Advertisement
Platinum Priority – Prostate Cancer Editorial by Matthew T. Gettman on pp. 72–73 of this issue| Volume 70, ISSUE 1, P64-71, July 01, 2016

Work Disability After Robot-assisted or Open Radical Prostatectomy: A Nationwide, Population-based Study

  • Anna Plym
    Correspondence
    Corresponding author. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, PO Box 281, 171 77 Stockholm, Sweden. Tel. +46 8 524 823 88; Fax: +46 8 31 49 75.
    Affiliations
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
    Search for articles by this author
  • Flaminia Chiesa
    Affiliations
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
    Search for articles by this author
  • Margaretha Voss
    Affiliations
    Department for Analysis and Forecast, Swedish Social Insurance Agency, Stockholm, Sweden

    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
    Search for articles by this author
  • Lars Holmberg
    Affiliations
    Regional Cancer Centre, Uppsala University Hospital, Uppsala, Sweden

    King's College London, School of Medicine, Division of Cancer Studies, Cancer Epidemiology Group, London, UK
    Search for articles by this author
  • Eva Johansson
    Affiliations
    Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
    Search for articles by this author
  • Pär Stattin
    Affiliations
    Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden

    Department of Urology, Uppsala University Hospital, Uppsala, Sweden
    Search for articles by this author
  • Mats Lambe
    Affiliations
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden

    Regional Cancer Centre, Uppsala University Hospital, Uppsala, Sweden
    Search for articles by this author

      Abstract

      Background

      Robot-assisted radical prostatectomy (RARP) has been associated with reduced bleeding and shorter hospital stays than open retropubic radical prostatectomy (RRP), but it is unclear whether these differences translate into shorter absence from work.

      Objective

      To investigate short- and long-term rates of work disability following RARP and RRP.

      Design, setting, and participants

      We conducted a nationwide population-based cohort study of 2571 men of working age treated with RARP or RRP between 2007 and 2009 identified in the National Prostate Cancer Register of Sweden. Information about physician-certified sick leave and disability pension was retrieved from the Swedish Social Insurance Agency through 2012.

      Outcome measurements and statistical analysis

      We used Cox regression to calculate time to return to work (RTW, or duration of sick leave) after surgery and used generalised estimating equations to analyse days lost from work (because of sick leave and disability pension) after RTW.

      Results and limitations

      Men treated with RARP returned to work after a median of 35 d, whereas the corresponding time for RRP was 48 d (p < 0.001). The difference was seen early; within the first month, men treated with RARP returned to work nearly four times faster than men treated with RRP (adjusted relative RTW rate 3.76; 95% confidence interval [CI], 3.04–4.66). During a median of 3.6 yr after return to work, men treated with RARP lost fewer days from work per person-year than men treated with RRP—12 d versus 15 d—but the association was not statistically significant (p = 0.10). The adjusted rate ratio was 1.08 (95% CI, 0.82–1.42). One limitation is the nonrandomised design of this study.

      Conclusions

      RARP was associated with a faster RTW compared with RRP, but the surgical method did not influence long-term rates of work disability in terms of days lost from work after RTW.

      Patient summary

      We compared disease-related absence from work between two surgical methods for the removal of the prostate. Robot-assisted surgery was associated with a faster return to work compared with open surgery but did not influence absence from work in a long-term perspective.

      Keywords

      To read this article in full you will need to make a payment

      Subscribe:

      Subscribe to European Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Fridriksson J.O.
        • Holmberg E.
        • Adolfsson J.
        • et al.
        Rehospitalization after radical prostatectomy in a nationwide, population based study.
        J Urol. 2014; 192: 112-119
        • Trinh Q.D.
        • Sammon J.
        • Sun M.
        • et al.
        Perioperative outcomes of robot-assisted radical prostatectomy compared with open radical prostatectomy: results from the nationwide inpatient sample.
        Eur Urol. 2012; 61: 679-685
        • Moran P.S.
        • O’Neill M.
        • Teljeur C.
        • et al.
        Robot-assisted radical prostatectomy compared with open and laparoscopic approaches: a systematic review and meta-analysis.
        Int J Urol. 2013; 20: 312-321
        • Novara G.
        • Ficarra V.
        • Rosen R.C.
        • et al.
        Systematic review and meta-analysis of perioperative outcomes and complications after robot-assisted radical prostatectomy.
        Eur Urol. 2012; 62: 431-452
      1. Ferlay J, Soerjomataram I, Ervik M, et al. GLOBOCAN 2012 v1.0, cancer incidence and mortality worldwide: IARC CancerBase No. 11. International Agency for Research on Cancer Web site. http://globocan.iarc.fr. Accessed October 6, 2015.

