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NON-FINANCIAL COSTS


were important to patients’ lives, or the severity of the disease experience.122


Pediatric Issues Quality of life affects everyone who has IBD, adults and children. It is important to distinguish that children may experience a disease differently, and thus have different impacts of their disease. An IBD-specific measure to assess quality of life impact for children has also been developed.123


Children with IBD have a reduced quality of life, as do children with other diseases; however, teenagers are most strongly affected by their IBD.124,125 Adolescents are


significantly affected in multiple ways; they have reduced functioning and autonomy, at an age when separation and independence are extremely important. Their social functioning is compromised, when this is a critical factor in their lives. Attendance with school can be difficult, at a time when important lifetime choices need to be made (such as, post-secondary education). Adolescents easily fall prey to negative emotions and poor self-esteem, resulting in troubled behaviour or depressive issues.


Quality of Life and Treatment


Since quality of life is most affected by disease activity, it makes sense that effective treatment can improve quality of life by reducing symptoms, inducing remission, and helping people feel that they are in control of their disease.


Surgical treatments are associated with a normalization in quality of life, both for CD and for UC.126,127


effective at improving quality of life.128


As well, conventional drugs such as steroids and azathioprine have been proven More recently, the new biological agents have shown


significant increases in quality of life for all types of disease: UC, CD and fistulizing CD.129,130,131 The improvement in quality of life seen with treatment can effectively place a person suffering from active disease into a state of remission, without significant symptoms. It can also be important to the individual with IBD that effective treatment provides them with some feeling of control or predictability to their disease, reducing the fear and anxiety that are problematic even when people are not suffering from active disease.


Quality of Life and Productivity


Quality of life has a direct relationship with productivity. Unemployment, disability and sick leave are related to low quality of life.132 who are employed.133


Conversely, quality of life is higher in people with IBD People who achieve remission with effective drug therapy often report


not only an improvement in quality of life but also a return to employment – either returning to work (for those who were not employed) or returning to full-time work (for those who were employed part-time). A study in CD found that people who responded to treatment had twice the employment rate than for people who did not respond to treatment after a year of therapy.134


A study in UC found similar dramatic results, with responders 2.5 times more likely to be employed and three times more likely to not receive disability compensation.135


THE IMPACT OF INFLAMMATORY BOWEL DISEASE IN CANADA 71


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