Impact of whole brain radiotherapy after treatment of melanoma brain metastases on an individual’s employment and household income

Impact of whole brain radiotherapy after treatment of melanoma brain metastases on an individual’s employment and household income | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Impact of whole brain radiotherapy after treatment of melanoma brain metastases on an individual’s employment and household income ANH DAM TRAN, SHARON NG, ANGELA M HONG, MAI TH NGUYEN, Gerald Fogarty, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2724882/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose: A cancer diagnosis can result in a considerable financial burden to individuals and their households. This study aimed to investigate this problem in patients treated for melanoma brain metastases. Methods: An economic evaluation was conducted as a sub-study of a randomised controlled trial of whole brain radiotherapy (WBRT) versus observation following surgery and/or stereotactic radiosurgery (SRS) for 1-3 melanoma brain metastases. Employment status and pre-tax household income were measured at baseline and every 2 months for 12 months. Outcomes included changes in employment status or household income category at 12 months. Results: Of 125 patients, 64 were included in the analysis, 31 randomised to WBRT and 33 to observation, 61 patients were excluded because they were not in the workforce at baseline (42) or were unsure about their income (19). Mean age was 61 years (range 27-88), 37 (58%) completed employment questionnaires and 61 (96%) completed income questionnaires at baseline. Prior to treatment, 39% worked full-time, 8% part-time and 53% were unemployed. At 12 months, 23%, 12% and 65% individuals were employed full-time, part-time and unemployed, respectively. Job status change and household income at 12 months were not significantly different between the two treatment groups (p=0.18 and 0.87, respectively). Conclusions: A substantial proportion of patients experienced job loss after treatment of melanoma brain metastases, however this was similar for those undergoing WBRT or observation alone. Strategies to reduce the impact for both groups (e.g., financial counselling, employment rehabilitation) could be implemented by clinicians and allied health workers. Melanoma survivorship income employment radiotherapy whole brain radiotherapy brain metastases trial. Figures Figure 1 Background Melanoma is the most common cancer among young, working-age individuals in Australia, with approximately 2,500 (18%) Australians aged 25–49 years diagnosed with melanoma in 2017 [ 1 ]. Brain metastases are common in patients with advanced melanoma [ 2 ]. Despite advances in understanding disease mechanisms and improved therapies, patients with late-stage melanoma who develop brain metastases typically have limited treatment options available and historically their median overall survival has been poor (median 7–10 months) despite receiving surgery or stereotactic radiotherapy (SRS) [ 3 – 5 ]. The overall survival rate, however, has significantly improved with systemic drug therapy in recent years, with more recently reported overall survival rates of 89% at one year[ 6 ], 64% at 2 years [ 7 ], and 58% at 3 years[ 8 ]. As well as being directly responsible for the death of many patients, brain metastases may also cause significant morbidity, including impairment of neurocognitive function, seizures, headaches, nausea and vomiting, ataxia, and mental changes [ 9 ]. The available treatments can also cause a range of adverse effects including a decline in cognitive function which may affect an individual’s ability to work and reduce their productivity [ 10 ]. Therefore, individuals may face not only physical and psychological challenges from their cancer diagnosis and treatment, but may encounter financial difficulties, often not considered during the treatment decision-making process. Undergoing treatment for advanced melanoma may delay an individual’s return to the workforce, which can have either a temporary or a permanent impact on their employment, household finances and social relationships [ 11 – 13 ]. In a study of 255 individuals with cancer in Australia, (71% with breast and colorectal cancers), 67% indicated a change in employment since their diagnosis and 63% of those reported reduced household income [ 12 ]. Loss of income is one of the commonly cited factors influencing treatment decision-making [ 12 ]. One review of 64 studies showed 26%-53% of cancer survivors lost their job or stopped working over a 72-month period after diagnosis [ 14 ]. A national longitudinal survey in the US found that annual income was reduced by 40% and total family income was reduced by 20% within 2 years of diagnosis [ 15 ]. There have been no studies conducted specifically in melanoma patients and no studies comparing employment and income loss in different treatment settings. There has been a focus on out-of-pocket costs for healthcare, particularly for patients with advanced cancer, however, the impact on employment and income has been largely ignored. As the number of cancer survivors increases as a result of advances in diagnosis and treatment, it is important to better understand how the effects of cancer, such as melanoma brain metastases, affect employment opportunities and income. This may help to inform individuals and their health-care providers during the treatment decision-making process, as well as guiding policy makers who seek to support individuals with cancer and their families. With the aim of filling some of the gaps outlined above, this study was undertaken to investigate the impact of WBRT on employment and household income for individuals with 1–3 melanoma brain metastases following definitive local treatment. Methods Study design and sample This sub-study involved patients who were enrolled in an international phase III randomized trial, conducted by the Australia and New Zealand Melanoma Trials Group (ANZMTG Study 01–07) and the Trans-Tasman Radiation Oncology Group (TROG) between 2009 and 2017. This trial was undertaken to determine the effect of WBRT on outcomes in individuals with 1–3 melanoma brain metastases after local treatment with surgery and/or stereotactic radiosurgery (SRS) [ 16 ]. The trial was registered with the Australian Clinical Trials Registry (ACTRN12607000512426) and ClinicalTrials.gov (NCT01503827). The details of the trial and its main findings have been reported elsewhere [ 17 ]. The present employment sub-study was approved by relevant Human Research Ethics Committee in March 2013. No socio-economic factors had been used as stratification factors in the original trial randomisation process. Inclusion and exclusion criteria for the employment and income sub-study This sub-study was only offered to trial participants resident in Australia. Excluded were individuals who did not complete the employment status or income questionnaire at baseline, or who were unsure about their household income at baseline. Employment and income questionnaire Information was collected from patients at study baseline and at each 2-month follow-up visit to 12 months or until death or study withdrawal. Individual self-reported information involved a questionnaire seeking socio-demographic information, employment status, pre-tax household income, main source of income and health insurance status. Employment status was categorised as full-time paid work (included self-employment), part-time paid work, unemployed and looking for work, and not in the workforce. The level of household income at the time of diagnosis with melanoma brain metastases was based on an Australian median household pre-tax income of AUD $ 1,234 per week in 2009. We chose household income rather than personal income because high unemployment rates were anticipated among individuals after a diagnosis of brain metastases. The total weekly income before tax of all members in the household aged 15 years and above was categorised into 4 income brackets (less than half the national median income (AUD $ 1,234 per week in 2009), between $ 618 and $ 1,234 AUD, between $ 1,235 and $ 2,467 AUD, and more than $ 2,468 Outcome measures We assessed changes in employment status (eg. full-time to part-time, full-time/ part-time to unemployed), and the changes in average household income category per week over 12 months. Statistical Analysis A binary outcome (yes/no) for reduction in employment was used to capture any changes in an individual’s employment status. A “yes” was given to a negative change in employment status, including a change from full time to part time, full-time to unemployed, or part-time to unemployed at month 12 compared to baseline. An unchanged or a positive change in employment status was given a “no”. Similarly, for income, a “yes” was given if the income had decreased by month 12 compared to the income at baseline and had a “no” was given if the income was unchanged. For example, if the income moved from category 3 ( $ 1235 - $ 2467 per wk) at baseline to category 1 (less than $ 617 per wk), then the binary outcome variable was “yes”. Logistic regression with repeated measures was used to evaluate the impact of WBRT on employment status and income level compared with observation. A p value of less than 0.05 was considered statistically significant. All statistical analyses were performed using SAS version 9.4 (SAS Institute, Cary, NC, USA). Results Baseline individual characteristics The employment and income sub-study was commenced for Australian trial participants part way through the trial. Of 125 patients subsequently enrolled, 61 were excluded because they were either not in the workforce at baseline (n = 42) or were unsure about their income (n = 19). A total of 64 patients (31 in the WBRT group, 33 in the observation group) were thus included in the analysis (Fig. 1). Thirty-seven individuals completed the employment questionnaire (18 in the WBRT group and 19 in the observation group) and 61 patients (95%) completed the baseline income questionnaire (30 in the WBRT group and 31 in the observation group). Baseline characteristics were not significantly different for the two treatment groups (Table 1 ). The majority of individuals were males (72%), with a median age of 61 years (range 27–88 years). Two patients in the sub-study died within the 12 month study period. Table 1. Individual baseline characteristics Individual characteristics WBRT (n=31) Observation (n=33) Overall (n=64) Age (years) Mean (SD) 61 (13) 61 (12) 61 (12) Median 61 61 61 Min - Max 37 - 88 41 - 83 37 - 88 Gender N (%) Female 7 (23) 11 (33) 18 (28) Male 24 (77) 22 (67) 46 (72) Number of lesions N (%) 1 16 (52) 21 (64) 37 (58) 2 10 (32) 6 (18) 16 (25) 3 5 (16) 6 (18) 11 (17) ECOG Performance Status* N (%) 0 19 (61) 22 (67) 41 (64) 1 12 (39) 10 (30) 22 (34) 2 0 (0) 1 (3) 1 (2) Work status at basline N (%) Full-time 14 (35) 17 (44) 31 (39) Part-time 4 (10) 2 (5) 6 (8) Not in the workforce 13 (55) 14 (51) 27 (53) Household income at baseline N(%) Less than or equal $1,234 AU per week 14 (45) 11 (33) 25 (39) More than $1,234 AU per week 16 (52) 19 (58) 35 (55) Unknown 1 (3) 3 (9) 4 (6) Main source of income at baseline N(%) Wages/ Salaries 17 (55) 15 (46) 32 (50) Self-employed 0 (0) 1 (3) 1 (2) Spouse/ Partner 2 (7) 3 (9) 5 (8) Government benefits 9 (29) 5 (15) 14 (22) Unknown 2 (7) 6 (18) 8 (13) Health insurance status N(%) Public 10 (32) 5 (15) 15 (23) Private 12 (39) 16 (49) 28 (44) Department of veterans affairs 1 (3) 0 (0) 1 (2) *The Eastern Cooperative Oncology Group Score. ECOG1: Able to carry out all normal activities without restriction ECOG2: Restricted in physical strenuous activity but ambulatory and able to carry out work of a light or sedentary nature, e.g., light housework, office work ECOG3: Ambulatory and capable of all self-care but unable to carry out any work activities; up and about more than 50% of waking hours Note: SD = Standard deviation, Min = Minimum, Max = Maximum Percentages are based on the number of subjects in the population, excluding missing values Employment analysis Of the 40 patients in the WBRT group who responded to the employment baseline questionnaire 14 (35%) were employed full-time prior to treatment, 4 (10%) were employed part-time, and 22 (55%) were not in the workforce. Of the 19 patients who completed the questionnaire at 12 months, 3 (16%) were employed full time, 3 (16%) were working part-time and 13 (68%) were not in the workforce (Table 2 ). Of the 33 patients in the observation group, at baseline, 17 (44%) were working full-time and 2 (5%) were working part-time and 20 (51%) were not in the workforce. Of the 7 patients who completed the questionnaire at 12 months, 3 (43%) individuals were working full-time and 4 (57%) individuals were not in the workforce (Table 2 ). The association between treatment groups and employment status change was not significantly different (p = 0.18). Table 2 Employment status categories over 12-month follow-up WBRT n (%) n = 31 Observation n (%) n = 33 Total Baseline Full-time 14 (35) 17 (44) 31 (39) Part-time 4 (10) 2 (5) 6 (8) Not in workforce 13 (55) 14 (51) 27 (53) Month 02 Full-time 4 (22) 10 (53) 14 (38) Part-time 4 (22) 2 (10) 6 (16) Not in workforce 10 (56) 7 (37) 17 (46) Missing data 0 (0) 0 (0) 0 (0) Month 04 Full-time 2 (11) 9 (47) 11 (30) Part-time 2 (11) 1 (5) 3 (8) Not in workforce 14 (78) 8 (43) 22 (59) Missing data 0 (0) 1(5) 1 (3) Month 06 Full-time 4 (22) 9 (47) 13 (34) Part-time 0 (0) 2 (11) 2 (5) Not in workforce 11 (61) 8 (42) 19 (50) Missing data 3 (17) 0 (0) 3 (8) Month 08 Full-time 1 (6) 4 (21) 5 (14) Part-time 2 (11) 1 (5) 3 (8) Not in workforce 10 (56) 9 (47) 19 (51) Missing data 5 (28) 5 (26) 10 (27) Month 10 Full-time 4 (22) 4 (21) 10 (27) Part-time 1 (6) 0 (0) 1 (3) Not in workforce 10 (56) 2 (11) 12 (32) Missing data 3 (17) 13 (68) 14 (38) Month 12 Full-time 3 (17) 3 (16) 6 (16) Part-time 3 (17) 0 (0) 3 (8) Not in workforce 13 (67) 4 (21) 16 (43) Missing data 0 (0) 12 (63) 12 (32) Analysis of effect of adding WBRT treatment on individuals’ employment status over 12 months follow-up Employment Estimate 95% CI p-value WBRT -0.26 -0.66 0.13 0.18 *Missing data due to progression/death/other reasons Household income analysis There was no significant difference in the baseline income between two groups (Table 3 ). Of the 30 patients in the WBRT group who responded to the baseline questionnaire, 14 (46%) reported a gross income below or equal to the median (1,234 AUD per week). At 12 months, 14 patients in the WBRT group completed the questionnaire and nine (64%) reported a gross income below or equal to the average median per week. The association between treatment groups and household income was not statistically significant (p = 0.87) (Table 3 ). Table 3 Household income categories over 12-month follow-up WBRT n (%) Observation n (%) Total Baseline Less than $617 per wk 7 (23) 5 (16) 12 (20) $618- $1234 per wk 7 (23) 6 (19) 13 (21) $1235 - $2467 per wk 8 (27) 12 (39) 20 (33) > $2468 per wk 8 (27) 8 (26) 16 (26) Month 02 Less than $617 per wk 4 (13) 5 (16) 9 (15) $618- $1234 per wk 9 (30) 6 (19) 15 (25) $1235 - $2467 per wk 5 (17) 9 (29) 14 (23) > $2468 per wk 2 (7) 3 (10) 5 (8) Missing 10 (33) 8 (26) 18 (30) Month 04 Less than $617 per wk 7 (23) 4 (13) 11 (18) $618- $1234 per wk 8 (27) 4 (13) 12 (20) $1235 - $2467 per wk 3 (10) 5 (16) 8 (13) > $2468 per wk 3 (10) 2 (6) 5 (8) Missing 9 (30) 16 (52) 25 (41) Month 06 Less than $617 per wk 6 (20) 2 (6) 8 (13) $618- $1234 per wk 5 (17) 10 (32) 15 (25) $1235 - $2467 per wk 4 (13) 4 (13) 8 (13) > $2468 per wk 1 (3) 2 (6) 3 (5) Missing 14 (47) 13 (42) 27 (44) Month 08 Less than $617 per wk 4 (13) 2 (6) 6 (10) $618- $1234 per wk 6 (20) 7 (23) 13 (21) $1235 - $2467 per wk 1 (3) 3 (10) 4 (7) > $2468 per wk 2 (7) 0 (0) 2 (3) Missing 17 (57) 19 (61) 36 (59) Month 10 Less than $617 per wk 3 (10) 2 (6) 5 (8) $618- $1234 per wk 8 (27) 4 (13) 12 (20) $1235 - $2467 per wk 3 (10) 3 (10) 6 (10) > $2468 per wk 3 (10) 0 (0) 3 (5) Missing 13 (43) 22 (71) 35 (57) Month 12 Less than $617 per wk 6 (20) 3 (10) 9 (15) $618- $1234 per wk 3 (10) 1 (3) 4 (7) $1235 - $2467 per wk 4 (13) 3 (10) 7 (11) > $2468 per wk 1 (3) 2 (6) 3 (5) Missing 16 (53) 22 (71) 38 (62) Analysis of effect of adding WBRT treatment on household income over 12 months follow-up Income Estimate 95% CI p-value WBRT -0.02 -0.34 0.29 0.87 *Missing data due to progression/death/other reasons Discussion Nearly half of individuals randomised to WBRT reduced their employment from full time to part time at 12 months, and for those who were unemployed at baseline, the proportion who were unemployed rose from one half to two thirds at 12 months. There was a small but generally downward shift in income bracket for both groups. Negative employment change and household income at 12-months were not significantly different between the two groups. The median age was 61 years in both groups, which is over the minimum age that an individual can access their superannuation in Australia (55 to 60, depending on their date of birth) [ 18 ]. The Australian Bureau of Statistics (ABS) 2016-17 Survey found that the average age of retirement in those who had retired in the previous 5 years was 62.9 years [ 19 ]. There is a trend for Australians to retire later in life and this is reflected by the Australian pension eligibility age which is currently 66 years and is expected to increase to 67 years by 2023. The ABS found that among the men and women whose last job was less than 20 years ago, the most commonly reported reason for ceasing their last job was due to reaching “retirement age/eligible for superannuation/pension” and the second main reason was due to “own sickness, injury or disability”. As the median age of our study population was close to the average retirement age, it is possible that a number of our trial participants stopped working due to retirement rather than illness. A 2003 Survey of Disability, Aging and Carers found that nearly half of older Australians with cancer (aged between 45 and 64 years) were not in the labour force. This was also reflected in a study by Bastes et al. which suggested that people with cancer were less likely to be in the labour workforce (46%), resulting in a reduction of $ 1.7 billion to the Australian gross domestic product. Munir et al suggested that the type of cancer and the intensity of the treatment regimen involved will differentially affect an individual’s ability to work [ 11 ]. Paul et al conducted a study in two hospitals in Australia and found that among 255 patients who had a cancer diagnosis, there was a 67% change in employment, which in 16% was job loss [ 12 ]. In another study by Zajacova et al. it was found that individuals are 10% less likely to be employed after diagnosis, with annual working time decreased by up to 200 hours in the first year after diagnosis [ 13 ]. In the current randomised study of adjuvant WBRT versus observation following treatment for melanoma brain metastases, we found that individuals in the WBRT group incurred a reduction in their employment status that was similar to the reduction that occurred in the observation group. This could be because the trial did not show a statistically significant difference in oncological outcomes between the WBRT and observation groups. There was no significant difference between the WBRT group and the observation group for the changes to household income during the first year of treatment. This could be due to other family members increasing work hours or starting work, leave entitlements (e.g, sick leave, annual and long service leave), superannuation in those who had reached the retirement age, and government assistance schemes (e.g. the pension/allowance) which may have assisted in maintaining the same household income as was achieved prior to the diagnosis of brain metastasis. Previously, a number of studies have had the limitation that they examined the effects of a cancer diagnosis and treatments using the general population as a control group. The systematic review performed by Munir et al. highlighted this limitation, and reported that the majority of the studies that they reviewed compared cancer survivors with the healthy general population [ 11 ]. In our study, the control group was patients with SRS/surgery only, not the general population, providing a more appropriate comparison of cancer diagnosis and treatments on financial status. Our sub-study nevertheless had several limitations. The sample size of individuals with advanced melanoma was too small for precise estimates. Due to disease progression, a number of our patients were not able to complete the scheduled follow-up visits, which resulted in missing data. The missed visits were attributed mainly to death due to melanoma, neurocognitive impairment, and disease progression. These patients were therefore most likely not in the workforce. We did not capture financial assistance where individuals used specific sources of financial assistance, or reasons for not assessing financial assistance. Reporting errors from respondents might also distort the true effects of cancer treatment on individuals’ income and employment status. Thus our findings may have underestimated or overestimated the true effects of WBRT compared with observation. Furthermore, income is an important yet challenging concept to measure in surveys as it is a sensitive topic and some people do not like to divulge personal or household weekly income. Self-reporting of data relies on individual interpretation of the question. A number of individuals did not know their exact income so we had to create categories to facilitate responses. This could be improved in future by linking to government databases such as the Australian Taxation Office, although privacy issues would make this difficult to achieve. Conclusions Our findings suggest that WBRT incurred a similar reduction in employment status and pre-tax household income, compared with observation, for adults with locally treated melanoma brain metastases. Strategies to reduce this impact for both groups (e.g., financial counselling, employment rehabilitation and the provision of appropriate cancer support services) could be implemented by clinicians and allied health workers. Declarations Author contribution: ADT : designed of the analysis, conducted data analysis, wrote the manuscript. SN, MTHN: wrote part of the manuscript, presented tables, VS, EP: undertook Medicare coding, cleaned the data, commented on the manuscript. AH, GF, BB, JFT, RLM: designed the study, interpreted findings, wrote and critically reviewed the manuscript, supervised the research team. Acknowledgement: We thank all melanoma patients who consented to this sub-study. We thank the trial coordinators who helped collect and clean the data. We thank the clinicians in melanoma clinics for facilitating the data collection. The authors thank the Australia and New Zealand Melanoma Trials Group in collaboration with the Trans-Tasman Radiation Oncology Group for their coordination and support of this trial. The authors acknowledge and thank Cancer Australia for funding both the original protocol and this substudy. Funding : RLM is supported by an NHMRC Investigator Grant #1194703 and a University of Sydney Robinson Fellowship. JFT was the recipient of an NHMRC Program Grant (APP1093017). This sub-study was funded by Cancer Australia, Priority-driven Collaborative Cancer Research Scheme, Project #1046923. Conflict of interest AMH: Consultancy fee for Oncobeta and Qbiotics. JFT: Honoraria for advisory board participation from BMS Australia, MSD Australia, GSK and Provectus Inc, and travel and conference support from GSK, Provectus Inc and Novartis. References Australian Institute of Health and Welfare, Australian Cancer Incidence and Mortality (ACIM) books: melanoma skin cancer . 