Cancer and the meaning of work

Breast cancer patients' return to work (B-CARE): protocol of a longitudinal mixed-methods study aiming to explore medical and occupational rehabilitation of patients with breast cancer in Germany

INTRODUCTION

In recent years, research has been done on determinants of return to work (RTW) in cancer survivors and their long-term work outcomes. Nevertheless, little is known about the survivors' evaluation of these outcomes in terms of job satisfaction and voluntariness. Hence, B-CARE aims at filling the research gap by providing a longitudinal cohort study investigating medical and occupational rehabilitation including an evaluation by breast cancer survivors.

METHODS AND ANALYSIS

A mixed-methods approach, combining a quantitative survey with qualitative semi-structured interviews, is used to study breast cancer survivors 5-6 years after diagnosis. These data will be linked to data from prior waves of patients during hospitalisation and 10 and 40 weeks after hospital discharge as well as routine data from the German Statutory Pension Insurance Scheme and German Cancer Society if available. The actual survey focuses on determinants of medical rehabilitation use, RTW, subsequent employment patterns post care as well as the voluntariness of and satisfaction with job changes.

ETHICS AND DISSEMINATION

A positive vote from the ethics committee of the Medical Faculty of the University of Bonn has been obtained. Data protection regulations will be adhered to for all handled data. Personal identifiers of participants will be pseudonymised. Dissemination strategies include a workshop to discuss results among stakeholders such as representatives of the German Statutory Pension Insurance Scheme, social workers and self-help groups.

TRIAL REGISTRATION NUMBER

German Clinical Trials Register (DRKS00016982); Pre-results.

Impact of Breast Cancer Treatment on Employment: Results of a Multicenter Prospective Cohort Study (CANTO)

PURPOSE

Adverse effects of breast cancer treatment can negatively affect survivors’ work ability. Previous reports lacked detailed clinical data or health-related patient-reported outcomes (PROs) and did not prospectively assess the combined impact of treatment and related sequelae on employment.

METHODS

We used a French prospective clinical cohort of patients with stage I-III breast cancer including 1,874 women who were working and ≥ 5 years younger than legal retirement age (≤ 57 years) at breast cancer diagnosis. Our outcome was nonreturn to work (non-RTW) 2 years after diagnosis. Independent variables included treatment characteristics as well as toxicities (Common Toxicity Criteria Adverse Events [CTCAE] v4) and PROs (European Organization for Research and Treatment of Cancer [EORTC] Quality of life Questionnaires, Breast cancer module [QLQ-BR23] and Fatigue module [QLQ-FA12], Hospital Anxiety and Depression Scale) collected 1 year after diagnosis. Logistic regression models assessed correlates of non-RTW, adjusting for age, stage, comorbidities, and socioeconomic covariates.

RESULTS

Two years after diagnosis, 21% of patients had not returned to work. Odds of non-RTW were significantly increased among patients treated with combinations of chemotherapy and trastuzumab (odds ratio [OR] v chemotherapy-hormonotherapy: for chemotherapy-trastuzumab, 2.01; 95% CI, 1.18 to 3.44; for chemotherapy-trastuzumab-hormonotherapy, 1.62; 95% CI, 1.10 to 2.41). Other significant associations with non-RTW included grade ≥ 3 CTCAE toxicities (OR v no, 1.59; 95% CI, 1.15 to 2.18), arm morbidity (OR v no, 1.59; 95% CI, 1.19 to 2.13), anxiety (OR v no, 1.47; 95% CI, 1.02 to 2.11), and depression (OR v no, 2.29; 95% CI, 1.34 to 3.91).

CONCLUSION

Receipt of systemic therapy combinations including trastuzumab was associated with increased odds of non-RTW. Likelihood of unemployment was also higher among patients who reported severe physical and psychological symptoms. This comprehensive study identifies potentially vulnerable patients and warrants supportive interventional strategies to facilitate their RTW.

