Prolonged cancer treatment may affect return to work on gynecologic cancer

Prolonged cancer treatment may affect return to work on gynecologic cancer | 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 Prolonged cancer treatment may affect return to work on gynecologic cancer Yoshinori Tani, Keiichiro Nakamura, Hanako Sugihara, Shinsuke Shirakawa, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4302349/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 Background: Gynecologic cancer (GC) is one of the most common malignancies in working-age women. This study aimed to investigate the period of sick leave (PSL) after GC treatment in Japan. Methods: We investigated the correlation between PSL, treatment methods, and adverseeffects after GC treatment in 207 cancer survivors who returned to work at the same workplace. We distributed questionnaires to patients with cancer who visited Okayama University (more than one year post-treatment, <65 years old), extracted information from their medical records, and used the Mann–Whitney U-test and logistic regression analysis to determine the impact on PSL. Results: Surgery plus more than six courses of chemotherapy (Cx) led to a significantly longer PSL than surgery without lymph node dissection (LND)alone, surgery with LND, surgery plus less than six courses of Cx, and radiotherapy alone (all p<0.001). GC survivors who experienced adverse effects after treatment had a significantly delayed time to PSL (p=0.045). In univariate and multivariate analyses, patients who received surgery plus more than six courses of Cx were most involved in long PSL than other factors (both p<0.001). Conclusions: Patients with GC requiring long-term treatment required the most time to return to work. period of sick leave surgery plus chemotherapy six or more cycles of chemotherapy gynecologic cancer survivors Figures Figure 1 Figure 2 Figure 3 Figure 4 Background According to the data released by the Japanese National Cancer Center in 2019, the cumulative risk of cancer incidence for all people was 51.2% for women [ 1 ]. In 2020, the incidences of cervical cancer (CC), endometrial cancer (EC), and ovarian cancer (OC) with tubal and peritoneal cancer were 7,689, 13,113, and 8,004, respectively [ 2 ]. The most common age at diagnosis for CC was in the 40s, and 50s for EC and OC. The frequency of CC in less 70s was 78.7%; EC, 75.3%; and OC, 75.0% [ 3 ]. The five-year survival rates of patients with early stage (I and II) CC, EC, and OC were 92.3% and 76.2%, 93.9% and 87.6%, and 91.7% and 80.6%, respectively [ 3 ]. Gynecological cancer (GC) is a malignant tumor with a good prognosis and is associated with many cancer survivors. Treatment methods vary by cancer site. The Japan Society of Obstetrics and Gynecology has reported the frequency of CC treatment was surgery alone (31.3%), concurrent chemoradiotherapy (CCRT) (26.3%), radiotherapy (RT) alone (9.8%), surgery plus chemotherapy (surgery + Cx) (9.8%), and surgery plus CCRT (surgery + CCRT) (11.6%). The frequencies of the EC treatments were surgery alone (58.5%), surgery + Cx (35.2%), surger y + RT (0.7%), Cx alone (1.6%), hormonal therapy alone (0.8%), and RT alone (1%). The frequency of OC treatments was surgery + adjuvant Cx (49.2%), surgery alone (22.4%), Cx alone (2.8%), surgery, adjuvant Cx, and targeted therapy included neoadjuvant Cx (14.3%). Surgery cases made up 52.7%, 94.6%, and 85.9% for CC, EC, and OC, respectively; and 21.4%, 36.1%, and 63.5% of patients with CC, EC, and OC, respectively, received additional treatment before and after surgery [ 3 ]. Cancer survivors face a variety of problems, one of which is returning to work. Return to work (RTW) rates range from 42.9–95.2% among GC survivors (GCSs) in Japan [ 4 ]. At our institution, the RTW rates for GCS were 71.3% in 2015 and 82% in 2023. Compared to surveys conducted seven years ago, the frequency of returning to the same workplace increased [ 5 , 6 ]. In a review of all cancer survivors, 62% returned to work after 12 months, and the average period of sick leave (PSL) was 151 days [ 7 ]. Endo et al. reported that GCSs returned to work after an average of 83 days of PSL [ 8 ]. However, there have been no reports that have examined PSL in detail. Therefore, we conducted a survey regarding PSL and conducted research with the aim of providing a comfortable working environment not only for employees but also for employers. Methods Samples Questionnaires were distributed to GCSs (≥ 1 year after treatment; age: <65 years) who visited Okayama University for consultation from October 5, 2023, to March 28, 2024. All participants were informed about the survey by their consulting doctors and provided written informed consent to participate in this study. All answers were voluntary. The completed questionnaires were collected in in-hospital collection boxes. The study protocol was approved by the Institutional Review Board of Okayama University Hospital (No. 2310-033). Variables Employment status at the time of diagnosis was divided into “self-employed,” “publicly employed,” “regularly employed” (permanent employment), and “non-regularly employed” (part-time, temporary, contract-based, and dispatched workers). We asked the participants to answer questions on employment patterns, working days per week, working hours per day, number of people in the workplace, personal income, household income, returning to the same workplace, and PSL in an original questionnaire (supplementary Table 1). We also extracted data from medical records on age, marital status, presence of children, cancer site, cancer stage, cancer treatment, and adverse effects after treatment. Statistical analysis Statistical analyses were performed using the Mann–Whitney U-test. Univariate and multivariate logistic regression analyses were performed to investigate PSL. Analyses were performed using the