Impact of the treatment of chronic myeloid leukaemia by tyrosine-kinase inhibitors on sick leaves refund: a nationwide cohort study.

BACKGROUND: The advent of chronic myeloid leukaemia (CML) tyrosine-kinase inhibitors (TKI) has led to new paradigms including occupational rehabilitation. OBJECTIVES: This study aimed to characterize the impact of CML treatment on sick leaves within the 2 years following diagnosis in working-age patients. METHODS: A cohort of all 18-60-year-old newly diagnosed CML patients initiating a TKI between January 1st 2011 and December 31st 2014 in France was identified in the French National Healthcare database (Système National des Données de Santé [SNDS]). Patients with a sick leave identified in the 24 months after TKI initiation were compared with sex and initiation date matched controls in a nested case-control design. Factors associated with sick leaves were identified through a conditional logistic regression model, providing adjusted odds-ratio (OR) with their 95% confidence interval (CI). RESULTS: Among 646 18-60-year-old patients, 268 were prescribed at least one sick leave in the study period, with 176 (27.2%) having their first sick leave prescribed after TKI initiation. The median number of sick days over the 2-years period was 115 per patient (interquartile range 25.5-384.5). In the nested case-control study (176 cases and 176 matched controls), sick leaves were more likely observed with second generation TKI (OR 4.11 [1.80-9.38]), whereas they were less likely observed in case if social deprivation (OR 0.07 [0.02-0.28]. CONCLUSION: More than 25% of working-age CML patients had at least one sick leave within 2 years of TKI initiation, with a higher impact of second generation TKI, and with a median duration of 115 days.

Work adjustments and employment among breast cancer survivors: a French prospective study.

PURPOSE: The objective of our study was to assess the rate of work adjustments 1 year after the diagnosis in a population of female breast cancer (BC) survivors, in the context of the French system of social protection. We also characterised these adjustments and their influence on the reduction of professional exclusion of patients 1 year after the diagnosis. METHODS: This observational, prospective study was conducted from February 2015 to April 2016 among female patients with BC. Inclusion criteria were women aged between 18 and 65 years, treated for BC and integrated into the labour market at the time of diagnosis (working or on sick leave). Exclusion criteria were metastatic BC, retired patients and refusal to participate. A 1-year follow-up was scheduled, and data collection was performed with questionnaires. RESULTS: In total, 213 patients were included between February 2015 and April 2016. One year after the diagnosis (T1), among 185 BC survivors, 78 (42.2%) patients were working. Among them, 13 patients did not interrupt their occupational activity and 65 returned to work after a period of sick leave. Sixty-four patients returned to work after the end of chemotherapy (after 6 months), and one returned to work before this therapeutic threshold. Sixty-six patients (35.7%) benefited from at least one adjustment of their work conditions to facilitate their return to work (RTW) or maintenance at work: working hours were decreased for 43 patients, and workstation changes were performed for 22 patients. An occupational health physician was involved for some patients; work adjustments were prescribed to 42 patients, 7 patients had medical restrictions for physical reasons and 4 patients had restrictions for psychological reasons. Forty-three patients benefited from part-time work prescribed for therapeutic reasons. CONCLUSIONS: Referral to occupational health physicians and work adjustments remain limited in the process of RTW or maintenance at work after BC in France, despite their positive impact.

Lung cancer survivors and employment: A systematic review.

BACKGROUND: The aim of this systematic review is to identify, in a comprehensive manner, the impact of lung cancer on the employment status of survivors. METHODS: The Preferred Reported Items for Systematic Reviews and Meta-analyses (PRISMA) statement was used as a formal guideline. The systematic review includes scientific papers published between January 2000 and October 2018. The search strategy queried the database MEDLINE. Inclusion criteria comprised: (1) inclusion of patients diagnosed with lung cancer (LC) (2); assessment of employment status or employment outcomes or work adjustments or return to work (3); inclusion of scientific papers published in peer-reviewed journals (4); inclusion of articles written either in English or in French. Literature reviews were not included. RESULTS: A total of 642 scientific papers were retrieved. Twenty-three articles were included in the systematic review: 5 longitudinal studies and 18 cross-sectional studies. LC survivors are 2-3 times more likely to be unemployed as compared with control groups. Previous studies highlight a median duration of sickness absence increased for LC survivors compared to control groups. The strongest decline in earnings was observed among LC survivors as compared to other cancer types. CONCLUSIONS: LC is associated with a significant impact on employment of patients. The promising results of recent therapeutic strategies could lead to a better social and professional prognosis. A reduction of indirect costs is to be expected.

Barriers to seeking help for physicians with substance use disorder: A review.