The Mediating Effect of Workplace Spirituality on the Relation between Job Stress and Job Satisfaction of Cancer Survivors Returning to Work

This study aimed to investigate the mediating effect of workplace spirituality in the relation between job stress and job satisfaction as well as the level of job stress, job satisfaction, and workplace spirituality of cancer survivors returning to work. A total of 126 cancer survivors who returned to work more than six months prior to the research participated in this study. Participants were recruited through snowball sampling; they were visiting the outpatient clinic at two general hospitals located in a metropolitan city and their clinical stage was stage 0 or stage 1. The collected data were analyzed using SPSS 22.0. Job stress, workplace spirituality, and job satisfaction had a negative correlation, whereas workplace spirituality and job satisfaction had a positive correlation. The Sobel test was performed to verify the significance of the mediating effect size of workplace adaptation, the results confirmed a partial mediating effect of workplace spirituality on the relation between job stress and job satisfaction (Z = –4.72, p < 0.001). This study confirmed the mediating effect of workplace spirituality in the relation between job stress and job satisfaction. A systematic program needs to be developed to enhance workplace spirituality, a spiritual approach, to relieve job stress and increase job satisfaction.

Role of physical medicine for cancer rehabilitation and return to work under the premise of the "Wiedereingliederungsteilzeitgesetz"

Background

With the intention of enabling people a phased return to work after long-term sick leave the so-called “Wiedereingliederungsteilzeitgesetz” (WIETZ) was implemented in Austria on 1 July 2017.

Methods

To explore the overall awareness about the WIETZ and the value of physical modalities together with further supporting measures in return to work of cancer survivors, a survey by using a self-constructed questionnaire was performed in 30 experts 6 months after the WIETZ came into force.

Results

The awareness of Austrian specialists regarding the WIETZ seems to be excellent. Regarding expert opinions, return to work in cancer survivors is notable hampered in workplaces with great physical stress even in times of the WIETZ, whereas for professions in offices and banks it is easier to return to work, with and without WIETZ. The highest impact on return to work seems to be due to exercise, as an intervention of the field of physical medicine and rehabilitation to improve sensorimotor functions and to increase endurance capacity as well as muscular strength.

Conclusion

Early information about cancer rehabilitation and the WIETZ seems to be necessary to facilitate return to work of cancer survivors. Furthermore, exercise interventions seem to be the most important measures from the field of physical medicine and rehabilitation.

Health-related quality of life analysis in stage III melanoma patients treated with adjuvant dendritic cell therapy

BACKGROUND

Health-related quality of life (HRQoL) is an important issue in the rapidly evolving field of adjuvant treatment for stage III melanoma. Dendritic cell vaccination is one of the adjuvant forms of therapy currently investigated.

METHODS

We enrolled adults with stage III melanoma to receive adjuvant dendritic cell vaccination after a complete radical lymph node dissection. HRQoL assessment was one of the secondary endpoints of this trial and investigated with the EORTC-QLQ-C30 questionnaire at baseline and week 26.

RESULTS

Fifteen patients with a median age of 50 years were included in the study, with twelve evaluable patients on study at time of the second questionnaire. Global health status and role functioning improved clinically relevant with a mean difference of 15 (p = 0.010) and 26 points (p = 0.005), respectively.

DISCUSSION

Despite the small number of patients, we found a clinically relevant improved global health status. Besides, compared to the other investigated therapies, toxicity of dendritic cell vaccination is low, which supports our finding.

CONCLUSION

This is the first description of HRQoL in melanoma patients receiving dendritic cell vaccination. We show the expected improvement in global health status after surgical treatment of stage III melanoma. Thus, adjuvant dendritic cell vaccination does not seem to hamper this improvement, as shown in our small explorative study.

Illness perceptions as predictors of psychological distress among head and neck cancer survivors: a longitudinal study

BACKGROUND

Leventhal's commonsense model implies illness perceptions influence illness outcomes. This study examined illness perceptions among head and neck cancer survivors, and whether these predicted subsequent psychological distress.

METHODS

A total of 124 survivors of head and neck cancer (87% nasopharyngeal carcinoma; NPC) completed measures of psychological distress (Hospital Anxiety and Depression Scale; HADS), illness perceptions (Brief Illness Perception Questionnaire; B-IPQ), dispositional optimism (revised Chinese version of the Life Orientation Test; C-LOT-R), and clinical and demographic data approximately12.9 months after diagnosis (T1). Six months later (T2) psychological distress (HADS) was again measured. Adjusted multivariate analyses tested whether illness perceptions predicted T2 HADS scores.

