Center for Primary Care and Public Health (Unisanté), University of Lausanne, 1010 Lausanne, Switzerland.
Department of Occupational Epidemiology, National Research and Safety Institute (INRS), 54500 Vandoeuvre lès Nancy, France.
Int J Environ Res Public Health. 2022 Oct 25;19(21):13856. doi: 10.3390/ijerph192113856.
While previous Swiss studies have demonstrated differences in lung cancer mortality between occupational groups, no estimates are available on the association of occupation-related factors with lung cancer survival. This study aimed at determining whether occupation or work-related factors after diagnosis affect lung cancer survival. We used cancer registry records to identify lung cancer patients diagnosed between 1990 and 2014 in western Switzerland ( = 5773) matched with the Swiss National Cohort. The effect of occupation, the skill level required for the occupation, and the socio-professional category on 5-year lung cancer survival was assessed using non-parametric and parametric methods, controlling for histological type and tumour stage. We found that the net survival varied across skill levels and that the lowest skill level was associated with worse survival in both men and women. In the parametric models with minimal adjustment, we identified several occupational groups at higher risk of mortality compared to the reference category, particularly among men. After adjustment for histological type of lung cancer and tumour stage at diagnosis, most hazard ratios remained higher than 1, though non-statistically significant. Compared to top managers and self-employed workers, workers in paid employment without specific information on occupation were identified as the most at-risk socio-professional category in nearly all models. As this study was conducted using a relatively small sample and limited set of covariates, further studies are required, taking into account smoking habits and administrated cancer treatments. Information on return to work and working conditions before and after lung cancer diagnosis will also be highly valuable for analysing their effect on net lung cancer survival in large nationwide or international studies. Such studies are essential for informing health and social protection systems, which should guarantee appropriate work conditions for cancer survivors, beneficial for their quality of life and survival.
尽管先前的瑞士研究已经证明了不同职业群体之间肺癌死亡率的差异，但目前尚无关于职业相关因素与肺癌生存的关联的估计。本研究旨在确定诊断后职业或与工作相关的因素是否会影响肺癌的生存。我们使用癌症登记记录，在瑞士西部确定了 1990 年至 2014 年间诊断出的肺癌患者（n=5773），并与瑞士全国队列进行了匹配。使用非参数和参数方法评估了职业、职业所需技能水平以及社会职业类别对 5 年肺癌生存率的影响，控制了组织学类型和肿瘤分期。我们发现，技能水平不同，生存率也不同，男性和女性的最低技能水平与生存率较差相关。在参数模型中，经过最小调整后，我们发现与参考类别相比，有几个职业群体的死亡率更高，尤其是男性。在调整肺癌组织学类型和诊断时的肿瘤分期后，大多数风险比仍然高于 1，尽管没有统计学意义。与高层管理人员和自雇人员相比，在几乎所有模型中，从事有偿职业且无特定职业信息的工人被确定为最易受影响的社会职业类别。由于本研究使用了相对较小的样本和有限的协变量集，因此需要进一步的研究，同时考虑到吸烟习惯和接受的癌症治疗。在大型全国或国际研究中，关于肺癌诊断前后的工作返回和工作条件的信息对于分析其对净肺癌生存的影响也将非常有价值。这些研究对于为卫生和社会保护系统提供信息至关重要，这些系统应保证癌症幸存者有适当的工作条件，这对他们的生活质量和生存都有益。