SPSS software (version 29.0; IBM Corp., Armonk, NY, USA). Statistical significance was set at p < 0.05. Results We conducted a questionnaire survey among 282 post-treatment GCSs. Before treatment, 247 participants were employed and 35 were unemployed. A total of 207 participants returned to the same workplace and 40 left or changed jobs. Of the participants who returned to the same workplace, 23 (11.1%) were self-employed, 14 (6.8%) were publicly employed, 92 (44.4%) were regularly employed, and 78 (37.8%) were non-regularly employed. Among participants who quit or changed jobs, four were self-employed, three were publicly employed, nine were regularly employed, and 26 were non-regularly employed (Fig. 1 ). The mean age at the time of diagnosis was 47.7 years (median, 49 ± 8.3 years; range, 20–63 years), and the average number of years after treatment was 3.1. Table 1 details cancer survivors who returned to the same workplace. Participants with GC took an average of 76.3 days to return to the same job. The PSL was 0 (7.2%), seven (11.6%), 14 (10.1%), 30 (25.1%), 60 (17.4%), 90 (12.6%), and 180 (7.2%) days for 15, 24, 21, 52, 36, 26, and 15 participants, respectively. Ten participants had less than 365 days (4.8%) and eight had more than 365 days (3.9%) of PSL (Fig. 2 ). Treatment methods and PSL were examined in six groups: Surg without lymph node dissection (LND) alone, Surg with LND alone, surgery + < 6 courses of Cx, surgery + ≧ 6 courses of Cx, surgery + RT (including CCRT), and RT alone (including CCRT). The average length of hospitalization or treatment was 9.4 days for surgery without LND alone, 11.5 days for surgery with LND alone, 90.4 days for surgery + < 6 courses of Cx, 172.8 days for surgery + ≧ 6 courses of Cx, 74.6 days for surgery + RT, and 57.3 days for RT alone. The results showed that participants who received surgery + < 6 courses of Cx, surgery + ≧ 6 courses of Cx, and surgery + RT had a significantly longer PSL than participants who received surgery without LND alone (p = 0.003, p < 0.001, p = 0.009, respectively). In particular, surgery + ≧ 6 courses of Cx had a significantly longer PSL than participants who received surgery with LND alone, surgery + < 6 courses of Cx, or RT alone (p < 0.001, p < 0.001, and p < 0.001, respectively). The group that received ≧ 6 courses of Cx took significantly longer to RTW than the other treatment groups. We found that many GCS who received ≥ 6 courses of Cx treatment required nearly six months to RTW (Fig. 3 ). We investigated the surgical methods with and without LND in patients with GCSs who underwent surgery alone. The group that underwent LND tended to RTW later than the group that did not (p = 0.068). However, we observed no relationship between the minimally invasive surgery group and time of return (data not shown). Treatment of GC often has adverse effects, including Cx-induced peripheral neurotoxicity (CIPN), lower extremity lymphedema (LEL), and urological and bowel complications (UBC). CIPN affects the lower and upper extremities with the use of certain chemotherapeutic agents, such as taxanes and platinum derivatives, and can cause loss of vibratory sensation and taste, paresthesia, weakness, tremors, and functional impairment [ 9 – 13 ]. LEL is also known to have a negative impact on patients’ quality of life, as it is associated with symptoms such as swelling, pain, numbness, and functional impairment [ 14 – 18 ]. We investigated the correlations between CIPN, LEL, UBC, and PSL. After treatment, CIPN, LEL, and UBC were observed in 13, 20, and 17 participants, respectively. Five cancer survivors experienced multiple adverse events. GCSs who experienced adverse effects after treatment had a significantly delayed time to RTW (p = 0.045, Fig. 4 A). In particular, LEL was shown to be associated with the time to RTW (p = 0.014; Fig. 4 B). Univariate and multivariate analyses were used to analyze the factors that caused PSL to last for more than 100 days to PSL. In univariate analysis, advanced stage (p = 0.003), low personal income (p = 0.030), adverse effects after treatment (p = 0.009), and surgery + Cx ( ≧ 6 courses) were significantly associated with longer PSL. In multivariate analysis, short work time per day (p = 0.039), low personal income (p = 0.024), adverse effects after treatment (p = 0.001), and surgery + Cx ( ≧ 6 courses) (p < 0.001) were significantly associated with longer PSL. Although long-term treatment led to the longest PSL, post-treatment adverse effects were also found to have a large effect on PSL (Table 2). Discussion RTW rates vary widely by cancer site, with lung cancer and hematological malignancies having lower total RTW rates than other cancer sites [ 19 , 20 ]. The RTW rates reported in 13 reviewed papers ranged from 53.8–95.2% in Japan [ 21 ]. Strong evidence suggests that less invasive surgery, Cx, and cancer sites are predictive factors for RTW [ 22 ]. We reported that participants with early-stage CC treated with surgery + CCRT had a significantly higher rate of separation from employment than those treated with surgery alone on CC [ 17 ]. Although many studies have been conducted on RTW, there have been few reports on PSL. In a review of cancer survivors, 62% returned to work after 12 months and the average PSL was 151 days [ 7 ]. Endo et al. reported that patients with GC returned to work after an average of 83 days of PSL [ 8 ]. Therefore, we conducted research to understand PSL among GCSs. We examined PSL, treatment methods, and adverse effects after treatment in all occupations. The participants returned to the same workplace at an average of 77.6 days after treatment. In our analysis, the PSL was similar to that reported by Endo et al. [ 8 ]. In the present study, no correlation was observed between PSL and occupation. GCSs who received surgery + Cx and surgery + RT had longer PSL than