BACKGROUND: Substance use disorders (SUD) might concern as many as 8-15% of physicians. Previous studies suggest that self-diagnosis and self-medication are common practices among physicians. The aim of this review was to identify if barriers to seeking help and medical care for impaired physicians exist. We also aimed at characterizing the nature of these barriers. METHODS: The review included scientific papers published on the MEDLINE and PsychINFO databases between January 2000 and September 2018. The inclusion criteria were: (i) articles that focused on SUD in physicians. The exclusion criteria were: (i) no mention of SUD; (ii) no mention of barriers to seeking help; (iii) articles focused on burn-out and work-related stress; (iv) articles focused on risk factors or treatments for SUD; (v) articles focused on psychiatric comorbidities and (vi) those focused on other professionals. RESULTS: Potential barriers to seeking help that were identified for impaired physicians with SUD included denial of the disease and of loss of performance, fear of stigma, psychiatric comorbidities, fear of familial/social/professional and economic consequences and a lack of knowledge. CONCLUSIONS: Different barriers to seeking help could be identified. Priority should be given to educating medical students to ameliorate this. Increased awareness should reduce the stigma, which, even nowadays, still prevents some physicians from seeking help.

The impact of chronic myeloid leukemia on employment: the French prospective study.

Patients with chronic myeloid leukemia treated with breakpoint cluster region-Abelson tyrosine kinase inhibitors are likely to survive in excess of 20 years after diagnosis. New challenges appear as we consider life after the disease, including professional challenges and the social reintegration of patients. The purpose of this study was to determine the impact of chronic myeloid leukemia on employment within 2 years after diagnosis. This prospective, observational study included patients diagnosed with chronic myeloid leukemia and treated with a tyrosine kinase inhibitor. Two populations were defined as patients who reported modifications in their professional activity during the study (Acti-Pro+) and patients who did not report a modification (Acti-Pro-). Cancer survivors received a self-assessment questionnaire. The primary endpoint was to determine the professional status of patients. One hundred patients completed the questionnaire. Sixty-six patients out of 100 reported professional activity within 2 years after their diagnosis. During the 2 years after the diagnosis, 65.2% (95% confidence interval (CI), 53.7-76.7) of patients faced modifications in their professional activity due to chronic myeloid leukemia or adverse effects of drug treatments (group Acti-Pro+); in contrast, 34.8% of patients did not report any impact on their occupational activity (group Acti-Pro-). Among modifications to work organization, a change in the number of working hours was the most represented. Other modifications comprised changes in status or work pace. A majority of chronic myeloid leukemia patients face professional consequences of their disease and treatments. Our findings suggest that adverse drug reactions are a major factor affecting the occurrence of work modifications in this context.

Nasal fibroscopy as a routine screening procedure of sinonasal adenocarcinoma of woodworkers: French longitudinal case study.

BACKGROUND: The purpose of this study was to assess the relevancy of flexible nasoendoscopy as a routine screening procedure of sinonasal adenocarcinoma among people occupationally exposed to wood dust. METHODS: This study included woodworkers, occupationally exposed to wood dust. Evaluations were scheduled at the time of inclusion (T0) and after a 2-year period (T1). A questionnaire was used for standardized data collection. The score was based on anatomic landmarks on each side that are parts of the olfactory clefts: the area of middle turbinate, the anterior part of the olfactory cleft, the top of the choanal arch, the spheno-ethmoidal recess, the posterior part of the olfactory cleft, and the middle part of the olfactory cleft. RESULTS: A total of 965 nasoendoscopies (T0+T1) were performed. Olfactory clefts were visualized in 72% of the cases. Nasoendoscopies revealed pathological findings in 33.6% of cases: polyps, thick nasal secretion aspect, mucous edema, retractile scars and synechia, crusts, mucous erythema, and growth. One case of carcinoma was confirmed. Adverse effects (epistaxis, blood mark on the endo-sheath, sneezing, or rhinorrhea) after the medical procedure occurred in 30% of cases without severe complications. CONCLUSION: Flexible nasoendoscopy offers meaningful efficacy and a promising safety profile, and, therefore, could become the new cornerstone of the routine screening procedure of sinonasal adenocarcinoma among woodworkers.

Occupational exposure to human Mycobacterium bovis infection: A systematic review.

BACKGROUND: Mycobacterium bovis (M. bovis) is the main causative agent of bovine zoonotic tuberculosis. The aim of this systematic review is to highlight the occupational exposure to bovine tuberculosis due to M. bovis. METHODOLOGY/PRINCIPAL FINDINGS: A computer based literature search was carried out to identify papers published between January 2006 and March 2017. "PubMed, Cochrane Library and Science Direct" databases were searched systematically. Articles presenting the following properties were included: (i) focusing on M. bovis; (ii) concerning occupational exposure to bovine tuberculosis. A quality assessment was performed after selection of studies. Our search strategy identified a total of 3,264 papers of which 29 studies met the inclusion criteria. Of the 29 articles, 17 were cross-sectional studies (6 were of high quality and scored in the range of 6-7, 11 were of moderate quality and scored in the range 3-5), 10 were case reports, and 2 were reviews. Different occupational fields exposing to the disease were described: livestock sector, particularly in contact with dairy cattle (farmers, veterinaries and assistants, abattoir workers) and working in contact with wildlife (hunters, taxidermists). CONCLUSIONS: A specific guideline for occupational practitioners taking care of employees exposed to bovine tuberculosis is warranted and should be tailored to level of exposure. This review was intended to be the first step of such a project. Articles were identified from various continents and countries with different socio-economic situations, broadening our understanding of the worldwide situation. Published data on occupational exposure in developed countries are scarce. We had to extrapolate findings from countries with higher prevalence of the disease.