Abstract 686: Longitudinal analysis of the indirect burden of prostate cancer management on paid and unpaid work: Data from CaPSURE database
Authors: Washington Samuel L. , Lonergan Peter E. , Cowan Janet E. , Zhao Shoujun , Greenberg Scott , Broering Jeanette M. , Palmer Nynikka R. , Cooperberg Matthew R. , Carroll Peter R. 
Published: July 2021

Abstract
Introduction: For clinically localized prostate cancer (PCa) men must choose between various management options [radical prostatectomy (RP), external beam radiation therapy (EBRT), brachytherapy (BT, with or without EBRT), or active surveillance/watchful waiting (AS/WW)] but little is known about the long-term, indirect impact of management on paid work, unpaid responsibilities, and general health up to 10 years after initial management.
Methods: We identified men diagnosed with PCa managed with RP, EBRT, BT, or AS/WW in a longitudinal, observational study of 43 primarily community-based US urology practices with available work type including paid work (full-time, part-time) or unpaid work (retired, on leave/unemployed, disabled, unspecified). Work type, weeks of work missed, general health, and number of clinic visits annually were collected via surveys administered prior to treatment and at 1,3,5 and 10 years after treatment. Using multivariate repeated measures generalized estimating equation modeling we examined the association between primary treatment, work type (paid vs unpaid), race, income, and time since treatment with work weeks missed over time and SF-36 General Health after adjustments for clinicodemographics.
Results:6,673 men were identified. Mean age of 64.4 years (standard deviation 8.3). Most were insured (54% private, 43% Medicare, 3% Veteran's), white (90%, 7% Black, 1% Latino) with low- (60%) or intermediate-risk (32%) disease by CAPRA. Most had paid work (44%) or were retired (45%) and underwent RP (62%, 14% BT, 14% EBRT, 10% AS/WW). Median 5.3 weeks missed in first year (IQR 1.6-12.2) with up to 2.1 weeks missed at all other time points. AS/WW (RR 0.62, 95% CI 0.51-0.74) conferred lowest risk of missed weeks [BT (RR 0.70, 95% CI 0.61-0.80), EBRT (RR 0.72, 95% CI 0.62-0.83)] compared to RP. Black patients had lower risk of reporting missed weeks (vs white, RR 0.68, 95% CI 0.55-0.83); job status was not associated. SF-36 General Health declined across 10 years after treatment after adjustments, with RP and BT having better scores than AS/WW and EBRT.
Conclusions: Nearly one-quarter of men with PCa reported missed work weeks due to PCa management, up to 10 years after treatment, irrespective of job status. Relative to other treatment types, AS/WW had the lowest risk of missed weeks, independent of job status, although long-term general health scores declined more than with RP or BT. In carefully selected men with PCa, management with AS/WW can confer a lower risk of missed work but the long-term impact of PCa management on QoL and work, irrespective of job type, should be considered when counseling about making treatment decisions.
Citation Format: Samuel L. Washington, Peter E. Lonergan, Janet E. Cowan, Shoujun Zhao, Scott Greenberg, Jeanette M. Broering, Nynikka R. Palmer, Matthew R. Cooperberg, Peter R. Carroll. Longitudinal analysis of the indirect burden of prostate cancer management on paid and unpaid work: Data from CaPSURE database [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 686.