Title

Return to Work Among Young Adult Survivors of Allogeneic Hematopoietic Cell Transplantation in the United States

Authors

Neel S. Bhatt, Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington. Electronic address: nbhatt@fredhutch.org.
Ruta Brazauskas, Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute of Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin.
Rachel B. Salit, Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
Karen Syrjala, Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
Stephanie Bo-Subait, Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, Minnesota.
Heather Tecca, Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
Sherif M. Badawy, Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
K Scott Baker, Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
Amer Beitinjaneh, Division of Transplantation and Cellular Therapy, University of Miami, Miami, Florida.
Nelli Bejanyan, Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida.
Michael Byrne, Vanderbilt University Medical Center, Nashville, Tennessee.
Ajoy Dias, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Nosha Farhadfar, Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, Florida.
César O. Freytes, Texas Transplant Institute, San Antonio, Texas.
Siddhartha Ganguly, Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, Kansas.
Shahrukh Hashmi, Department of Internal Medicine, Mayo Clinic, Minnesota; Department of Medicine, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates.
Robert J. Hayashi, Division of Pediatric Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine in St Louis, St Louis, Missouri.
Sanghee Hong, Blood and Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
Yoshihiro Inamoto, Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan.
Kareem Jamani, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada.
Kimberly A. Kasow, University of North Carolina, Chapel Hill, North Carolina.
Nandita Khera, Department of Hematology/Oncology, Mayo Clinic, Phoenix, Arizona.
Maxwell M. Krem, Markey Cancer Center, University of Kentucky College of Medicine, Lexington, Kentucky.
Hillard M. Lazarus, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio.
Catherine J. Lee, Utah Blood and Marrow Transplant Program at Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah.
Stephanie Lee, Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
Navneet S. Majhail, Blood and Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
Adriana K. Malone, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
David I. Marks, Adult Bone Marrow Transplant, University Hospitals Bristol NHS Trust, Bristol, United Kingdom.
Lih-Wen Mau, Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, Minnesota.
Samantha J. Mayo, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.
Lori S. Muffly, Division of Blood and Marrow Transplantation, Stanford University, Stanford, California.
Sunita Nathan, Section of Bone Marrow Transplant and Cell Therapy, Rush University Medical Center, Chicago, Illinois.

Abstract

Young adult (YA) survivors of allogeneic hematopoietic cell transplantation (HCT) are at risk for late psychosocial challenges, including the inability to return to work post-HCT. Work-related outcomes in this population remain understudied, however. We conducted this study to assess the post-HCT work status of survivors of allogeneic HCT who underwent HCT as YAs and to analyze the patient-, disease-, and HCT-related factors associated with their work status at 1 year post-HCT. Using Center for International Blood and Marrow Transplant Research data, we evaluated the post-HCT work status (full-time, part-time work, unemployed, or medical disability) of 1365 YA HCT survivors who underwent HCT between 2008 and 2015. Percentages of work status categories were reported at 4 time points: 6 months, 1 year, 2 years, and 3 years post-HCT. Percentages of post-HCT work status categories at the 1-year time point were also described in relation to survivors' pre-HCT work status categories. Factors associated with 1-year post-HCT work status (full-time or part-time work) were examined using logistic regression. From 6 months to 3 years post-HCT, the percentage of survivors working full-time increased from 18.3% to 50.7% and the percentage working part-time increased from 6.9% to 10.5%. Of patients in full-time work pre-HCT, 50% were unemployed or on medical disability at 1 year post-HCT. Female sex (odds ratio [OR], 0.55; 95% confidence interval [CI], 0.40 to 0.77), HCT Comorbidity Index score ≥3 (OR, 0.57; 95% CI, 0.39 to 0.82), pre-HCT unemployment (OR, 0.37; 95% CI, 0.24 to 0.56), medical disability (OR, 0.44; 95% CI, 0.28 to 0.70), development of grade III-IV acute graft-versus-host disease (OR, 0.52; 95% CI, 0.34 to 0.80), and relapse within 1 year post-HCT (OR, 0.34; 95% CI, 0.21 to 0.56) were associated with a lower likelihood of employment at 1 year post-HCT. Compared with myeloablative conditioning (MAC) with total body irradiation (TBI), MAC without TBI (OR, 1.71; 95% CI, 1.16 to 2.53) was associated with a greater likelihood of employment at 1 year post-HCT. Graduate school-level education (OR, 2.47; 95% CI, 1.49 to 4.10) was also associated with a greater likelihood of employment at 1 year post-HCT. Although the work status among YA HCT survivors continued to improve over time, a substantial subset became or remained unemployed or on medical disability. These findings underscore the need for effective interventions to support return to work in this population.

Publication Title

Transplantation and cellular therapy

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