Return to Work Among Young Adult Survivors of Allogeneic Hematopoietic Cell Transplantation in the United States. Transplantation and cellular therapy Bhatt, N. S., Brazauskas, R., Salit, R. B., Syrjala, K., Bo-Subait, S., Tecca, H., Badawy, S. M., Baker, K. S., Beitinjaneh, A., Bejanyan, N., Byrne, M., Dias, A., Farhadfar, N., Freytes, C. O., Ganguly, S., Hashmi, S., Hayashi, R. J., Hong, S., Inamoto, Y., Jamani, K., Kasow, K. A., Khera, N., Krem, M. M., Lazarus, H. M., Lee, C. J., Lee, S., Majhail, N. S., Malone, A. K., Marks, D. I., Mau, L., Mayo, S. J., Muffly, L. S., Nathan, S., Nishihori, T., Page, K. M., Preussler, J., Rangarajan, H. G., Rotz, S. J., Salooja, N., Savani, B. N., Schears, R., Schechter-Finkelstein, T., Schiller, G., Shah, A. J., Sharma, A., Wang, T., Wirk, B., Battiwalla, M., Schoemans, H., Hamilton, B., Buchbinder, D., Phelan, R., Shaw, B. 2021


BACKGROUND: Young adult (YA) survivors of allogeneic hematopoietic cell transplant (HCT) are at risk for late psychosocial challenges, including inability to return to work post-HCT. However, work-related outcomes in this population remain understudied.OBJECTIVES: To assess the post-HCT work status of survivors of allogeneic HCT who underwent HCT as YA and analyze the patient-, disease-, and HCT-related factors associated with their work status at 1-year post-HCT.STUDY DESIGN: Using the Center for International Blood and Marrow Transplant Research (CIBMTR) data, we described post-HCT work status (full-time, part-time work, unemployed, and medical disability) of YA HCT survivors (N=1365) who underwent HCT between 2008 and 2015. Percentages of work status categories were reported at four timepoints: 6-months, 1-, 2-, and 3-year post-HCT. Percentages of post-HCT work status categories at the 1-year timepoint 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.RESULTS: From 6 months to 3 years post-HCT, the percentage of survivors working full-time and part-time increased from 18.3% to 50.7%, and from 6.9% to 10.5%, respectively. 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] 0.40-0.77), HCT-comorbidity index (HCT-CI) score =3 (OR 0.57; 95% CI 0.39-0.82), pre-HCT unemployment (OR 0.37; 95% CI 0.24-0.56), and medical disability (OR 0.44; 95% CI 0.28-0.70), development of grade 3-4 acute graft vs. host disease (OR 0.52; 95% CI 0.34-0.80), and relapse within one-year post-HCT (OR 0.34; 95% CI 0.21-0.56) were associated with lower likelihood of employment at 1-year post-HCT. Compared to myeloablative conditioning with total body irradiation (TBI), myeloablative conditioning without TBI (OR 1.71; 95% CI 1.16-2.53) was associated with higher likelihood of employment at 1-year post-HCT. Graduate school level education (OR 2.47; 95% CI 1.49-4.10) was also associated with higher likelihood of employment at 1-year post-HCT.CONCLUSIONS: While 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 return to work supportive interventions in this population.

View details for DOI 10.1016/j.jtct.2021.04.013

View details for PubMedID 33895402