The Potential for Lost Productivity and Daily Activity Impairment in Patients with Follicular (FL) and Other Indolent Non-Hodgkin’s Lymphoma (NHL).
Authors: Cheung Matthew C. , Imrie Kevin R. , Friedlich Jessica , Buckstein Rena , Hicks Lisa K. , Zaretsky Yael , Hales Brigette , Piliotis Eugenia , Mittmann Nicole 
Published: October 2019

Abstract
Introduction: Nearly one in five cancer survivors report limitations in ability to work following diagnosis, with poor work-related outcomes particularly noted in the hematologic cancers. Although much is known about the efficacy, toxicity and direct costs of treatment for follicular lymphoma, there is no data assessing the impact of this diagnosis on productivity of affected individuals.
Methods: We conducted a consecutive cross-sectional study of patients attending a malignant hematology clinic at a large multi-disciplinary cancer centre. Patients with a diagnosis of FL or other indolent NHL were asked to complete questionnaires assessing demographics, health status (EQ-5D), and work productivity and activity impairment (WPAI questionnaire).
Results: Eighty-four patients completed the survey study (>95% response rate). Mean age was 58.7 (+/−13.8 SD) and 55% were male. Diagnoses included FL (55%), CLL (25%), and other indolent NHL (20%). The majority of patients presented in advanced stage (stage III–IV; 65%) and had received some therapy, although 29% were still being observed without having received therapy by the time of survey administration. The median disclosed income was $40,000–$59,000; 76% had pursued post-secondary education. Over 61% were working full-time prior to diagnosis while 14% were retired. Patients reported a minimal impact on their work productivity (1.9+/−3.2 on a scale of 0 to 10; 0=no effect and 10=complete impairment of activity) and on their daily activities (2.4+/−3.1) attributable to their cancer diagnosis. However, following diagnosis of NHL (and at the time of survey completion), only 33% were able to continue full-time work, 7% were working part-time, 10% required disability, and 37% were retired. Of those still working, a mean of 2.1 days (+/−6.9) were missed due to illness in the preceding 4 weeks, with a mean of 16 days (+/−8.7) worked in that period. Only 6% received paid assistance, while 17% required unpaid care from a partner/spouse, relative, or friend. Unpaid caregivers missed a mean of 11.3 days (+/−16.2) of work and provided a mean of 9.8 days (+/−13.4) of care. There was a significant inverse correlation between daily activity scores (high values=complete impairment) and health status ratings (high values=excellent health status/utilities) ascertained by the EQ-5D instrument (Spearman correlation coefficient −0.69; p<0.0001). After controlling for age, stage, and remission status, significant activity impairment (score >5) was predicted by poor self-rated health status (OR 32.1; 95% CI 5.9–174.2; p<0.0001) and also trended to be worse in patients receiving active treatment (OR 14.5; 95% CI 0.91–230.9; p=0.059).
Conclusion: Although few patients with indolent lymphoma identified significant impairment in daily activity or work productivity, many were unable to continue full time employment following diagnosis, needed to miss days from work due to illness, or imposed a significant burden on caregivers. The greatest impact on activity and productivity is apparent in patients who rate their health status as poor and in those who are currently receiving systemic therapy.