those in the group that received surgery alone. In particular, the group that received more than six courses of Cx took significantly longer to RTW than the other treatment groups. Furthermore, cancer survivors who experienced adverse effects of LEL showed a significant relationship with PSL. Adverse effects were related to PSL after long-term treatment. Our study has some limitations. The number of participants was relatively small, and the examinations were performed at a single facility. Further prospective studies involving more patients and facilities should provide definitive data to clarify the significance of our findings. Conclusion In conclusion, it is important to clearly communicate the period of cancer treatment and RTW after treatment to patients with cancer, and to provide appropriate information so that they can smoothly return to their work and daily life after treatment. We found that long-term post-surgery cancer treatment had the greatest impact on when the participants returned to work. RTW is a major challenge for both employees and employers, and providing information in advance about it is an important element in building a good relationship. Abbreviations GC gynecologic cancer PSL period of sick leave CC cervical cancer EC endometrial cancer OC ovarian cancer CCRT concurrent chemoradiotherapy RT radiotherapy Cx chemotherapy RTW return to work CIPN chemotherapy-induced peripheral neurotoxicity LEL lower extremity lymphedema LND lymph node dissection UBC urological and bowel complications GCS gynecological cancer survivor Declarations Ethics approval and consent to participate The study protocol was approved by the Institutional Review Board of Okayama University Hospital (No. 2310-033). All participants were aged ≥20 years and provided informed consent to participate in the study. Consent for publication Not applicable. Availability of data and materials The datasets supporting the conclusions of this article are available upon reasonable request from Dr. Keiichiro Nakamura ( [email protected] ). Competing interests The authors declare that they have no competing interests. Funding None. Authors’ contributions Conceptualization: KN; methodology: KN and YT; formal analysis and investigation: KN, YT, and HM; writing (original draft preparation): KN and YT; writing (review and editing): HS, SS, HM, NI, JH, CO, and SN; supervision: KN and HM. Acknowledgements Not applicable. Author details Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan References Ministry of Health, Labour and Welfare. Tokyo: Cancer Statistics. Cancer Information Service, National Cancer Center, Japan. [Summary of latest cancer statistics]. 2022. https://ganjoho.jp/reg_stat/statistics/stat/summary.html. Accessed 15 Nov 2022. Yoshino K, Kurita T, Takahashi F, Nagase S. Annual report of the Committee on Gynecologic Oncology, the Japan Society of Obstetrics and Gynecology: Annual Patient Report for 2020 and Annual Treatment Report for 2015. J Obstet Gynaecol Res. 2023;49:2584-92. Yamagami W, Nagase S, Takahashi F, Ino K, Hachisuga T, Aoki D, et al. Clinical statistics of gynecologic cancers in Japan. J Gynecol Oncol. 2017;28:e32. Ota A, Fujisawa A, Kawada K, Yatsuya H. Recent status and methodological quality of return-to-work rates of cancer patients reported in Japan: a systematic review. Int J Environ Res Public Health. 2019;16:1461. Nakamura K, Masuyama H, Nishida T, Haraga J, Ida N, Saijo M, et al. Return to work after cancer treatment of gynecologic cancer in Japan. BMC Cancer. 2016;16:558. Nakamura K, Matsuoka H, Kubo K, Shirakawa S, Ida N, Haraga J, et al. Not taking sick leave for gynecologic cancer treatment is negatively associated with returning to the same workplace. Jpn J Clin Oncol. 2023:159. doi: 10.1093/jjco/hyad159. Mehnert A. Employment and work-related issues in cancer survivors. Crit Rev Oncol Hematol. 2011;77:109-30. Endo M, Haruyama Y, Takahashi M, Nishiura C, Kojimahara N, Yamaguchi N. Returning to work after sick leave due to cancer: a 365-day cohort study of Japanese cancer survivors. J Cancer Surviv. 2016;10:320-9. Gutiérrez-Gutiérrez G, Sereno M, Miralles A, Casado-Sáenz E, Gutiérrez-Rivas E. Chemotherapy-induced peripheral neuropathy: clinical features, diagnosis, prevention and treatment strategies. Clin Transl Oncol. 2010;12:81-91. Kannarkat G, Lasher EE, Schiff D. Neurologic complications of chemotherapy agents. Curr Opin Neurol. 2007;20:719-25. Postma TJ, Heimans JJ. Grading of chemotherapy-induced peripheral neuropathy. Ann. Oncol. 2000;11:509-13. Visovsky C. Chemotherapy-induced peripheral neuropathy. Cancer Invest. 2003;21:439-51. Matsuoka H, Nakamura K, Matsubara Y, Ida N, Saijo M, Ogawa C, et al. The influence of chemotherapy-induced peripheral neuropathy on quality of life of gynecologic cancer survivors. Int J Gynecol Cancer. 2018;28:1394-402. Abu-Rustum NR, Alektiar K, Iasonos A, Lev G, Sonoda Y, Aghajanian C, et al. The incidence of symptomatic lower-extremity lymphedema following treatment of uterine corpus malignancies: a 12-year experience at Memorial Sloan-Kettering Cancer Center. Gynecol Oncol. 2006;103:714-8. Tanaka T, Ohki N, Kojima A, Maeno Y, Miyahara Y, Sudo T, et al. Radiotherapy negates the effect of retroperitoneal nonclosure for prevention of lymphedema of the legs following pelvic lymphadenectomy for gynecological malignancies: an analysis from a questionnaire survey. Int J Gynecol Cancer. 2007;17:460-4. Kim JH, Choi JH, Ki EY, Lee SJ, Yoon JH, Lee KH, et al. Incidence and risk factors of lower-extremity lymphedema after surgery with or without adjuvant radiotherapy in patients with FIGO stage I to stage IIA cervical cancer. Int J Cancer. 2012;22:686-91. Nakamura K, Masuyama H, Ida N, Haruma T, Kusumoto T, Seki N, et al. Radical hysterectomy plus concurrent chemoradiation/radiation therapy is negatively associated with return to work in patients with cervical cancer. Int J Gynecol Cancer. 