2016, AIHW: Canberra. Posner, J.B. and N.L. Chernik, Intracranial metastases from systemic cancer . Adv Neurol, 1978. 19: p. 579–92. Tio, M., X. Wang, M.S. Carlino, et al., Survival and prognostic factors for patients with melanoma brain metastases in the era of modern systemic therapy . Pigment Cell Melanoma Res, 2018. 31(4): p. 509–515. Bottoni, U., R. Clerico, G. Paolino, et al., Predictors and survival in patients with melanoma brain metastases . Med Oncol, 2013. 30(1): p. 466. Vecchio, S., F. Spagnolo, D.F. Merlo, et al., The treatment of melanoma brain metastases before the advent of targeted therapies: associations between therapeutic choice, clinical symptoms and outcome with survival . Melanoma Res, 2014. 24(1): p. 61–7. Long, G.V., V. Atkinson, J.S. Cebon, et al., Standard-dose pembrolizumab in combination with reduced-dose ipilimumab for patients with advanced melanoma (KEYNOTE-029): an open-label, phase 1b trial . The Lancet Oncology, 2017. 18(9): p. 1202–1210. Hodi, F.S., J. Chesney, A.C. Pavlick, et al., Combined nivolumab and ipilimumab versus ipilimumab alone in patients with advanced melanoma: 2-year overall survival outcomes in a multicentre, randomised, controlled, phase 2 trial . The Lancet Oncology, 2016. 17(11): p. 1558–1568. Wolchok, J.D., V. Chiarion-Sileni, R. Gonzalez, et al., Overall survival with combined nivolumab and ipilimumab in advanced melanoma . New England Journal of Medicine, 2017. 377(14): p. 1345–1356. Posner, J.B., Management of central nervous system metastases . Semin Oncol, 1977. 4(1): p. 81–91. Tran, A.D., G. Fogarty, A.K. Nowak, et al., A systematic review and meta-analysis of utility estimates in melanoma . Br J Dermatol, 2018. 178(2): p. 384–393. Munir, F., J. Yarker, and H. McDermott, Employment and the common cancers: correlates of work ability during or following cancer treatment . Occup Med (Lond), 2009. 59(6): p. 381–9. Paul, C., A. Boyes, A. Hall, et al., The impact of cancer diagnosis and treatment on employment, income, treatment decisions and financial assistance and their relationship to socioeconomic and disease factors . Support Care Cancer, 2016. 24(11): p. 4739–46. Zajacova, A., J.B. Dowd, R.F. Schoeni, et al., Employment and income losses among cancer survivors: Estimates from a national longitudinal survey of American families . Cancer, 2015. 121(24): p. 4425–32. Mehnert, A., Employment and work-related issues in cancer survivors . Critical reviews in oncology/hematology, 2011. 77(2): p. 109–130. Zajacova, A., J.B. Dowd, R.F. Schoeni, et al., Employment and income losses among cancer survivors: estimates from a national longitudinal survey of American families . Cancer, 2015. 121(24): p. 4425–4432. Hong, A.M., G.B. Fogarty, K. Dolven-Jacobsen, et al., Adjuvant Whole-Brain Radiation Therapy Compared With Observation After Local Treatment of Melanoma Brain Metastases: A Multicenter, Randomized Phase III Trial . J Clin Oncol, 2019. 37(33): p. 3132–3141. Fogarty, G., R.L. Morton, J. Vardy, et al., Whole brain radiotherapy after local treatment of brain metastases in melanoma patients–a randomised phase III trial . BMC Cancer, 2011. 11: p. 142. Australian Taxation Office. Preservation age . 2019 06 September 2019]; Available from: https://www.ato.gov.au/rates/key-superannuation-rates-and-thresholds/?page=11 . Australian Bureau of Statistics, Retirement and Retirement Intentions, Australia, July 2016 to June 2017 . 2017: Canberra. Aoyama, H., H. Shirato, M. Tago, et al., Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases: a randomized controlled trial . JAMA, 2006. 295(21): p. 2483–91. Patchell, R.A., P.A. Tibbs, W.F. Regine, et al., Postoperative radiotherapy in the treatment of single metastases to the brain: a randomized trial . JAMA, 1998. 280(17): p. 1485–9. Additional Declarations No competing interests reported. Supplementary Files floatimage2.jpeg Figure S1. Trajectory of employment status and income in WBRT and Observation group over 12 month follow-up Appendix.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2724882","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":187343107,"identity":"6b1a4f7a-04c5-44fc-96cf-0afb01bd2fa9","order_by":0,"name":"ANH DAM TRAN","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3UlEQVRIiWNgGAWjYFACHgjFD+UyNhCl5QCQkmwgWYvBAWK18M/uPcD8cY9dnvGN3MOfeRhsZDccYH4mgU+LxJ1zCQwHniUXm93IS5PmYUgz3nCAzQyvFoYbOQYMBw4wJ267kWPGnMNwOHHDAQb8WuQhWuoTN8/IMf6cw/AfqIX9G14tBhAtQMMlcgykcxgOALXw4LfFEKjlwJkDxxNnnHljJv3HINl45mGeYgt8WuRu5Bg+qDhQndjfnmP8cUaFnWzf8faNN/BpAYEDSO4EYmZC6kfBKBgFo2AUEAQAwJZNsiA+th0AAAAASUVORK5CYII=","orcid":"","institution":"The University of Sydney","correspondingAuthor":true,"prefix":"","firstName":"ANH","middleName":"DAM","lastName":"TRAN","suffix":""},{"id":187343108,"identity":"f0dd7b00-e572-4c32-ba0e-836e5cdd0196","order_by":1,"name":"SHARON NG","email":"","orcid":"","institution":"The University of Sydney","correspondingAuthor":false,"prefix":"","firstName":"SHARON","middleName":"","lastName":"NG","suffix":""},{"id":187343109,"identity":"b3eb792b-b047-4327-9b45-b4c80025c672","order_by":2,"name":"ANGELA M HONG","email":"","orcid":"","institution":"The University of Sydney","correspondingAuthor":false,"prefix":"","firstName":"ANGELA","middleName":"M","lastName":"HONG","suffix":""},{"id":187343110,"identity":"49527195-f0c9-4f0f-96e8-9c10ceb30559","order_by":3,"name":"MAI TH NGUYEN","email":"","orcid":"","institution":"The University of Sydney","correspondingAuthor":false,"prefix":"","firstName":"MAI","middleName":"TH","lastName":"NGUYEN","suffix":""},{"id":187343111,"identity":"8067b4e8-6012-4a1d-bf9d-1239ef6625b0","order_by":4,"name":"Gerald Fogarty","email":"","orcid":"","institution":"Icon Cancer Centre Revesby","correspondingAuthor":false,"prefix":"","firstName":"Gerald","middleName":"","lastName":"Fogarty","suffix":""},{"id":187343112,"identity":"4f49d34d-46b8-4f7b-ae4c-4694cc1633de","order_by":5,"name":"Elizabeth Paton","email":"","orcid":"","institution":"Melanoma Institute Australia","correspondingAuthor":false,"prefix":"","firstName":"Elizabeth","middleName":"","lastName":"Paton","suffix":""},{"id":187343113,"identity":"266bc29b-1a49-4af5-a08a-0ffe52f977c0","order_by":6,"name":"Victoria Steel","email":"","orcid":"","institution":"Melanoma Institute Australia","correspondingAuthor":false,"prefix":"","firstName":"Victoria","middleName":"","lastName":"Steel","suffix":""},{"id":187343114,"identity":"53eee820-7548-4e3a-a196-4dcaf798d54f","order_by":7,"name":"Bryan Burmeister","email":"","orcid":"","institution":"Melanoma Institute Australia","correspondingAuthor":false,"prefix":"","firstName":"Bryan","middleName":"","lastName":"Burmeister","suffix":""},{"id":187343115,"identity":"00483f89-3acc-446c-8a04-b3a266356571","order_by":8,"name":"John F Thompson","email":"","orcid":"","institution":"Melanoma Institute Australia","correspondingAuthor":false,"prefix":"","firstName":"John","middleName":"F","lastName":"Thompson","suffix":""},{"id":187343116,"identity":"107fd572-6428-4323-ab44-f10f390d5b03","order_by":9,"name":"Rachael L Morton","email":"","orcid":"","institution":"The University of Sydney","correspondingAuthor":false,"prefix":"","firstName":"Rachael","middleName":"L","lastName":"Morton","suffix":""}],"badges":[],"createdAt":"2023-03-22 22:44:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2724882/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2724882/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":35122234,"identity":"bf2e8677-6399-4c47-8626-5d8b8c92d049","added_by":"auto","created_at":"2023-03-31 21:16:15","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":501830,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eIndividual flow chart\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-2724882/v1/9ee6f28bf31458f4eeb13792.jpeg"},{"id":48232248,"identity":"e7397170-717d-4ed9-a552-d9479e3c0f3f","added_by":"auto","created_at":"2023-12-14 20:07:25","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":464467,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2724882/v1/7337cdd7-2922-49d8-9c29-e4e4e4a463f6.pdf"},{"id":35122235,"identity":"bf901a7a-5f97-42f8-823e-fca437b5d307","added_by":"auto","created_at":"2023-03-31 21:16:15","extension":"jpeg","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":820121,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFigure S1. Trajectory of employment status and income in WBRT and Observation group over 12 month follow-up\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-2724882/v1/834f0dcdaa832dd13d8b1330.jpeg"},{"id":35122233,"identity":"d44c8ab3-cfc3-47eb-9af6-013f53d43fea","added_by":"auto","created_at":"2023-03-31 21:16:15","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":115526,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix.docx","url":"https://assets-eu.researchsquare.com/files/rs-2724882/v1/091a420a9791c26e14c837d2.