GLIOMAS

ObjectiveTo investigate employment status and return to work in relation to fatigue in patients with World Health Organization (WHO) grade II glioma.DesignExploratory cross-sectional study.SubjectsPatients with grade II glioma, who underwent surgery between 2005 and 2016.MethodsA postal survey was sent in 2019, which included the Short Form-Health and Labour Questionnaire and the Multi-dimensional Fatigue Index. Outcomes of fatigue in subgroups of (not-) return to work were compared using independent t-tests and x² tests. The association between fatigue and return to work was analysed using multivariable logistic regression.ResultsIn total, 73 patients were included in the study (age at diagnosis 41.0 years (standard deviation (SD) 9.2 years), time post-diagnosis 8.0 years (interquartile range (IQR) 6-11 years). At diagnosis, 61 patients were employed and 32 returned to work during follow-up. The return to work group was significantly younger than the not-return to work group (p = 0.007). The proportion of patients who indicated that the consequences of glioma had affected return to work, in terms of demotion or reduced working hours, was 68.7%. The not-return to work group reported significantly more fatigue in all domains than the return to work group (p < 0.05). Mental fatigue (p = 0.023) and physical fatigue (p = 0.065) were independently associated with return to work, adjusted for age, sex and the use of anti-epileptic drugs.ConclusionLong-term fatigue is associated with return to work in patients with grade II glioma. Patients who were able to work in the long term were less fatigued, younger, more often male, and used less anti-epileptic drugs than the patients who did not return to work.LAY ABSTRACTPatients with glioma have adult brain cancer. These patients are relatively young and are of working age when they develop this disease. Treatment options for glioma have improved over recent years, and patients will survive approximately 5-15 years. Almost all patients are of working age. Because of the increased survival time, patients find it important to continue to participate in society, especially in work. This study examined working patterns in patients with glioma several years after the start of their disease. Fifty-two percent of patients were working 8 years after the diagnosis of glioma. Many patients with brain tumours felt tired (fatigued), both mentally and physically. Patients who were able to work in the long term were less fatigued, younger, more often male, and used less anti-epileptic drugs than the patients who did not return to work.Key words: employment, glioma, return to work, fatigue

Engagement in work is very important from a societal perspective and from an individual perspective, in preventing financial stress, social isolation and loss of self-esteem (1–3).In the general cancer population, improvements in diagnosis and treatment have increased the prognosis of patients, and an increasing number of patients return to work (RTW) following treatment or continue to work during therapy (4). A focus on RTW is part of the societal reintegration of cancer survivors (5).Rates of RTW in the overall cancer population range widely, from 30% to 93% (5–7). A metaanalysis reported that cancer survivors overall were 1.37 times more likely to be unemployed than healthy control participants, but patients with a central nervous system cancer were 1.78 times more likely to be unemployed (7).Patients diagnosed with grade II glioma are usually early in their working age and have a favourable midterm prognosis, with a survival time between 5 and 15 years (8, 9). RTW has long been an understudied aspect. Recently, Yoshida et al. (10) and Senft et al. (11) studied rates of RTW for patients with grade II and III glioma. They reported a RTW rate of 54.0% one year after surgery and after a median follow-up of 43.8 months (range 11–82 months) 70.7% of patients were able to resume a working life.Fatigue is a highly prevalent and debilitating symptom in cancer survivors, including patients with glioma (12). Cancer-related fatigue is defined as a “persistent, subjective sense of tiredness related to cancer and cancer treatment that interferes with usual functioning” It is described as a multidimensional phenomenon. In all types of cancer, fatigue is common during treatment and follow-up (13, 14).Fatigue is a negative predictor of RTW in patients who survive cancer (1, 15, 16). Fatigue and treatment-related symptoms are important reasons for not returning to work in diffuse glioma of all grades (11, 17). Since many patients with low-grade glioma have a relatively favourable prognosis, RTW is an important element of survival. The present study therefore investigated employment status and RTW in patients who underwent surgery for a grade II glioma after diagnosis, and the association between fatigue and employment status.