2017;27:117-22. Beesley V, Janda M, Eakin E, Obermair A, Battistutta D. Lymphedema after gynecological cancer treatment: prevalence, correlates, and supportive care needs. Cancer. 2007;109:2607-14. Roelen CA, Koopmans PC, Groothoff JW, van der Klink JJ, Bultmann U. Sickness absence and full return to work after cancer: 2-year follow-up of register data for different cancer sites. Psycho-Oncol. 2011;20:1001-6. Roelen CA, Koopmans PC, Schellart AJ, van der Beek AJ. Resuming work after cancer: a prospective study of occupational register data. J Occup Rehabil. 2011;21:431-40. Ota A, Fujisawa A, Kawada K, Yatsuya H. Recent status and methodological quality of return-to-work rates of cancer patients reported in Japan: a systematic review. Int J Environ Res Public Health. 2019;16:1461. Van Muijen P, Weevers NLEC, Snels IAK, Duijts SFA, Bruinvels DJ, Schellart AJM, van der Beek AJ. Predictors of return to work and employment in cancer survivors: a systematic review. Eur J Cancer Care. 2013;22:144-60. Tables Tables 1 to 2 are available in the Supplementary Files section Additional Declarations No competing interests reported. Supplementary Files Table.I.xlsx Table.II.xlsx 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. 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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-4302349","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":299220040,"identity":"4063441e-b3d2-47bc-a9bd-c656fa22e8ad","order_by":0,"name":"Yoshinori Tani","email":"","orcid":"","institution":"Okayama University","correspondingAuthor":false,"prefix":"","firstName":"Yoshinori","middleName":"","lastName":"Tani","suffix":""},{"id":299220043,"identity":"5943d94a-3bcf-4d69-af9b-dac687a18adc","order_by":1,"name":"Keiichiro 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questionnaire at the time of diagnosis and after cancer treatment.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4302349/v1/2045e844f691e62410e6a86d.png"},{"id":56281254,"identity":"65724865-3ff2-48f4-bfc4-609d65e51118","added_by":"auto","created_at":"2024-05-10 21:11:37","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":8183,"visible":true,"origin":"","legend":"\u003cp\u003eThe period of sick leave after cancer treatment for all occupations.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4302349/v1/e4efeb74c641569fca564ec2.png"},{"id":56281266,"identity":"bb599b5b-2930-4182-94fe-aa0324d53769","added_by":"auto","created_at":"2024-05-10 21:12:58","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":16316,"visible":true,"origin":"","legend":"\u003cp\u003eThe period of sick leave after cancer treatment on treatment method [Surgery (Surg) without lymph node dissection (LND) alone, Surg with LND alone, Surg+\u0026lt;6 courses of chemotherapy (Cx), Surg+\u0026gt;6 courses of Cx, Surg+radiation (RT) (including concurrent chemoradiotherapy; CCRT), and RT alone (including CCRT)].\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-4302349/v1/ba82e1cd89f7fec4668976ba.png"},{"id":56281184,"identity":"5d101d02-9e32-471a-a6ab-d620da37efbc","added_by":"auto","created_at":"2024-05-10 21:08:45","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":9339,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eA. \u003c/strong\u003eThe period of sick leave after cancer treatment due to adverse effects after treatment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eB.\u003c/strong\u003e Current situation regarding return to work due to chemotherapy-induced peripheral neurotoxicity (CIPN), lower extremity lymphedema (LEL), and urological and bowel complications (UBC).\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-4302349/v1/26bceb643203ab4e0e2a734b.png"},{"id":66576433,"identity":"143237ac-7871-4f80-b12c-259cf08f7f89","added_by":"auto","created_at":"2024-10-14 12:38:28","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":397710,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4302349/v1/b5a4ae21-dc19-4611-a5cc-be37b01fa1ad.pdf"},{"id":56281268,"identity":"db93387e-2f9a-4ba4-aa4f-f373bab952c0","added_by":"auto","created_at":"2024-05-10 21:13:01","extension":"xlsx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":13406,"visible":true,"origin":"","legend":"","description":"","filename":"Table.I.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-4302349/v1/c420411faf1f631dac2e7440.xlsx"},{"id":56281223,"identity":"933e53ef-bfff-43db-b254-4e2539e5cc97","added_by":"auto","created_at":"2024-05-10 21:09:19","extension":"xlsx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":14669,"visible":true,"origin":"","legend":"","description":"","filename":"Table.II.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-4302349/v1/38ae69fe624b6606f07c9688.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prolonged cancer treatment may affect return to work on gynecologic cancer","fulltext":[{"header":"Background","content":"\u003cp\u003eAccording to the data released by the Japanese National Cancer Center in 2019, the cumulative risk of cancer incidence for all people was 51.2% for women [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In 2020, the incidences of cervical cancer (CC), endometrial cancer (EC), and ovarian cancer (OC) with tubal and peritoneal cancer were 7,689, 13,113, and 8,004, respectively [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The most common age at diagnosis for CC was in the 40s, and 50s for EC and OC. The frequency of CC in less 70s was 78.7%; EC, 75.3%; and OC, 75.0% [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The five-year survival rates of patients with early stage (I and II) CC, EC, and OC were 92.3% and 76.2%, 93.9% and 87.6%, and 91.7% and 80.6%, respectively [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Gynecological cancer (GC) is a malignant tumor with a good prognosis and is associated with many cancer survivors.