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Impact of whole brain radiotherapy after treatment of melanoma brain metastases on an individual’s employment and household income","fulltext":[{"header":"Background","content":"\u003cp\u003eMelanoma is the most common cancer among young, working-age individuals in Australia, with approximately 2,500 (18%) Australians aged 25\u0026ndash;49 years diagnosed with melanoma in 2017 [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Brain metastases are common in patients with advanced melanoma [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Despite advances in understanding disease mechanisms and improved therapies, patients with late-stage melanoma who develop brain metastases typically have limited treatment options available and historically their median overall survival has been poor (median 7\u0026ndash;10 months) despite receiving surgery or stereotactic radiotherapy (SRS) [\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The overall survival rate, however, has significantly improved with systemic drug therapy in recent years, with more recently reported overall survival rates of 89% at one year[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], 64% at 2 years [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], and 58% at 3 years[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAs well as being directly responsible for the death of many patients, brain metastases may also cause significant morbidity, including impairment of neurocognitive function, seizures, headaches, nausea and vomiting, ataxia, and mental changes [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The available treatments can also cause a range of adverse effects including a decline in cognitive function which may affect an individual\u0026rsquo;s ability to work and reduce their productivity [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Therefore, individuals may face not only physical and psychological challenges from their cancer diagnosis and treatment, but may encounter financial difficulties, often not considered during the treatment decision-making process. Undergoing treatment for advanced melanoma may delay an individual\u0026rsquo;s return to the workforce, which can have either a temporary or a permanent impact on their employment, household finances and social relationships [\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn a study of 255 individuals with cancer in Australia, (71% with breast and colorectal cancers), 67% indicated a change in employment since their diagnosis and 63% of those reported reduced household income [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Loss of income is one of the commonly cited factors influencing treatment decision-making [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. One review of 64 studies showed 26%-53% of cancer survivors lost their job or stopped working over a 72-month period after diagnosis [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. A national longitudinal survey in the US found that annual income was reduced by 40% and total family income was reduced by 20% within 2 years of diagnosis [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. There have been no studies conducted specifically in melanoma patients and no studies comparing employment and income loss in different treatment settings.\u003c/p\u003e \u003cp\u003eThere has been a focus on out-of-pocket costs for healthcare, particularly for patients with advanced cancer, however, the impact on employment and income has been largely ignored. As the number of cancer survivors increases as a result of advances in diagnosis and treatment, it is important to better understand how the effects of cancer, such as melanoma brain metastases, affect employment opportunities and income. This may help to inform individuals and their health-care providers during the treatment decision-making process, as well as guiding policy makers who seek to support individuals with cancer and their families.\u003c/p\u003e \u003cp\u003e With the aim of filling some of the gaps outlined above, this study was undertaken to investigate the impact of WBRT on employment and household income for individuals with 1\u0026ndash;3 melanoma brain metastases following definitive local treatment.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and sample\u003c/h2\u003e \u003cp\u003eThis sub-study involved patients who were enrolled in an international phase III randomized trial, conducted by the Australia and New Zealand Melanoma Trials Group (ANZMTG Study 01\u0026ndash;07) and the Trans-Tasman Radiation Oncology Group (TROG) between 2009 and 2017. This trial was undertaken to determine the effect of WBRT on outcomes in individuals with 1\u0026ndash;3 melanoma brain metastases after local treatment with surgery and/or stereotactic radiosurgery (SRS) [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The trial was registered with the Australian Clinical Trials Registry (ACTRN12607000512426) and ClinicalTrials.gov (NCT01503827). The details of the trial and its main findings have been reported elsewhere [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe present employment sub-study was approved by relevant Human Research Ethics Committee in March 2013. No socio-economic factors had been used as stratification factors in the original trial randomisation process.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eInclusion and exclusion criteria for the employment and income sub-study\u003c/h3\u003e\n\u003cp\u003eThis sub-study was only offered to trial participants resident in Australia. Excluded were individuals who did not complete the employment status or income questionnaire at baseline, or who were unsure about their household income at baseline.\u003c/p\u003e\n\u003ch3\u003eEmployment and income questionnaire\u003c/h3\u003e\n\u003cp\u003eInformation was collected from patients at study baseline and at each 2-month follow-up visit to 12 months or until death or study withdrawal. Individual self-reported information involved a questionnaire seeking socio-demographic information, employment status, pre-tax household income, main source of income and health insurance status. Employment status was categorised as full-time paid work (included self-employment), part-time paid work, unemployed and looking for work, and not in the workforce.\u003c/p\u003e \u003cp\u003eThe level of household income at the time of diagnosis with melanoma brain metastases was based on an Australian median household pre-tax income of AUD\u003cspan\u003e$\u003c/span\u003e1,234 per week in 2009. We chose household income rather than personal income because high unemployment rates were anticipated among individuals after a diagnosis of brain metastases. The total weekly income before tax of all members in the household aged 15 years and above was categorised into 4 income brackets (less than half the national median income (AUD\u003cspan\u003e$\u003c/span\u003e1,234 per week in 2009), between \u003cspan\u003e$\u003c/span\u003e618 and \u003cspan\u003e$\u003c/span\u003e1,234 AUD, between \u003cspan\u003e$\u003c/span\u003e1,235 and \u003cspan\u003e$\u003c/span\u003e2,467 AUD, and more than \u003cspan\u003e$\u003c/span\u003e2,468\u003c/p\u003e\n\u003ch3\u003eOutcome measures\u003c/h3\u003e\n\u003cp\u003eWe assessed changes in employment status (eg. full-time to part-time, full-time/ part-time to unemployed), and the changes in average household income category per week over 12 months.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eA binary outcome (yes/no) for reduction in employment was used to capture any changes in an individual\u0026rsquo;s employment status. A \u0026ldquo;yes\u0026rdquo; was given to a negative change in employment status, including a change from full time to part time, full-time to unemployed, or part-time to unemployed at month 12 compared to baseline. An unchanged or a positive change in employment status was given a \u0026ldquo;no\u0026rdquo;.\u003c/p\u003e \u003cp\u003eSimilarly, for income, a \u0026ldquo;yes\u0026rdquo; was given if the income had decreased by month 12 compared to the income at baseline and had a \u0026ldquo;no\u0026rdquo; was given if the income was unchanged. For example, if the income moved from category 3 (\u003cspan\u003e$\u003c/span\u003e1235 - \u003cspan\u003e$\u003c/span\u003e2467 per wk) at baseline to category 1 (less than \u003cspan\u003e$\u003c/span\u003e617 per wk), then the binary outcome variable was \u0026ldquo;yes\u0026rdquo;.\u003c/p\u003e \u003cp\u003eLogistic regression with repeated measures was used to evaluate the impact of WBRT on employment status and income level compared with observation. A p value of less than 0.05 was considered statistically significant. All statistical analyses were performed using SAS version 9.4 (SAS Institute, Cary, NC, USA).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\n\u003ch2\u003eBaseline individual characteristics\u003c/h2\u003e\n\u003cp\u003eThe employment and income sub-study was commenced for Australian trial participants part way through the trial. Of 125 patients subsequently enrolled, 61 were excluded because they were either not in the workforce at baseline (n\u0026thinsp;=\u0026thinsp;42) or were unsure about their income (n\u0026thinsp;=\u0026thinsp;19). A total of 64 patients (31 in the WBRT group, 33 in the observation group) were thus included in the analysis (Fig.\u0026nbsp;1). Thirty-seven individuals completed the employment questionnaire (18 in the WBRT group and 19 in the observation group) and 61 patients (95%) completed the baseline income questionnaire (30 in the WBRT group and 31 in the observation group).\u003c/p\u003e\n\u003cp\u003eBaseline characteristics were not significantly different for the two treatment groups (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). The majority of individuals were males (72%), with a median age of 61 years (range 27\u0026ndash;88 years). Two patients in the sub-study died within the 12 month study period.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1. Individual baseline characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" width=\"594\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"300\"\u003e\n\u003cp\u003e\u003cstrong\u003eIndividual characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e\u003cstrong\u003eWBRT (n=31)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e\u003cstrong\u003eObservation (n=33)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e\u003cstrong\u003eOverall (n=64)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"300\"\u003e\n\u003cp\u003eAge (years)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"300\"\u003e\n\u003cp\u003eMean (SD)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e61 (13)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e61 (12)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e61 (12)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"300\"\u003e\n\u003cp\u003eMedian\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e61\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e61\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e61\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"300\"\u003e\n\u003cp\u003eMin - Max\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e37 - 88\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e41 - 83\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e37 - 88\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"300\"\u003e\n\u003cp\u003eGender N (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"300\"\u003e\n\u003cp\u003eFemale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e7 (23)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e11 (33)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e18 (28)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"300\"\u003e\n\u003cp\u003eMale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e24 (77)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e22 (67)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e46 (72)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"300\"\u003e\n\u003cp\u003eNumber of lesions N (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"300\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e16 (52)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e21 (64)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e37 (58)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"300\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e10 (32)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e6 (18)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e16 (25)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"300\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e5 (16)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e6 (18)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e11 (17)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"300\"\u003e\n\u003cp\u003eECOG Performance Status* N (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"300\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e19 (61)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e22 (67)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e41 (64)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"300\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e12 (39)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e10 (30)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e22 (34)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"300\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e0 (0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e1 (3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e1 (2)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"300\"\u003e\n\u003cp\u003eWork status at basline \u0026nbsp;N (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"300\"\u003e\n\u003cp\u003eFull-time\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e14 (35)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e17 (44)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e31 (39)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"300\"\u003e\n\u003cp\u003ePart-time\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e4 (10)\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e2 (5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e6 (8)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"300\"\u003e\n\u003cp\u003eNot in the workforce\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e13 (55)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e14 (51)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e27 (53)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"300\"\u003e\n\u003cp\u003eHousehold income at baseline N(%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"300\"\u003e\n\u003cp\u003eLess than or equal $1,234 AU per week\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e14 (45)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e11 (33)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e25 (39)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"300\"\u003e\n\u003cp\u003eMore than $1,234 AU per week\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e16 (52)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e19 (58)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e35 (55)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"300\"\u003e\n\u003cp\u003eUnknown\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e1 (3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e3 (9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e4 (6)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"300\"\u003e\n\u003cp\u003eMain source of income at baseline N(%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"300\"\u003e\n\u003cp\u003eWages/ Salaries\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e17 (55)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e15 (46)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e32 (50)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"300\"\u003e\n\u003cp\u003eSelf-employed\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e0 (0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e1 (3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e1 (2)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"300\"\u003e\n\u003cp\u003eSpouse/ Partner\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e2 (7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e3 (9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e5 (8)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"300\"\u003e\n\u003cp\u003eGovernment benefits\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e9 (29)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e5 (15)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e14 (22)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"300\"\u003e\n\u003cp\u003eUnknown\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e2 (7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e6 (18)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e8 (13)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"300\"\u003e\n\u003cp\u003eHealth insurance status N(%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"300\"\u003e\n\u003cp\u003ePublic\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e10 (32)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e5 (15)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e15 (23)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"300\"\u003e\n\u003cp\u003ePrivate\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e12 (39)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e16 (49)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e28 (44)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"300\"\u003e\n\u003cp\u003eDepartment of veterans affairs\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e1 (3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e0 (0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"98\"\u003e\n\u003cp\u003e1 (2)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*The\u0026nbsp;Eastern\u0026nbsp;Cooperative\u0026nbsp;Oncology\u0026nbsp;Group\u0026nbsp;Score.\u003c/p\u003e\n\u003cp\u003eECOG1: Able to carry out all normal activities without restriction\u003c/p\u003e\n\u003cp\u003eECOG2: Restricted in physical strenuous activity but ambulatory and able to carry out work of a light or sedentary nature, e.g., light housework, office work\u003c/p\u003e\n\u003cp\u003eECOG3: Ambulatory and capable of all self-care but unable to carry out any work activities; up and about more than 50% of waking hours\u003cbr /\u003e Note:\u0026nbsp;SD\u0026nbsp;=\u0026nbsp;Standard\u0026nbsp;deviation,\u0026nbsp;Min\u0026nbsp;=\u0026nbsp;Minimum,\u0026nbsp;Max\u0026nbsp;=\u0026nbsp;Maximum\u003cbr /\u003e Percentages\u0026nbsp;are\u0026nbsp;based\u0026nbsp;on\u0026nbsp;the\u0026nbsp;number\u0026nbsp;of\u0026nbsp;subjects\u0026nbsp;in\u0026nbsp;the\u0026nbsp;population, \u0026nbsp;excluding\u0026nbsp;missing\u0026nbsp;values\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eEmployment analysis\u003c/h3\u003e\n\u003cp\u003eOf the 40 patients in the WBRT group who responded to the employment baseline questionnaire 14 (35%) were employed full-time prior to treatment, 4 (10%) were employed part-time, and 22 (55%) were not in the workforce. Of the 19 patients who completed the questionnaire at 12 months, 3 (16%) were employed full time, 3 (16%) were working part-time and 13 (68%) were not in the workforce (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). Of the 33 patients in the observation group, at baseline, 17 (44%) were working full-time and 2 (5%) were working part-time and 20 (51%) were not in the workforce. Of the 7 patients who completed the questionnaire at 12 months, 3 (43%) individuals were working full-time and 4 (57%) individuals were not in the workforce (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). The association between treatment groups and employment status change was not significantly different (p\u0026thinsp;=\u0026thinsp;0.18).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eEmployment status categories over 12-month follow-up\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eWBRT n (%)\u003c/p\u003e\n\u003cp\u003en\u0026thinsp;=\u0026thinsp;31\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eObservation n (%)\u003c/p\u003e\n\u003cp\u003en\u0026thinsp;=\u0026thinsp;33\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eTotal\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eBaseline\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFull-time\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e14 (35)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e17 (44)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e31 (39)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePart-time\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4 (10)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e2 (5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e6 (8)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNot in workforce\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13 (55)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e14 (51)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e27 (53)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"4\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eMonth 02\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFull-time\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4 (22)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e10 (53)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e14 (38)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePart-time\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4 (22)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e2 (10)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e6 (16)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNot in workforce\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10 (56)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e7 (37)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e17 (46)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMissing data\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0 (0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0 (0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0 (0)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"4\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eMonth 04\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFull-time\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2 (11)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e9 (47)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e11 (30)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePart-time\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2 (11)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e1 (5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e3 (8)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNot in workforce\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e14 (78)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e8 (43)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e22 (59)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMissing data\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0 (0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e1(5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e1 (3)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"4\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eMonth 06\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFull-time\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4 (22)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e9 (47)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e13 (34)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePart-time\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0 (0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e2 (11)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e2 (5)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNot in workforce\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11 (61)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e8 (42)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e19 (50)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMissing data\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3 (17)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0 (0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e3 (8)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"4\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eMonth 08\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFull-time\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e4 (21)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e5 (14)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePart-time\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2 (11)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e1 (5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e3 (8)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNot in workforce\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10 (56)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e9 (47)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e19 (51)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMissing data\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5 (28)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e5 (26)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e10 (27)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"4\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eMonth 10\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFull-time\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4 (22)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e4 (21)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e10 (27)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePart-time\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0 (0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e1 (3)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNot in workforce\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10 (56)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e2 (11)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e12 (32)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMissing data\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3 (17)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e13 (68)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e14 (38)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"4\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eMonth 12\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFull-time\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3 (17)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e3 (16)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e6 (16)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePart-time\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3 (17)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0 (0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e3 (8)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNot in workforce\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13 (67)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e4 (21)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e16 (43)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMissing data\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0 (0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e12 (63)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e12 (32)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd colspan=\"6\" align=\"left\"\u003e\n\u003cp\u003eAnalysis of effect of adding WBRT treatment on individuals\u0026rsquo; employment status over 12 months follow-up\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eEmployment\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eEstimate\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eWBRT\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.26\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e-0.66\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0.13\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.18\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"7\"\u003e*Missing data due to progression/death/other reasons\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003ch3\u003eHousehold income analysis\u003c/h3\u003e\n\u003cp\u003eThere was no significant difference in the baseline income between two groups (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e). Of the 30 patients in the WBRT group who responded to the baseline questionnaire, 14 (46%) reported a gross income below or equal to the median (1,234 AUD per week). At 12 months, 14 patients in the WBRT group completed the questionnaire and nine (64%) reported a gross income below or equal to the average median per week. The association between treatment groups and household income was not statistically significant (p\u0026thinsp;=\u0026thinsp;0.87) (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eHousehold income categories over 12-month follow-up\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr style=\"height: 59px;\"\u003e\n\u003cth style=\"height: 59px;\" align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth style=\"height: 59px;\" align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth style=\"height: 59px;\" align=\"left\"\u003e\n\u003cp\u003eWBRT n (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth style=\"height: 59px;\" align=\"left\"\u003e\n\u003cp\u003eObservation\u003c/p\u003e\n\u003cp\u003en (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth style=\"height: 59px;\" align=\"left\"\u003e\n\u003cp\u003eTotal\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 140px;\" rowspan=\"4\" align=\"left\"\u003e\n\u003cp\u003eBaseline\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003eLess than $617 per wk\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e7 (23)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e5 (16)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e12 (20)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e$618- $1234 per wk\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e7 (23)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e6 (19)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e13 (21)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e$1235 - $2467 per wk\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e8 (27)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e12 (39)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e20 (33)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e\u0026gt; $2468 per wk\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e8 (27)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e8 (26)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e16 (26)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 175px;\" rowspan=\"5\" align=\"left\"\u003e\n\u003cp\u003eMonth 02\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003eLess than $617 per wk\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e4 (13)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e5 (16)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e9 (15)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e$618- $1234 per wk\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e9 (30)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e6 (19)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e15 (25)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e$1235 - $2467 per wk\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e5 (17)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e9 (29)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e14 (23)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e\u0026gt; $2468 per wk\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e2 (7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e3 (10)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e5 (8)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003eMissing\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e10 (33)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e8 (26)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e18 (30)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 175px;\" rowspan=\"5\" align=\"left\"\u003e\n\u003cp\u003eMonth 04\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003eLess than $617 per wk\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e7 (23)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e4 (13)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e11 (18)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e$618- $1234 per wk\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e8 (27)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e4 (13)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e12 (20)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e$1235 - $2467 per wk\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e3 (10)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e5 (16)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e8 (13)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e\u0026gt; $2468 per wk\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e3 (10)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e2 (6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e5 (8)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003eMissing\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e9 (30)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e16 (52)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e25 (41)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 175px;\" rowspan=\"5\" align=\"left\"\u003e\n\u003cp\u003eMonth 06\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003eLess than $617 per wk\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e6 (20)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e2 (6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e8 (13)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e$618- $1234 per wk\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e5 (17)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e10 (32)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e15 (25)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e$1235 - $2467 per wk\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e4 (13)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e4 (13)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e8 (13)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e\u0026gt; $2468 