Patients with Philadelphia-negative myeloproliferative neoplasms (MPNs), which include myelofibrosis (MF), polycythemia vera (PV), and essential thrombocythemia (ET), have an increased risk of mortality and substantial symptom burden compared with the general population. Common symptoms experienced by patients with MPNs include severe fatigue, night sweats, bone pain, itching, concentration problems, and splenomegaly-related symptoms. These symptoms negatively affect patients’ quality of life (QoL) and ability to perform activities of daily living (ADLs). Results from several studies have demonstrated that chronic diseases, such as MPNs, are associated with economic burdens due to both direct medical costs and indirect costs (eg, loss of work productivity). As few studies have investigated the effect of MPNs on employment status, career potential, and work productivity, Yu et al conducted a cross-sectional survey-based study, the Living With MPNs survey, to analyze the association between MPNs and these employment outcomes.1

Study Design

Patients were eligible to participate in the Living With MPNs survey if they were aged 18 to 70 years; diagnosed with MF, PV, or ET; and living in the United States. The Web-based survey consisted of approximately 100 questions related to MPN diagnosis, disease-related history, MPN-related symptoms, functional status, changes in employment status, work productivity, and ADLs. The Work Productivity and Activity Impairment Specific Health Problem (WPAI-SHP) questionnaire was used to assess the impact of MPNs on work productivity and activities of respondents who were employed. MPN-related symptoms were assessed using the Myeloproliferative Neoplasm Symptom Assessment Form Total Symptom Score (MPN-SAF TSS) questionnaire.1

Results

A total of 904 respondents with MPN completed the survey, including 270 with MF, 393 with PV, and 241 with ET. At the time of MPN diagnosis, 65.5% of the respondents were employed, 9.6% were retired, 7.2% were self-employed, 6.5% were disabled, 6.4% were homemakers, and 4.8% were unemployed. On average, patients had been diagnosed with an MPN 6.1 years prior to study enrollment.1

Impact on Employment Status

Among respondents who were employed at the time of diagnosis, investigators evaluated changes in employment status, type of employment, income, and other relevant factors following diagnosis. More than half of respondents who were employed at diagnosis reported at least 1 employment status change (50.5%), and the average time to first change was 2.1 years after diagnosis (MF = 1.4 years, PV = 2.9 years, ET = 1.9 years). The most commonly reported employment status changes were leaving a job, going on medical disability leave, and having a reduction in work hours for at least 3 months.1

After diagnosis, the average time to first occurrence of leaving a job ranged from 1.9 to 3.9 years, depending on whether the condition was MF, PV, or ET. The majority of respondents who reported leaving their job following diagnosis remained unemployed at the time of the survey (MF = 90%, PV = 68.2%, ET = 58.3%). Approximately two-thirds of respondents who returned to work following diagnosis reported a decrease in salary.1

Some respondents indicated that after diagnosis, they retired earlier than planned. Among these respondents, on average, those with PV retired 9.7 years earlier than planned, while patients with MF and ET retired 7.7 and 7.8 years earlier, respectively. Respondents who retired early reported that their retirement occurred an average of 2.4 to 4.5 years after diagnosis.1

Of those who reported going on medical disability leave, the percentage of respondents who were able to return to employment was lowest in patients with MF (22.8%) compared with higher return rates among patients with PV and ET (49.1% and 50.0%, respectively). The average length of leave ranged from 2.2 to 5.7 months. The average time from diagnosis to first medical disability leave ranged from 1.8 to 2.6 years. Among respondents who had a reduction in working hours for at least 3 months due to MPN, the average time from diagnosis to first reduction in work hours ranged from 1 to 4 years, depending on whether the condition was MF, PV, or ET.1

Impact on Career Potential

Respondents who were employed at the time of diagnosis reported career limitations following their MPN diagnosis, including limitations in their career opportunities (54.4%), ability to pursue certain types of jobs (58.4%), and wages or salaries (43.9%). A MPN diagnosis forced a career change among 42.1% of respondents.1

Impact on Work Productivity

Among the respondents who were employed at the time of participation in the study (n = 398), 40.7% of respondents with MF, 29.4% with PV, and 3.1% with ET reported missing work in the preceding 7 days, with an average amount of time missed of 6.2, 7.2, and 6.7 hours, respectively.1

The correlation between MPN symptoms and loss of work productivity was evaluated using WPAI-SHP and MPN-SAF TSS scores. The analysis revealed that MPN symptoms and loss of work productivity were highly correlated, with the highest correlation occurring with symptoms of fatigue, inactivity, and lacking concentration (P <.001 for all correlations) (Table).1

Conclusion

Based on the results of the Living With MPNs survey, investigators concluded that MPNs adversely affect patients’ employment, career potential, and work productivity. Although MF is often viewed as the most severe MPN, the results of this study show that PV and ET also have a substantial negative impact on a patient’s employment and QoL. The investigators noted that MPNs were associated with adverse employment outcomes as severe as those seen in patients with terminal cancers or chronic debilitating diseases. Loss of work productivity and the proportion of patients taking medical disability leave due to MPN were comparable with patients with other chronic disorders, such as rheumatoid arthritis. Patients with MPN may experience substantial financial losses and diminished QoL, and these effects can potentially impact patients’ families. The analysis of the correlation between MPN symptoms and work productivity indicated that greater symptom burden may impair work productivity and ability to carry out ADLs. Comprehensive supportive care and effective management of MPN symptom burden may improve work productivity and ADL functionality.1

Reference

1. Yu J, Parasuraman S, Paranagama D, et al. Impact of myeloproliferative neoplasms on patients’ employment status and work productivity in the United States: results from the Living With MPNs survey. BMC Cancer. 2018;18(1):420. doi: 10.1186/s12885-018-4322-9.