\u003c/p\u003e \u003cp\u003eTreatment methods vary by cancer site. The Japan Society of Obstetrics and Gynecology has reported the frequency of CC treatment was surgery alone (31.3%), concurrent chemoradiotherapy (CCRT) (26.3%), radiotherapy (RT) alone (9.8%), surgery plus chemotherapy (surgery\u0026thinsp;+\u0026thinsp;Cx) (9.8%), and surgery plus CCRT (surgery\u0026thinsp;+\u0026thinsp;CCRT) (11.6%). The frequencies of the EC treatments were surgery alone (58.5%), surgery\u0026thinsp;+\u0026thinsp;Cx (35.2%), surger y\u0026thinsp;+\u0026thinsp;RT (0.7%), Cx alone (1.6%), hormonal therapy alone (0.8%), and RT alone (1%). The frequency of OC treatments was surgery\u0026thinsp;+\u0026thinsp;adjuvant Cx (49.2%), surgery alone (22.4%), Cx alone (2.8%), surgery, adjuvant Cx, and targeted therapy included neoadjuvant Cx (14.3%). Surgery cases made up 52.7%, 94.6%, and 85.9% for CC, EC, and OC, respectively; and 21.4%, 36.1%, and 63.5% of patients with CC, EC, and OC, respectively, received additional treatment before and after surgery [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCancer survivors face a variety of problems, one of which is returning to work. Return to work (RTW) rates range from 42.9\u0026ndash;95.2% among GC survivors (GCSs) in Japan [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. At our institution, the RTW rates for GCS were 71.3% in 2015 and 82% in 2023. Compared to surveys conducted seven years ago, the frequency of returning to the same workplace increased [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. In a review of all cancer survivors, 62% returned to work after 12 months, and the average period of sick leave (PSL) was 151 days [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Endo et al. reported that GCSs returned to work after an average of 83 days of PSL [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. However, there have been no reports that have examined PSL in detail. Therefore, we conducted a survey regarding PSL and conducted research with the aim of providing a comfortable working environment not only for employees but also for employers.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSamples\u003c/h2\u003e \u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eQuestionnaires were distributed to GCSs (\u0026ge;\u0026thinsp;1 year after treatment; age: \u0026lt;65 years) who visited Okayama University for consultation from October 5, 2023, to March 28, 2024. All participants were informed about the survey by their consulting doctors and provided written informed consent to participate in this study. All answers were voluntary. The completed questionnaires were collected in in-hospital collection boxes. The study protocol was approved by the Institutional Review Board of Okayama University Hospital (No. 2310-033).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eVariables\u003c/h2\u003e \u003cp\u003eEmployment status at the time of diagnosis was divided into \u0026ldquo;self-employed,\u0026rdquo; \u0026ldquo;publicly employed,\u0026rdquo; \u0026ldquo;regularly employed\u0026rdquo; (permanent employment), and \u0026ldquo;non-regularly employed\u0026rdquo; (part-time, temporary, contract-based, and dispatched workers). We asked the participants to answer questions on employment patterns, working days per week, working hours per day, number of people in the workplace, personal income, household income, returning to the same workplace, and PSL in an original questionnaire (supplementary Table\u0026nbsp;1). We also extracted data from medical records on age, marital status, presence of children, cancer site, cancer stage, cancer treatment, and adverse effects after treatment.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eStatistical analyses were performed using the Mann\u0026ndash;Whitney U-test. Univariate and multivariate logistic regression analyses were performed to investigate PSL. Analyses were performed using the SPSS software (version 29.0; IBM Corp., Armonk, NY, USA). Statistical significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eWe conducted a questionnaire survey among 282 post-treatment GCSs. Before treatment, 247 participants were employed and 35 were unemployed. A total of 207 participants returned to the same workplace and 40 left or changed jobs. Of the participants who returned to the same workplace, 23 (11.1%) were self-employed, 14 (6.8%) were publicly employed, 92 (44.4%) were regularly employed, and 78 (37.8%) were non-regularly employed. Among participants who quit or changed jobs, four were self-employed, three were publicly employed, nine were regularly employed, and 26 were non-regularly employed (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe mean age at the time of diagnosis was 47.7 years (median, 49\u0026thinsp;\u0026plusmn;\u0026thinsp;8.3 years; range, 20\u0026ndash;63 years), and the average number of years after treatment was 3.1. Table\u0026nbsp;1 details cancer survivors who returned to the same workplace.