per wk\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e1 (3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e2 (6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e3 (5)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003eMissing\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e14 (47)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e13 (42)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e27 (44)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 175px;\" rowspan=\"5\" align=\"left\"\u003e\n\u003cp\u003eMonth 08\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003eLess than $617 per wk\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e4 (13)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e2 (6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e6 (10)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e$618- $1234 per wk\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e6 (20)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e7 (23)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e13 (21)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e$1235 - $2467 per wk\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e1 (3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e3 (10)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e4 (7)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e\u0026gt; $2468 per wk\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e2 (7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e0 (0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e2 (3)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003eMissing\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e17 (57)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e19 (61)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e36 (59)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 175px;\" rowspan=\"5\" align=\"left\"\u003e\n\u003cp\u003eMonth 10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003eLess than $617 per wk\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e3 (10)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e2 (6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e5 (8)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e$618- $1234 per wk\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e8 (27)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e4 (13)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e12 (20)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e$1235 - $2467 per wk\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e3 (10)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e3 (10)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e6 (10)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e\u0026gt; $2468 per wk\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e3 (10)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e0 (0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e3 (5)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003eMissing\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e13 (43)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e22 (71)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e35 (57)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 175px;\" rowspan=\"5\" align=\"left\"\u003e\n\u003cp\u003eMonth 12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003eLess than $617 per wk\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e6 (20)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e3 (10)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e9 (15)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e$618- $1234 per wk\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e3 (10)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e1 (3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e4 (7)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e$1235 - $2467 per wk\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e4 (13)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e3 (10)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e7 (11)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e\u0026gt; $2468 per wk\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e1 (3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e2 (6)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e3 (5)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003eMissing\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e16 (53)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e22 (71)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e38 (62)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003eAnalysis of effect of adding WBRT treatment on household income over 12 months follow-up\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eIncome\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eEstimate\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003eWBRT\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e-0.02\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e-0.34\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e0.29\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" align=\"left\"\u003e\n\u003cp\u003e0.87\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr style=\"height: 13.8125px;\"\u003e\n\u003ctd style=\"height: 13.8125px;\" colspan=\"5\"\u003e*Missing data due to progression/death/other reasons\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eNearly half of individuals randomised to WBRT reduced their employment from full time to part time at 12 months, and for those who were unemployed at baseline, the proportion who were unemployed rose from one half to two thirds at 12 months. There was a small but generally downward shift in income bracket for both groups. Negative employment change and household income at 12-months were not significantly different between the two groups.\u003c/p\u003e \u003cp\u003eThe median age was 61 years in both groups, which is over the minimum age that an individual can access their superannuation in Australia (55 to 60, depending on their date of birth) [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The Australian Bureau of Statistics (ABS) 2016-17 Survey found that the average age of retirement in those who had retired in the previous 5 years was 62.9 years [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. There is a trend for Australians to retire later in life and this is reflected by the Australian pension eligibility age which is currently 66 years and is expected to increase to 67 years by 2023. The ABS found that among the men and women whose last job was less than 20 years ago, the most commonly reported reason for ceasing their last job was due to reaching \u0026ldquo;retirement age/eligible for superannuation/pension\u0026rdquo; and the second main reason was due to \u0026ldquo;own sickness, injury or disability\u0026rdquo;. As the median age of our study population was close to the average retirement age, it is possible that a number of our trial participants stopped working due to retirement rather than illness.\u003c/p\u003e \u003cp\u003eA 2003 Survey of Disability, Aging and Carers found that nearly half of older Australians with cancer (aged between 45 and 64 years) were not in the labour force. This was also reflected in a study by Bastes et al. which suggested that people with cancer were less likely to be in the labour workforce (46%), resulting in a reduction of \u003cspan\u003e$\u003c/span\u003e1.7\u0026nbsp;billion to the Australian gross domestic product. Munir et al suggested that the type of cancer and the intensity of the treatment regimen involved will differentially affect an individual\u0026rsquo;s ability to work [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Paul et al conducted a study in two hospitals in Australia and found that among 255 patients who had a cancer diagnosis, there was a 67% change in employment, which in 16% was job loss [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. In another study by Zajacova et al. it was found that individuals are 10% less likely to be employed after diagnosis, with annual working time decreased by up to 200 hours in the first year after diagnosis [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the current randomised study of adjuvant WBRT versus observation following treatment for melanoma brain metastases, we found that individuals in the WBRT group incurred a reduction in their employment status that was similar to the reduction that occurred in the observation group. This could be because the trial did not show a statistically significant difference in oncological outcomes between the WBRT and observation groups.\u003c/p\u003e \u003cp\u003eThere was no significant difference between the WBRT group and the observation group for the changes to household income during the first year of treatment. This could be due to other family members increasing work hours or starting work, leave entitlements (e.g, sick leave, annual and long service leave), superannuation in those who had reached the retirement age, and government assistance schemes (e.g. the pension/allowance) which may have assisted in maintaining the same household income as was achieved prior to the diagnosis of brain metastasis.\u003c/p\u003e \u003cp\u003ePreviously, a number of studies have had the limitation that they examined the effects of a cancer diagnosis and treatments using the general population as a control group. The systematic review performed by Munir et al. highlighted this limitation, and reported that the majority of the studies that they reviewed compared cancer survivors with the healthy general population [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. In our study, the control group was patients with SRS/surgery only, not the general population, providing a more appropriate comparison of cancer diagnosis and treatments on financial status.\u003c/p\u003e \u003cp\u003eOur sub-study nevertheless had several limitations. The sample size of individuals with advanced melanoma was too small for precise estimates. Due to disease progression, a number of our patients were not able to complete the scheduled follow-up visits, which resulted in missing data. The missed visits were attributed mainly to death due to melanoma, neurocognitive impairment, and disease progression. These patients were therefore most likely not in the workforce. We did not capture financial assistance where individuals used specific sources of financial assistance, or reasons for not assessing financial assistance. Reporting errors from respondents might also distort the true effects of cancer treatment on individuals\u0026rsquo; income and employment status. Thus our findings may have underestimated or overestimated the true effects of WBRT compared with observation. Furthermore, income is an important yet challenging concept to measure in surveys as it is a sensitive topic and some people do not like to divulge personal or household weekly income. Self-reporting of data relies on individual interpretation of the question. A number of individuals did not know their exact income so we had to create categories to facilitate responses. This could be improved in future by linking to government databases such as the Australian Taxation Office, although privacy issues would make this difficult to achieve.