Complete response to therapy: why do primary central nervous system lymphoma patients not return to work?
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CLINICAL STUDY
Complete response to therapy: why do primary central nervous system lymphoma patients not return to work? Greta Wiemann1 · Milena Pertz1 · Thomas Kowalski1 · Sabine Seidel1 · Uwe Schlegel1 · Patrizia Thoma2 Received: 21 April 2020 / Accepted: 23 July 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose Although primary central nervous system lymphomas (PCNSL) represent extremely aggressive brain tumours, high-dose methotrexate in combination with other chemotherapeutic agents has resulted in long-term disease control in a substantial fraction of patients. Advances in treatment efficacy with longer survival resulted in a focus on additional outcome measures such as quality of life (QoL) and neurocognition. Despite recent evidence of return to work as an important aspect of patients’ QoL, little is known about occupational reintegration in PCNSL long-term survivors. This study aimed to detect specific characteristics of patients who successfully resumed work after complete response to therapy. Methods Patients with ongoing complete response to therapy completed a test battery capturing neurocognition, social integration, QoL and psychological burden. Of 25 patients who had been in regular employment before diagnosis only eight returned to work after treatment (32%). Results Patients who resumed work rated important aspects of their QoL and social integration as higher and suffered less from symptoms affecting QoL than patients who did not resume work. Also, the subjective confidence in their ability to work was higher in patients who resumed work, but independent predictors of return to work were not found in logistic regression analyses. Conclusion Occupational (re)integration is of clinical relevance in PCNSL patients after complete response to therapy. Due to the small size of our cohort the present results should be considered an exploratory first step. Return to work might be a crucial aspect of QoL and (re)integration into society after cure of PCNSL. Keywords Primary central nervous system lymphoma · Neurocognition · Quality of life · Social integration · Return to work
Introduction
Greta Wiemann, Milena Pertz, Uwe Schlegel and Patrizia Thoma contributed equally to this work. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11060-020-03587-5) contains supplementary material, which is available to authorized users. * Milena Pertz [email protected] 1
Department of Neurology, University Hospital Knappschaftskrankenhaus, Ruhr-University Bochum, In der Schornau 23‑25, 44892 Bochum, Germany
Neuropsychological Therapy Centre (NTC)/Clinical Neuropsychology, Faculty of Psychology, Ruhr-University Bochum, Universitätsstraße 150, 44780 Bochum, Germany
2
Primary central nervous system lymphomas (PCNSL) are aggressive extranodal non-Hodgkin lymphomas associated with poor prognosis, if untreated. Approximately 90% of all PCNSLs are diffuse large B-cell lymphomas [1]. The overall incidence is 0.47 per
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