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eParticipants with GC took an average of 76.3 days to return to the same job. The PSL was 0 (7.2%), seven (11.6%), 14 (10.1%), 30 (25.1%), 60 (17.4%), 90 (12.6%), and 180 (7.2%) days for 15, 24, 21, 52, 36, 26, and 15 participants, respectively. Ten participants had less than 365 days (4.8%) and eight had more than 365 days (3.9%) of PSL (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eTreatment methods and PSL were examined in six groups: Surg without lymph node dissection (LND) alone, Surg with LND alone, surgery\u0026thinsp;+\u0026thinsp;\u0026lt;\u0026thinsp;6 courses of Cx, surgery\u0026thinsp;+\u0026thinsp;≧\u0026thinsp;6 courses of Cx, surgery\u0026thinsp;+\u0026thinsp;RT (including CCRT), and RT alone (including CCRT). The average length of hospitalization or treatment was 9.4 days for surgery without LND alone, 11.5 days for surgery with LND alone, 90.4 days for surgery\u0026thinsp;+\u0026thinsp;\u0026lt;\u0026thinsp;6 courses of Cx, 172.8 days for surgery\u0026thinsp;+\u0026thinsp;≧\u0026thinsp;6 courses of Cx, 74.6 days for surgery\u0026thinsp;+\u0026thinsp;RT, and 57.3 days for RT alone. The results showed that participants who received surgery\u0026thinsp;+\u0026thinsp;\u0026lt;\u0026thinsp;6 courses of Cx, surgery\u0026thinsp;+\u0026thinsp;≧\u0026thinsp;6 courses of Cx, and surgery\u0026thinsp;+\u0026thinsp;RT had a significantly longer PSL than participants who received surgery without LND alone (p\u0026thinsp;=\u0026thinsp;0.003, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, p\u0026thinsp;=\u0026thinsp;0.009, respectively). In particular, surgery\u0026thinsp;+\u0026thinsp;≧\u0026thinsp;6 courses of Cx had a significantly longer PSL than participants who received surgery with LND alone, surgery\u0026thinsp;+\u0026thinsp;\u0026lt;\u0026thinsp;6 courses of Cx, or RT alone (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, and p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, respectively). The group that received\u0026thinsp;≧\u0026thinsp;6 courses of Cx took significantly longer to RTW than the other treatment groups. We found that many GCS who received\u0026thinsp;\u0026ge;\u0026thinsp;6 courses of Cx treatment required nearly six months to RTW (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eWe investigated the surgical methods with and without LND in patients with GCSs who underwent surgery alone. The group that underwent LND tended to RTW later than the group that did not (p\u0026thinsp;=\u0026thinsp;0.068). However, we observed no relationship between the minimally invasive surgery group and time of return (data not shown).\u003c/p\u003e \u003cp\u003eTreatment of GC often has adverse effects, including Cx-induced peripheral neurotoxicity (CIPN), lower extremity lymphedema (LEL), and urological and bowel complications (UBC). CIPN affects the lower and upper extremities with the use of certain chemotherapeutic agents, such as taxanes and platinum derivatives, and can cause loss of vibratory sensation and taste, paresthesia, weakness, tremors, and functional impairment [\u003cspan additionalcitationids=\"CR10 CR11 CR12\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. LEL is also known to have a negative impact on patients\u0026rsquo; quality of life, as it is associated with symptoms such as swelling, pain, numbness, and functional impairment [\u003cspan additionalcitationids=\"CR15 CR16 CR17\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. We investigated the correlations between CIPN, LEL, UBC, and PSL. After treatment, CIPN, LEL, and UBC were observed in 13, 20, and 17 participants, respectively. Five cancer survivors experienced multiple adverse events. GCSs who experienced adverse effects after treatment had a significantly delayed time to RTW (p\u0026thinsp;=\u0026thinsp;0.045, Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eA). In particular, LEL was shown to be associated with the time to RTW (p\u0026thinsp;=\u0026thinsp;0.014; Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eB).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eUnivariate and multivariate analyses were used to analyze the factors that caused PSL to last for more than 100 days to PSL. In univariate analysis, advanced stage (p\u0026thinsp;=\u0026thinsp;0.003), low personal income (p\u0026thinsp;=\u0026thinsp;0.030), adverse effects after treatment (p\u0026thinsp;=\u0026thinsp;0.009), and surgery\u0026thinsp;+\u0026thinsp;Cx (\u0026thinsp;≧\u0026thinsp;6 courses) were significantly associated with longer PSL. In multivariate analysis, short work time per day (p\u0026thinsp;=\u0026thinsp;0.039), low personal income (p\u0026thinsp;=\u0026thinsp;0.024), adverse effects after treatment (p\u0026thinsp;=\u0026thinsp;0.001), and surgery\u0026thinsp;+\u0026thinsp;Cx (\u0026thinsp;≧\u0026thinsp;6 courses) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were significantly associated with longer PSL. Although long-term treatment led to the longest PSL, post-treatment adverse effects were also found to have a large effect on PSL (Table\u0026nbsp;2).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eRTW rates vary widely by cancer site, with lung cancer and hematological malignancies having lower total RTW rates than other cancer sites [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The RTW rates reported in 13 reviewed papers ranged from 53.8\u0026ndash;95.2% in Japan [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Strong evidence suggests that less invasive surgery, Cx, and cancer sites are predictive factors for RTW [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. We reported that participants with early-stage CC treated with surgery\u0026thinsp;+\u0026thinsp;CCRT had a significantly higher rate of separation from employment than those treated with surgery alone on CC [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Although many studies have been conducted on RTW, there have been few reports on PSL. In a review of cancer survivors, 62% returned to work after 12 months and the average PSL was 151 days [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Endo et al. reported that patients with GC returned to work after an average of 83 days of PSL [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Therefore, we conducted research to understand PSL among GCSs.