We conducted a questionnaire survey among 282 post-treatment GCSs. Before treatment, 247 participants were employed and 35 were unemployed. A total of 207 participants returned to the same workplace and 40 left or changed jobs. Of the participants who returned to the same workplace, 23 (11.1%) were self-employed, 14 (6.8%) were publicly employed, 92 (44.4%) were regularly employed, and 78 (37.8%) were non-regularly employed. Among participants who quit or changed jobs, four were self-employed, three were publicly employed, nine were regularly employed, and 26 were non-regularly employed (Fig. 1).
The mean age at the time of diagnosis was 47.7 years (median, 49 ± 8.3 years; range, 20–63 years), and the average number of years after treatment was 3.1. Table 1 details cancer survivors who returned to the same workplace.
Participants with GC took an average of 76.3 days to return to the same job. The PSL was 0 (7.2%), seven (11.6%), 14 (10.1%), 30 (25.1%), 60 (17.4%), 90 (12.6%), and 180 (7.2%) days for 15, 24, 21, 52, 36, 26, and 15 participants, respectively. Ten participants had less than 365 days (4.8%) and eight had more than 365 days (3.9%) of PSL (Fig. 2).
Treatment methods and PSL were examined in six groups: Surg without lymph node dissection (LND) alone, Surg with LND alone, surgery + < 6 courses of Cx, surgery + ≧ 6 courses of Cx, surgery + RT (including CCRT), and RT alone (including CCRT). The average length of hospitalization or treatment was 9.4 days for surgery without LND alone, 11.5 days for surgery with LND alone, 90.4 days for surgery + < 6 courses of Cx, 172.8 days for surgery + ≧ 6 courses of Cx, 74.6 days for surgery + RT, and 57.3 days for RT alone. The results showed that participants who received surgery + < 6 courses of Cx, surgery + ≧ 6 courses of Cx, and surgery + RT had a significantly longer PSL than participants who received surgery without LND alone (p = 0.003, p < 0.001, p = 0.009, respectively). In particular, surgery + ≧ 6 courses of Cx had a significantly longer PSL than participants who received surgery with LND alone, surgery + < 6 courses of Cx, or RT alone (p < 0.001, p < 0.001, and p < 0.001, respectively). The group that received ≧ 6 courses of Cx took significantly longer to RTW than the other treatment groups. We found that many GCS who received ≥ 6 courses of Cx treatment required nearly six months to RTW (Fig. 3).
We investigated the surgical methods with and without LND in patients with GCSs who underwent surgery alone. The group that underwent LND tended to RTW later than the group that did not (p = 0.068). However, we observed no relationship between the minimally invasive surgery group and time of return (data not shown).
Treatment of GC often has adverse effects, including Cx-induced peripheral neurotoxicity (CIPN), lower extremity lymphedema (LEL), and urological and bowel complications (UBC). CIPN affects the lower and upper extremities with the use of certain chemotherapeutic agents, such as taxanes and platinum derivatives, and can cause loss of vibratory sensation and taste, paresthesia, weakness, tremors, and functional impairment [9–13]. LEL is also known to have a negative impact on patients’ quality of life, as it is associated with symptoms such as swelling, pain, numbness, and functional impairment [14–18]. We investigated the correlations between CIPN, LEL, UBC, and PSL. After treatment, CIPN, LEL, and UBC were observed in 13, 20, and 17 participants, respectively. Five cancer survivors experienced multiple adverse events. GCSs who experienced adverse effects after treatment had a significantly delayed time to RTW (p = 0.045, Fig. 4A). In particular, LEL was shown to be associated with the time to RTW (p = 0.014; Fig. 4B).
Univariate and multivariate analyses were used to analyze the factors that caused PSL to last for more than 100 days to PSL. In univariate analysis, advanced stage (p = 0.003), low personal income (p = 0.030), adverse effects after treatment (p = 0.009), and surgery + Cx ( ≧ 6 courses) were significantly associated with longer PSL. In multivariate analysis, short work time per day (p = 0.039), low personal income (p = 0.024), adverse effects after treatment (p = 0.001), and surgery + Cx ( ≧ 6 courses) (p < 0.001) were significantly associated with longer PSL. Although long-term treatment led to the longest PSL, post-treatment adverse effects were also found to have a large effect on PSL (Table 2).