Patients with Head and Neck Cancer See Impact on Ability to Work Due to Radiotherapy

In working patients with head and neck cancer receiving radiotherapy, weight loss and an increase in pain, fatigue, and ECOG status were all found to be significantly associated with reductions in working days per week.

A study presented at the American Society for Radiation Oncology (ASTRO) Annual Meeting indicated that in working patients with head and neck cancer (HNC) receiving radiotherapy (RT), weight loss and an increase in pain, fatigue, and ECOG status are all significantly associated with reductions in working days per week, with the most significant impact being pain.1

According to first author Charles Lee, MD, PharmD, a second-year resident in the department of Radiation Oncology at Fox Chase Cancer Center, these study findings are of particular importance given that many patients diagnosed with HNC are younger.2

“Of course, in younger patients, they are often working. Thus, we have a lot of time lost from work, lost productivity from patients who take time off to get daily radiation treatments for anywhere from five to seven weeks,” Lee explained. “We wanted to figure out what were factors that influenced patients taking time off from work or missing days from work during their treatments.”

For this study, researchers prospectively recorded the number of days worked in the past week at each on treatment visit for approximately 150 patients with HNC receiving definitive or adjuvant (chemo)radiation at Fox Chase Cancer Center from June 2016 to June 2018. Patients not working due to disability or unemployment were still eligible for the study, however retired patients were excluded.

Overall, 69 patients were evaluated in the study, including 40 patients who were of working age but were on disability or unemployment and 29 of whom were working at the start of RT. Of note, the mean age was higher in working patients (58.8 vs 53.7 years; P = .004).

Distance from cancer center, gender, tobacco use, alcohol use, hospitalizations during RT, presence of feeding tubes, surgery prior to RT, concurrent chemotherapy, p16 status, and location of tumor were not revealed to be significantly different between working and disabled groups. Additionally, changes in weight percentages, pain, fatigue, and ECOG status between the last on treatment visit and baseline were also not significantly different between the 2 patient groups.

However, in working patients, the mean number of days worked steadily declined, starting at 4.1 days in week 1 to 1.1 in week 7. Moreover, in univariate analysis, the investigators observed a 10% loss in weight from baseline results in 2.6 days per week lost from work (P < .005). Further, a pain increase by 1 unit was found to result in 0.25 days per week lost, fatigue increase by 1 unit resulted in 0.28 days per week lost, and ECOG status increase by 1 unit resulted in 1.48 days per week lost (P < .005 for all).

In multivariate analysis, change in pain was significantly associated with days per week lost from work (P = .05). Changes in weight (P = .08), fatigue (P = .11), and ECOG status (P = .07) were not deemed significant, however.

In the future, the researchers indicated that if these results continue to be seen in a larger cohort of patients, which they intend to collect over the next few years, then they may be able to determine which symptoms healthcare providers should prioritize to allow patients to keep working throughout treatment.

“For example, if weight loss or fatigue or pain were the most significant symptoms the patient reported that week, and they also missed 3 days of work that week, then we can say that if we treat pain better, if we mitigate weight loss better, provide better nutrition, then we can reduce the amount of productivity loss in HNC patients we’re working with,” Lee said.


1. Lee CT, Deng M, Bauman J, et al. Identifying Variables Associated With Leave From Work in Head and Neck Cancer Patients Receiving Radiotherapy. Presented at the American Society for Radiation Oncology (ASTRO) Annual Meeting. Abstract #: 3869.

2. Fox Chase Researchers Present Findings on Impact of Radiotherapy for Head and Neck Cancer on Time Off Work [news release]. Philadelphia. Published October 9, 2020. Accessed November 2, 2020.