The physical and psychological aspects of quality of life mediates the effect of radiation‐induced urgency syndrome on disability pension in gynecological cancer survivors

• Published in: Cancer medicine (Malden, MA) Vol. 12; no. 16; pp. 17377 - 17388
• Main Authors: Noor Baloch, Adnan, Hagberg, Mats, Thomée, Sara, Steineck, Gunnar, Sandén, Helena
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01.08.2023; John Wiley and Sons Inc; Wiley
• Subjects: Age; Anxiety; Arbetsterapi; Cancer; Cancer and Oncology; Cancer och onkologi; Cancer survivorship; Cancer therapies; Defecation; Disability pension; Disability pensions; Early retirement; Environmental Health and Occupational Health; Fecal incontinence; Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi; Gynecological cancer; Gynecology; Influence; Mental depression; Miljömedicin och yrkesmedicin; Nursing; Occupational Therapy; Omvårdnad; Patients; Psychological aspects; Public Health, Global Health, Social Medicine and Epidemiology; Quality of life; Questionnaires; Radiation therapy; Return to work; Risk assessment; Sleep; Social insurance numbers; Statistical analysis; Womens health; Sweden; disability pension; cancer survivorship; early retirement; quality of life; return to work; gynecological cancer
• ISSN: 2045-7634; 2045-7634
• DOI: 10.1002/cam4.6356

Background Radiation‐induced fecal urgency syndrome is highly prevalent in gynecological cancer survivors. It is associated with decreased quality of life (QoL) and with disability pension. The literature remains unclear about the mediating role of physical and psychological aspects of QoL in the association between urgency syndrome and disability pension. Identifying the pathways between urgency syndrome and disability pension may help to create effective and timely interventions for increasing QoL and reducing disability pension among gynecological cancer survivors. Methods We used patient‐reported outcome measures from working‐age gynecological cancer survivors (n = 247) and data on their disability pension from the official register. The mediating role of physical and psychological aspects of QoL was studied by utilizing mediation analysis based on the counterfactual framework, appropriate for binary outcome, binary mediator with an exposure–mediator interaction. The total effect (TE) was divided into direct and indirect effects using single mediation analysis. Adjusted relative risks and percentage mediated (95% confidence intervals) were calculated. All statistical tests were two‐sided. Results Urgency syndrome increased the risk of disability pension both directly and indirectly (via QoL). Satisfaction with sleep mediated half of the TE (RR = 2.2 (1.1–4.1)) of urgency syndrome on disability pension. Physical health also mediated a similar proportion of the TE (RR = 2.1 (1.2–3.9)). The proportions mediated were higher for physical aspects of QoL (35%–71%) than for psychological aspects (2%–47%). Conclusions The investigated aspects of the self‐assessed QoL of gynecological cancer survivors may play a role in these women's continuing work‐life. It appears that physical health, satisfaction with sleep, psychological well‐being, and other investigated aspects of QoL mediate the urgency syndrome–disability pension association. Quality of life (QoL) mediates the urgency syndrome and disability pension association among gynecological cancer survivors. Promoting QoL among gynecological cancer survivors may be an important approach to decrease their early exit from work‐life.