结直肠癌患者的收入与工作丧失：一项瑞典全国范围匹配队列研究

结直肠癌较为常见，且预后不断改善。因此，关于幸存者的治疗状况，包括经济后果，具有重要意义。本研究旨在量化结肠癌和直肠癌患者在工作年龄段中相较于匹配对照组的收入损失和工作丧失。本研究利用瑞典全国结直肠癌登记数据库（CRCBaSe）获取数据，该数据库由全国范围的瑞典结直肠癌登记处及多个全国性登记数据整合而成。研究周期为直肠癌患者自1995年至2020年，结肠癌患者自2007年至2020年。采用回顾性人口基础队列研究，分析I-III期结直肠癌幸存者的收入、可支配收入和工作丧失情况。收入和可支配收入采用中位数回归分析，工作丧失的概率采用逻辑回归分析。分析对象包括8863例在2017年前诊断的结直肠癌幸存者及52,514例根据出生年份、法定性别和居住县匹配的对照组。结果显示，诊断前后年度，收入明显下降：结肠癌患者从€31,319降至€23,924，直肠癌患者从€32,636降至€22,647，在随访的五年内，收入未能完全恢复。可支配收入变化甚微。诊断当年，工作丧失的概率显著增加，从前一年的29.8%和29.8%升至83.3%和84.4%，且未完全恢复。结肠癌和直肠癌幸存者的工作丧失概率相似，但接受新辅助治疗的直肠癌患者的风险更高。本研究显示，尽管福利体系提供持续的可支配收入，但结直肠癌幸存者仍面临经济负担，表现为工作丧失风险增加和收入减少。该研究得到瑞典癌症协会、瑞典癌症与过敏基金会及斯德哥尔摩癌症协会的支持，并由斯德哥尔摩县议会与卡罗林斯卡学院之间的医疗培训与临床研究地区协议（ALF）提供资助。

Colorectal cancer is common and prognosis is improving. The conditions of survivors of treatment, including financial consequences, are thus important. The aim of this study was to quantify loss of earnings and work loss in working-age patients with colon and rectal cancer relative to matched comparators.The study utilised data from the CRCBaSe database that is generated from the nationwide Swedish ColoRectal Cancer Register and includes data from several Swedish nationwide registers. The study period was 1995-2020 for rectal cancer patients and 2007-2020 for colon cancer patients. A retrospective population-based nationwide cohort study on earnings, disposable income, and work loss, in survivors of stage I-III colorectal cancer treatment was undertaken. Median regression was used to analyse earnings and disposable income, and logistic regression to analyse the probability of work loss.A cohort of 8863 colorectal cancer survivors diagnosed before 2017 and 52,514 comparators matched on birth year, legal sex, and county of residence, was analysed. There was a clear reduction in earnings between the calendar year prior to and the calendar year after diagnosis, from € 31,319 to € 23,924 for colon cancer patients and from € 32,636 to € 22,647 for rectal cancer patients, and earnings never fully recovered during the 5-year follow-up. Disposable income was practically unaltered. The probability of work loss increased in the calendar year of diagnosis, from 29.8% to 25.3% the previous year to 83.3% and 84.4% for colon and rectal cancer patients respectively, and never fully recovered. The probability of work loss was similar between colon and rectal cancer survivors, but was higher among patients with rectal cancer who had received neoadjuvant therapy.This study shows that despite an extensive welfare system providing maintained disposable income, there is a financial burden in the form of increased risk of work loss and a reduction in earnings among survivors of colorectal cancer.The study was supported by the Swedish Cancer Society, the Swedish Cancer and Allergy Foundation, and the Stockholm Cancer Society, and supported by grants provided by the Regional Agreement on Medical Training and Clinical Research (ALF) between the Stockholm County Council and Karolinska Institutet.