        • Fryers T.
        Work, identity and health.
        Clin Pract Epidemiol Ment Health. 2006; 2: 12
        • Johnsson A.
        • Fornander T.
        • Rutqvist L.E.
        • Olsson M.
        Factors influencing return to work: a narrative study of women treated for breast cancer.
        Eur J Cancer Care (Engl). 2010; 19: 317-323
        • Lilliehorn S.
        • Hamberg K.
        • Kero A.
        • Salander P.
        Meaning of work and the returning process after breast cancer: a longitudinal study of 56 women.
        Scand J Caring Sci. 2013; 27: 267-274
        • Van Hemelrijck M.
        • Wigertz A.
        • Sandin F.
        • et al.
        • NPCR and PCBaSe Sweden
        Cohort profile: the National Prostate Cancer Register of Sweden and Prostate Cancer data Base Sweden 2.0.
        Int J Epidemiol. 2013; 42: 956-967
        • Tomic K.
        • Sandin F.
        • Wigertz A.
        • Robinson D.
        • Lambe M.
        • Stattin P.
        Evaluation of data quality in the National Prostate Cancer Register of Sweden.
        Eur J Cancer. 2015; 51: 101-111
        • Tomic K.
        • Berglund A.
        • Robinson D.
        • et al.
        Capture rate and representativity of The National Prostate Cancer Register of Sweden.
        Acta Oncol. 2015; 54: 158-163
      2. Longitudinal integration database for health insurance and labour market studies [LISA by Swedish acronym]. Statistics Sweden (SCB) Web site. http://www.scb.se

      3. The National Patient Register. National Board of Health and Welfare (Socialstyrelsen) Web site. http://www.socialstyrelsen.se/register/halsodataregister/patientregistret/inenglish

        • Charlson M.E.
        • Pompei P.
        • Ales K.L.
        • MacKenzie C.R.
        A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.
        J Chronic Dis. 1987; 40: 373-383
      4. Sjukpenning och rehabiliteringspenning MiDAS, version 1.02 [in Swedish]. The Swedish Social Insurance Agency (Försäkringskassan) Web site. http://www.forsakringskassan.se

      5. Total Population Register. Statistics Sweden (SCB) Web site. http://www.scb.se

      6. NCCN clinical practice guidelines in oncology: prostate cancer. National Comprehensive Cancer Network Web site. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp

        • Lidwall U.
        Sick leave diagnoses and return to work: a Swedish register study.
        Disabil Rehabil. 2015; 37: 396-410
        • Krause N.
        • Dasinger L.K.
        • Deegan L.J.
        • Rudolph L.
        • Brand R.J.
        Psychosocial job factors and return-to-work after compensated low back injury: a disability phase-specific analysis.
        Am J Ind Med. 2001; 40: 374-392
        • Dahl S.
        • Steinsvik E.A.
        • Dahl A.A.
        • Loge J.H.
        • Cvancarova M.
        • Fosså S.D.
        Return to work and sick leave after radical prostatectomy: a prospective clinical study.
        Acta Oncol. 2014; 53: 744-751
        • Hohwu L.
        • Akre O.
        • Pedersen K.V.
        • Jonsson M.
        • Nielsen C.V.
        • Gustafsson O.
        Open retropubic prostatectomy versus robot-assisted laparoscopic prostatectomy: a comparison of length of sick leave.
        Scand J Urol Nephrol. 2009; 43: 259-264
      7. Basto M, Sathianathen N, Te Marvelde L, et al. Patterns-of-care and health economic analysis of robot-assisted radical prostatectomy in the Australian public health system. BJU Int. In press. http://dx.doi.org/10.1111/bju.13317

        • Tewari A.
        • Sooriakumaran P.
        • Bloch D.A.
        • Seshadri-Kreaden U.
        • Hebert A.E.
        • Wiklund P.
        Positive surgical margin and perioperative complication rates of primary surgical treatments for prostate cancer: a systematic review and meta-analysis comparing retropubic, laparoscopic, and robotic prostatectomy.
        Eur Urol. 2012; 62: 1-15
        • Wallerstedt A.
        • Tyritzis S.I.
        • Thorsteinsdottir T.
        • et al.
        • LAPPRO steering committee
        Short-term results after robot-assisted laparoscopic radical prostatectomy compared to open radical prostatectomy.
        Eur Urol. 2015; 67: 660-670
        • Sultan R.
        • Slova D.
        • Thiel B.
        • Lepor H.
        Time to return to work and physical activity following open radical retropubic prostatectomy.
        J Urol. 2006; 176: 1420-1423
        • Barocas D.A.
        • Salem S.
        • Kordan Y.
        • et al.
        Robotic assisted laparoscopic prostatectomy versus radical retropubic prostatectomy for clinically localized prostate cancer: comparison of short-term biochemical recurrence-free survival.
        J Urol. 2010; 183: 990-996
        • Barry M.J.
        • Gallagher P.M.
        • Skinner J.S.
        • Fowler Jr., F.J.
        Adverse effects of robotic-assisted laparoscopic versus open retropubic radical prostatectomy among a nationwide random sample of Medicare-age men.
        J Clin Oncol. 2012; 30: 513-518
        • Haglind E.
        • Carlsson S.
        • Stranne J.
        • et al.
        • LAPPRO steering committee
        Urinary incontinence and erectile dysfunction after robotic versus open radical prostatectomy: a prospective, controlled, nonrandomised trial.
        Eur Urol. 2015; 68: 216-225
        • Dahl S.
        • Loge J.H.
        • Berge V.
        • Dahl A.A.
        • Cvancarova M.
        • Fosså S.D.
        Influence of radical prostatectomy for prostate cancer on work status and working life 3 years after surgery.
        J Cancer Surviv. 2015; 9: 172-179
        • Canda A.E.
        • Balbay M.D.
        Robotic radical prostatectomy in high-risk prostate cancer: current perspectives.
        Asian J Androl. 2015; 17: 908-915