Multidomain predictors of long-term work disability in late survivorship after head and neck cancer

PURPOSE: To estimate the prevalence of long-term work disability (LTD) among head and neck cancer (HNC) survivors more than five years posttreatment, compare profiles of employed, retired, and LTD groups, and identify independent predictors of LTD versus employment. METHODS: Late effects were assessed using the EORTC QLQ-C30, EORTC QLQ-H&N35, Chalder Fatigue Questionnaire, and Body Image Scale in a cross-sectional sample of 251 HNC survivors (mean 8.3 years posttreatment). Employment status was categorized as employed, retired, or LTD (> 12 months sick leave). Predictors of LTD were examined among working-age survivors (n = 145) using hierarchical logistic regression. RESULTS: LTD prevalence was 19% overall and 33% among working-age survivors. In multivariable models, better physical functioning (OR = 0.13, 95% CI 0.05-0.34) and better cognitive functioning (OR = 0.41, 95% CI 0.18-0.93) were associated with lower odds of LTD, while blue-collar occupation (OR = 6.70, 95% CI 1.18-38.05) and body image distress (OR = 13.34, 95% CI 1.25-142.07) were associated with higher odds. Treatment modality of chemoradiotherapy plus surgery vs radiotherapy was marginally associated with lower LTD odds (OR = 0.06, 95% CI 0.01-0.87), but this finding should be interpreted cautiously due to the small RT subgroup. CONCLUSIONS: More than five years posttreatment, LTD remains common and is best explained by current physical and cognitive functioning, body image distress, and occupational context rather than historical clinical exposures or any single symptom.