\u003c/p\u003e \u003cp\u003eWe examined PSL, treatment methods, and adverse effects after treatment in all occupations. The participants returned to the same workplace at an average of 77.6 days after treatment. In our analysis, the PSL was similar to that reported by Endo et al. [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In the present study, no correlation was observed between PSL and occupation. GCSs who received surgery\u0026thinsp;+\u0026thinsp;Cx and surgery\u0026thinsp;+\u0026thinsp;RT had longer PSL than those in the group that received surgery alone. In particular, the group that received more than six courses of Cx took significantly longer to RTW than the other treatment groups. Furthermore, cancer survivors who experienced adverse effects of LEL showed a significant relationship with PSL. Adverse effects were related to PSL after long-term treatment.\u003c/p\u003e \u003cp\u003eOur study has some limitations. The number of participants was relatively small, and the examinations were performed at a single facility. Further prospective studies involving more patients and facilities should provide definitive data to clarify the significance of our findings.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, it is important to clearly communicate the period of cancer treatment and RTW after treatment to patients with cancer, and to provide appropriate information so that they can smoothly return to their work and daily life after treatment. We found that long-term post-surgery cancer treatment had the greatest impact on when the participants returned to work. RTW is a major challenge for both employees and employers, and providing information in advance about it is an important element in building a good relationship.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eGC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003egynecologic cancer\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePSL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eperiod of sick leave\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ecervical cancer\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eEC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eendometrial cancer\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eOC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eovarian cancer\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCCRT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003econcurrent chemoradiotherapy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eradiotherapy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCx\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003echemotherapy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRTW\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ereturn to work\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCIPN\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003echemotherapy-induced peripheral neurotoxicity\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLEL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003elower extremity lymphedema\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLND\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003elymph node dissection\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eUBC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eurological and bowel complications\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eGCS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003egynecological cancer survivor\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe\u0026nbsp;study protocol was approved by the Institutional Review Board of Okayama University Hospital\u0026nbsp;(No. 2310-033).\u0026nbsp;All participants were aged \u0026ge;20 years and provided informed consent to participate in the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets supporting the conclusions of this article are available upon reasonable request from Dr. Keiichiro Nakamura ([email protected]).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization: KN; methodology: KN and YT; formal analysis and investigation: KN, YT, and HM; writing (original draft preparation): KN and YT; writing (review and editing): HS, SS, HM, NI, JH, CO, and SN; supervision: KN and HM.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDepartment of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eMinistry of Health, Labour and Welfare. Tokyo: Cancer Statistics. Cancer Information Service, National Cancer Center, Japan. [Summary of latest cancer statistics]. 2022. https://ganjoho.jp/reg_stat/statistics/stat/summary.html. Accessed 15 Nov 2022.\u003c/li\u003e\n \u003cli\u003eYoshino K, Kurita T, Takahashi F, Nagase S. Annual report of the Committee on Gynecologic Oncology, the Japan Society of Obstetrics and Gynecology: Annual Patient Report for 2020 and Annual Treatment Report for 2015. J Obstet Gynaecol Res. 2023;49:2584-92.\u003c/li\u003e\n \u003cli\u003eYamagami W, Nagase S, Takahashi F, Ino K, Hachisuga T, Aoki D, et al. Clinical statistics of gynecologic cancers in Japan. J Gynecol Oncol. 2017;28:e32.\u003c/li\u003e\n \u003cli\u003eOta A, Fujisawa A, Kawada K, Yatsuya H. Recent status and methodological quality of return-to-work rates of cancer patients reported in Japan: a systematic review. Int J Environ Res Public Health. 2019;16:1461.\u003c/li\u003e\n \u003cli\u003eNakamura K, Masuyama H, Nishida T, Haraga J, Ida N, Saijo M, et al. Return to work after cancer treatment of gynecologic cancer in Japan. BMC Cancer. 2016;16:558.\u003c/li\u003e\n \u003cli\u003eNakamura K, Matsuoka H, Kubo K, Shirakawa S, Ida N, Haraga J, et al. Not taking sick leave for gynecologic cancer treatment is negatively associated with returning to the same workplace. Jpn J Clin Oncol. 2023:159. doi: 10.1093/jjco/hyad159.\u003c/li\u003e\n \u003cli\u003eMehnert A. Employment and work-related issues in cancer survivors. Crit Rev Oncol Hematol. 2011;77:109-30.\u003c/li\u003e\n \u003cli\u003eEndo M, Haruyama Y, Takahashi M, Nishiura C, Kojimahara N, Yamaguchi N. Returning to work after sick leave due to cancer: a 365-day cohort study of Japanese cancer survivors. J Cancer Surviv. 2016;10:320-9.