People living with multiple sclerosis can continue to thrive in the workforce with early access to specialists in the disease and accommodations that give them control over their work environment.
“MS really has a pretty broad impact on affected individuals’ health system and [on] society,” said Ruth Ann Marrie, professor of medicine and community health sciences at the University of Manitoba, during Benefits Canada’s 2022 Chronic Disease at Work conference in February. “Early, effective intervention really can help reduce those impacts by reducing relapses and progression of disease and saving that brain tissue, which then helps us with quality of life and remaining in the workforce.”
MS is a disease of the brain and spinal cord that’s potentially disabling. Roughly 100,000 Canadians currently live with MS and women are affected at two- to three-times the rate of men. Most people experience their first symptoms between ages 20 and 50. It’s the most common non-dramatic cause of disability in young adults and people with MS have life expectancies six to seven years shorter than those without the disease.
Individuals with MS can develop new symptoms like loss of vision in one eye or numbness from the waist down over hours or days, an experience called a relapse, and then gradually recover over weeks or months. Without treatment, most people will progress to a state called secondary progressive MS that involves a gradually worsening disability. A much smaller percentage of individuals have primary progressive MS, experiencing a gradual worsening of their disability right from the onset of the disease.
Between 40 and 70 per cent of MS patients experience challenges with cognitive function, more than 70 per cent experience pain and over 90 per cent experience fatigue, which Marrie said is one of the big reasons that people with leave the workforce.
“There’s a mixture of symptoms that are visible to the outside world and a mixture of symptoms that are invisible. Often, the really important hidden burden of the disease has a really negative impact on quality of life and the ability to function well in the workforce.”
Employees with MS also need access to specialists with experience treating the disease who can give them an accurate diagnosis — something that Marrie said remains a challenge for patients — and teach them self-management skills and disease-modifying therapies that are aimed at preventing relapses and slowing down the progression of their disability. These therapies need to start early on in the disease to prevent disease progression, she added, because there’s no way of repairing damage that’s already occurred.
While patients tend to be initially given lower efficacy therapies to determine if it’s effective, Marrie said it’s increasingly clear that employees with MS have access to higher-efficacy therapies immediately to keep them well for longer.
Plan sponsors can also help their employees with MS by introducing workplace accommodations for symptoms they’re experiencing, she added, encouraging employers whose employees have mobility challenges to help them adjust the type of tools they’re using or move them to a less physical job as necessary.
Allowing employees with MS to modify their environment and take breaks as needed can also help to address fatigue cognition challenges that limit someone’s ability to multitask or take in new information, she added.
Marrie also touched on the importance of helping employees with MS manage any co-morbid conditions, as patients often also live with depression and anxiety disorders, high blood pressure, higher cholesterol or diabetes. Referring to clinical trial data, she said MS patients with anxiety disorders had a 30 per cent higher chance of a relapse and the findings were similar for those with high cholesterol.
People also living with depression often see their disability progress faster, with both their MS and mental- health condition contributing to presenteeism and reduced performance at work, said Marrie. “That suggests there are some really important direct impacts of managing other health conditions and MS. And this is important because these are conditions that we can treat in the workforce.”
People with MS are likely to leave the workforce at a level when they have a moderate disability, she added, “so waiting to do something until later is not going to help us with our goal of helping people to continue to share their capital with us.”
Read more coverage of the 2022 Chronic Disease at Work conference.