\u003c/p\u003e "},{"header":"Conclusions","content":"\u003cp\u003e Our findings suggest that WBRT incurred a similar reduction in employment status and pre-tax household income, compared with observation, for adults with locally treated melanoma brain metastases. Strategies to reduce this impact for both groups (e.g., financial counselling, employment rehabilitation and the provision of appropriate cancer support services) could be implemented by clinicians and allied health workers.\u003c/p\u003e \u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contribution:\u0026nbsp;\u003c/strong\u003eADT\u003cu\u003e:\u003c/u\u003e designed of the analysis, conducted data analysis, wrote the manuscript. SN, MTHN: wrote part of the manuscript, presented tables, VS, EP: undertook Medicare coding, cleaned the data, commented on the manuscript. AH, GF, BB, JFT, RLM: designed the study, interpreted findings, wrote and critically reviewed the manuscript, supervised the research team.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement:\u0026nbsp;\u003c/strong\u003eWe thank all melanoma patients who consented to this sub-study. We thank the trial coordinators who helped collect and clean the data. We thank the clinicians in melanoma clinics for facilitating the data collection. The authors thank the Australia and New Zealand Melanoma Trials Group in collaboration with the Trans-Tasman Radiation Oncology Group for their coordination and support of this trial. The authors acknowledge and thank Cancer Australia for funding both the original protocol and this substudy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e:\u0026nbsp;RLM is supported by an NHMRC Investigator Grant #1194703\u0026nbsp;and a University of Sydney Robinson Fellowship. JFT was the recipient of an NHMRC Program Grant (APP1093017). \u0026nbsp;This sub-study was funded by Cancer Australia, Priority-driven Collaborative Cancer Research Scheme, Project #1046923.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAMH: Consultancy fee for Oncobeta and Qbiotics. JFT: Honoraria for advisory board participation from BMS Australia, MSD Australia, GSK and Provectus Inc, and travel and conference support from GSK, Provectus Inc and Novartis.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAustralian Institute of Health and Welfare, \u003cem\u003eAustralian Cancer Incidence and Mortality (ACIM) books: melanoma skin cancer\u003c/em\u003e. 2016, AIHW: Canberra.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePosner, J.B. and N.L. Chernik, \u003cem\u003eIntracranial metastases from systemic cancer\u003c/em\u003e. Adv Neurol, 1978. 19: p.\u0026nbsp;579\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTio, M., X. Wang, M.S. Carlino, et al., \u003cem\u003eSurvival and prognostic factors for patients with melanoma brain metastases in the era of modern systemic therapy\u003c/em\u003e. Pigment Cell Melanoma Res, 2018. 31(4): p.\u0026nbsp;509\u0026ndash;515.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBottoni, U., R. Clerico, G. Paolino, et al., \u003cem\u003ePredictors and survival in patients with melanoma brain metastases\u003c/em\u003e. Med Oncol, 2013. 30(1): p.\u0026nbsp;466.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVecchio, S., F. Spagnolo, D.F. Merlo, et al., \u003cem\u003eThe treatment of melanoma brain metastases before the advent of targeted therapies: associations between therapeutic choice, clinical symptoms and outcome with survival\u003c/em\u003e. Melanoma Res, 2014. 24(1): p.\u0026nbsp;61\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLong, G.V., V. Atkinson, J.S. Cebon, et al., \u003cem\u003eStandard-dose pembrolizumab in combination with reduced-dose ipilimumab for patients with advanced melanoma (KEYNOTE-029): an open-label, phase 1b trial\u003c/em\u003e. The Lancet Oncology, 2017. 18(9): p.\u0026nbsp;1202\u0026ndash;1210.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHodi, F.S., J. Chesney, A.C. Pavlick, et al., \u003cem\u003eCombined nivolumab and ipilimumab versus ipilimumab alone in patients with advanced melanoma: 2-year overall survival outcomes in a multicentre, randomised, controlled, phase 2 trial\u003c/em\u003e. The Lancet Oncology, 2016. 17(11): p.\u0026nbsp;1558\u0026ndash;1568.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWolchok, J.D., V. Chiarion-Sileni, R. Gonzalez, et al., \u003cem\u003eOverall survival with combined nivolumab and ipilimumab in advanced melanoma\u003c/em\u003e. New England Journal of Medicine, 2017. 377(14): p.\u0026nbsp;1345\u0026ndash;1356.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePosner, J.B., \u003cem\u003eManagement of central nervous system metastases\u003c/em\u003e. Semin Oncol, 1977. 4(1): p.\u0026nbsp;81\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTran, A.D., G. Fogarty, A.K. Nowak, et al., \u003cem\u003eA systematic review and meta-analysis of utility estimates in melanoma\u003c/em\u003e. Br J Dermatol, 2018. 178(2): p.\u0026nbsp;384\u0026ndash;393.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMunir, F., J. Yarker, and H. McDermott, \u003cem\u003eEmployment and the common cancers: correlates of work ability during or following cancer treatment\u003c/em\u003e. Occup Med (Lond), 2009. 59(6): p.\u0026nbsp;381\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePaul, C., A. Boyes, A. Hall, et al., \u003cem\u003eThe impact of cancer diagnosis and treatment on employment, income, treatment decisions and financial assistance and their relationship to socioeconomic and disease factors\u003c/em\u003e. Support Care Cancer, 2016. 24(11): p.\u0026nbsp;4739\u0026ndash;46.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZajacova, A., J.B. Dowd, R.F. Schoeni, et al., \u003cem\u003eEmployment and income losses among cancer survivors: Estimates from a national longitudinal survey of American families\u003c/em\u003e. Cancer, 2015. 121(24): p.\u0026nbsp;4425\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMehnert, A., \u003cem\u003eEmployment and work-related issues in cancer survivors\u003c/em\u003e. Critical reviews in oncology/hematology, 2011. 77(2): p.\u0026nbsp;109\u0026ndash;130.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZajacova, A., J.B. Dowd, R.F. Schoeni, et al., \u003cem\u003eEmployment and income losses among cancer survivors: estimates from a national longitudinal survey of American families\u003c/em\u003e. Cancer, 2015. 121(24): p.\u0026nbsp;4425\u0026ndash;4432.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHong, A.M., G.B. Fogarty, K. Dolven-Jacobsen, et al., \u003cem\u003eAdjuvant Whole-Brain Radiation Therapy Compared With Observation After Local Treatment of Melanoma Brain Metastases: A Multicenter, Randomized Phase III Trial\u003c/em\u003e. J Clin Oncol, 2019. 37(33): p.\u0026nbsp;3132\u0026ndash;3141.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFogarty, G., R.L. Morton, J. Vardy, et al., \u003cem\u003eWhole brain radiotherapy after local treatment of brain metastases in melanoma patients\u0026ndash;a randomised phase III trial\u003c/em\u003e. BMC Cancer, 2011. 11: p.\u0026nbsp;142.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAustralian Taxation Office. \u003cem\u003ePreservation age\u003c/em\u003e. 2019 06 September 2019]; Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ato.gov.au/rates/key-superannuation-rates-and-thresholds/?page=11\u003c/span\u003e\u003cspan address=\"https://www.ato.gov.au/rates/key-superannuation-rates-and-thresholds/?page=11\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAustralian Bureau of Statistics, \u003cem\u003eRetirement and Retirement Intentions, Australia, July 2016 to June 2017\u003c/em\u003e. 2017: Canberra.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAoyama, H., H. Shirato, M. Tago, et al., \u003cem\u003eStereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases: a randomized controlled trial\u003c/em\u003e. JAMA, 2006. 295(21): p.\u0026nbsp;2483\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePatchell, R.A., P.A. Tibbs, W.F. Regine, et al., \u003cem\u003ePostoperative radiotherapy in the treatment of single metastases to the brain: a randomized trial\u003c/em\u003e. JAMA, 1998. 280(17): p.\u0026nbsp;1485\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Melanoma, survivorship, income; employment, radiotherapy, whole brain radiotherapy, brain metastases, trial.","lastPublishedDoi":"10.21203/rs.3.rs-2724882/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2724882/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose: \u003c/strong\u003eA cancer diagnosis can result in a considerable financial burden to individuals and their households. This study aimed to investigate this problem in patients treated for melanoma brain metastases.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eAn economic evaluation was conducted as a sub-study of a randomised controlled trial of whole brain radiotherapy (WBRT) versus observation following surgery and/or stereotactic radiosurgery (SRS) for 1-3 melanoma brain metastases. Employment status and pre-tax household income were measured at baseline and every 2 months for 12 months. Outcomes included changes in employment status or household income category at 12 months.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eOf 125 patients, 64 were included in the analysis, 31 randomised to WBRT and 33 to observation, 61 patients were excluded because they were not in the workforce at baseline (42) or were unsure about their income (19). Mean age was 61 years (range 27-88), 37 (58%) completed employment questionnaires and 61 (96%) completed income questionnaires at baseline. Prior to treatment, 39% worked full-time, 8% part-time and 53% were unemployed. At 12 months, 23%, 12% and 65% individuals were employed full-time, part-time and unemployed, respectively. Job status change and household income at 12 months were not significantly different between the two treatment groups (p=0.18 and 0.87, respectively).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eA substantial proportion of patients experienced job loss after treatment of melanoma brain metastases, however this was similar for those undergoing WBRT or observation alone. Strategies to reduce the impact for both groups (e.g., financial counselling, employment rehabilitation) could be implemented by clinicians and allied health workers.\u003c/p\u003e","manuscriptTitle":"Impact of whole brain radiotherapy after treatment of melanoma brain metastases on an individual’s employment and household income","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-03-31 21:16:10","doi":"10.21203/rs.3.rs-2724882/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1f48794b-e0a9-494a-93d3-0076004e1c46","owner":[],"postedDate":"March 31st, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2023-12-14T19:59:18+00:00","versionOfRecord":[],"versionCreatedAt":"2023-03-31 21:16:10","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-2724882","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2724882","identity":"rs-2724882","version":["v1"]},"buildId":"J0_U0BvcaRcwD8yVFaRlm","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}