\u003c/li\u003e\n \u003cli\u003eGuti\u0026eacute;rrez-Guti\u0026eacute;rrez G, Sereno M, Miralles A, Casado-S\u0026aacute;enz E, Guti\u0026eacute;rrez-Rivas E. Chemotherapy-induced peripheral neuropathy: clinical features, diagnosis, prevention and treatment strategies. Clin Transl Oncol. 2010;12:81-91.\u003c/li\u003e\n \u003cli\u003eKannarkat G, Lasher EE, Schiff D. Neurologic complications of chemotherapy agents. Curr Opin Neurol. 2007;20:719-25.\u003c/li\u003e\n \u003cli\u003ePostma TJ, Heimans JJ. Grading of chemotherapy-induced peripheral neuropathy. Ann. Oncol. 2000;11:509-13.\u003c/li\u003e\n \u003cli\u003eVisovsky C. Chemotherapy-induced peripheral neuropathy. Cancer Invest. 2003;21:439-51.\u003c/li\u003e\n \u003cli\u003eMatsuoka H, Nakamura K, Matsubara Y, Ida N, Saijo M, Ogawa C, et al. The influence of chemotherapy-induced peripheral neuropathy on quality of life of gynecologic cancer survivors. Int J Gynecol Cancer. 2018;28:1394-402.\u003c/li\u003e\n \u003cli\u003eAbu-Rustum NR, Alektiar K, Iasonos A, Lev G, Sonoda Y, Aghajanian C, et al. The incidence of symptomatic lower-extremity lymphedema following treatment of uterine corpus malignancies: a 12-year experience at Memorial Sloan-Kettering Cancer Center. Gynecol Oncol.\u003cem\u003e\u0026nbsp;\u003c/em\u003e2006;103:714-8.\u003c/li\u003e\n \u003cli\u003eTanaka T, Ohki N, Kojima A, Maeno Y, Miyahara Y, Sudo T, et al. Radiotherapy negates the effect of retroperitoneal nonclosure for prevention of lymphedema of the legs following pelvic lymphadenectomy for gynecological malignancies: an analysis from a questionnaire survey. Int J Gynecol Cancer. 2007;17:460-4.\u003c/li\u003e\n \u003cli\u003eKim JH, Choi JH, Ki EY, Lee SJ, Yoon JH, Lee KH, et al. Incidence and risk factors of lower-extremity lymphedema after surgery with or without adjuvant radiotherapy in patients with FIGO stage I to stage IIA cervical cancer. Int J Cancer. 2012;22:686-91.\u003c/li\u003e\n \u003cli\u003eNakamura K, Masuyama H, Ida N, Haruma T, Kusumoto T, Seki N, et al. Radical hysterectomy plus concurrent chemoradiation/radiation therapy is negatively associated with return to work in patients with cervical cancer. Int J Gynecol Cancer. 2017;27:117-22.\u003c/li\u003e\n \u003cli\u003eBeesley V, Janda M, Eakin E, Obermair A, Battistutta D. Lymphedema after gynecological cancer treatment: prevalence, correlates, and supportive care needs. Cancer. 2007;109:2607-14.\u003c/li\u003e\n \u003cli\u003eRoelen CA, Koopmans PC, Groothoff JW, van der Klink JJ, Bultmann U. Sickness absence and full return to work after cancer: 2-year follow-up of register data for different cancer sites. Psycho-Oncol.\u003cem\u003e\u0026nbsp;\u003c/em\u003e2011;20:1001-6.\u003c/li\u003e\n \u003cli\u003eRoelen CA, Koopmans PC, Schellart AJ, van der Beek AJ. Resuming work after cancer: a prospective study of occupational register data. J Occup Rehabil. 2011;21:431-40.\u003c/li\u003e\n \u003cli\u003eOta A, Fujisawa A, Kawada K, Yatsuya H. Recent status and methodological quality of return-to-work rates of cancer patients reported in Japan: a systematic review. Int J Environ Res Public Health. 2019;16:1461.\u003c/li\u003e\n \u003cli\u003eVan Muijen P, Weevers NLEC, Snels IAK, Duijts SFA, Bruinvels DJ, Schellart AJM, van der Beek AJ. Predictors of return to work and employment in cancer survivors: a systematic review. Eur J Cancer Care. 2013;22:144-60.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 2 are available in the Supplementary Files section\u003c/p\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":"period of sick leave, surgery plus chemotherapy, six or more cycles of chemotherapy, gynecologic cancer survivors","lastPublishedDoi":"10.21203/rs.3.rs-4302349/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4302349/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eGynecologic cancer (GC) is one of the most common malignancies in working-age women. This study aimed to investigate the period of sick leave (PSL) after GC treatment in Japan.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eWe investigated the correlation between PSL, treatment methods, and adverseeffects after GC treatment in 207 cancer survivors who returned to work at the same workplace. We distributed questionnaires to patients with cancer who visited Okayama University (more than one year post-treatment, \u0026lt;65 years old), extracted information from their medical records, and used the Mann–Whitney U-test and logistic regression analysis to determine the impact on PSL.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Surgery plus more than six courses of chemotherapy (Cx) led to a significantly longer PSL than surgery without lymph node dissection (LND)alone, surgery with LND, surgery plus less than six courses of Cx, and radiotherapy alone (all p\u0026lt;0.001). GC survivors who experienced adverse effects after treatment had a significantly delayed time to PSL (p=0.045). In univariate and multivariate analyses, patients who received surgery plus more than six courses of Cx were most involved in long PSL than other factors (both p\u0026lt;0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003ePatients with GC requiring long-term treatment required the most time to return to work.\u003c/p\u003e","manuscriptTitle":"Prolonged cancer treatment may affect return to work on gynecologic cancer","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-10 20:53:54","doi":"10.21203/rs.3.rs-4302349/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":"02bcc065-6f55-4e36-941d-f2bcd48b93a5","owner":[],"postedDate":"May 10th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-03-11T03:19:10+00:00","versionOfRecord":[],"versionCreatedAt":"2024-05-10 20:53:54","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4302349","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4302349","identity":"rs-4302349","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}