RESULTS

Illness perception dimensions were significantly intercorrelated (0.01-0.68), explaining 8.0% of anxiety and 4.8% of depression symptom variability at T2. After adjustment for T1 distress, illness identity (β = 0.270, P < .01) and sex identification as a woman (β = 0.275, P < .01) predicted T2 anxiety symptoms while illness identity (β = 0.195, P < .05), unemployment (β = 0.195, P < .05), and pessimism (β = -0.227, P < .01) predicted T2 depression symptoms.

CONCLUSION

Perceived illness identity predicted psychological distress, accounting for modest levels of distress variance. Unresolved symptoms may exacerbate distress.

The mediating role of coping between self-reported health complaints and functional limitations, self-assessed work ability and work status of long-term sick-listed cancer survivors

Our purpose was to investigate the possible mediating role of active coping and passive coping between self-reported health complaints and functional limitations, as assessed by an insurance physician (IP), self-assessed work ability and work status in cancer survivors on long-term sick leave. Validated questionnaires were used for self-reported health complaints, work ability and work status. The functional limitations of the respondents were transformed into scales for mental and physical limitations and limitations in working hours. Using LISREL, we constructed a model with coping in a mediating role. Active coping mediated between fewer self-reported physical limitations, more depressive symptoms, better cognitive functioning and more fatigue on the one hand, and more physical limitations and limitations in working hours on the other hand. Passive coping played no mediating role and was associated with more self-reported depressive symptoms only. More functional limitations were associated with lower self-assessed work ability of cancer survivors, and with not being at work, whereas higher self-assessed work ability was associated with being at work. Regarding the role of active and passive coping strategies in cancer survivors on long-term sick leave, more longitudinal research is needed to confirm causality.

Associations between workability and patient-reported physical, psychological and social outcomes in breast cancer survivors: a cross-sectional study

PURPOSE

Workability is of increasing importance especially in Asia given the increasing incidence rates and young age of onset of breast cancer. This study explores the determinants of employment and suboptimal workability. And evaluate the association between workability and patient-reported physical, psychological, and social outcomes.

METHODS

In a hospital-based cross-sectional study, 327 breast cancer survivors, < 65 years of age and > 1 year post-diagnosis were recruited. Employed survivors filled out the workability index, which measures a person's capacity to meet work demands in relation to current health status. The EORTC-QLQ-C30, EORTC-QLQ-BR23, hospital anxiety and depression scale, multidimensional fatigue inventory, and brief pain index were administered. Fisher's exact test and Kruskal-Wallis test were used to test for associations of workability and employment status with demographic, clinical characteristics, and patient-reported outcomes. Linear models with standardised scores for patient-reported outcomes were fitted to study the associations of workability with patient-reported outcomes.

RESULTS

Of the 327 survivors, < 65 years of age (working age), 140 (43%) were in full-time and 34 (10%) in part-time employment. Employed survivors were younger at time of diagnosis and at time of survey. Employment status was not associated with time since diagnosis, ethnicity, or clinical characteristics. Suboptimal workability was present in 37% of employed survivors of the working age, and more common in jobs that include physical work activities. Higher level of depression, financial difficulty and physical fatigue, more breast symptoms, and poorer global health status were independently associated with poorer workability.

CONCLUSIONS

Lower employment and reduced workability in breast cancer survivors is common, and reduced workability is associated with higher levels of depression, financial difficulty and physical fatigue, more breast symptoms, and poorer global health status. Longitudinal research on psychosocial support with workability in Asia may find tailored approach to improve or maintain workability in employed breast cancer patients.

Evaluating the impact of spirituality on the quality of life, anxiety, and depression among patients with cancer: an observational transversal study

OBJECTIVE

Spiritual well-being was found to have some protective effect against end-of life despair in cancer patients. We aimed at assessing the impact of spirituality on the quality of life, depression, and anxiety of Lebanese cancer patients.

METHODS

Our observational transversal monocentric study was conducted between January and April 2016 among a convenient sample of 115 Lebanese cancer patients admitted to Hôtel-Dieu de France Hospital (HDF), Beirut-Lebanon. In addition to socio-demographic and clinical data, three questionnaires were used: EORTC QLQ-C30 (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, 3rd version), FACIT-Sp-12 (Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being; The 12-item Spiritual Well-Being Scale, 4th version), and HADS (Hospital Anxiety and Depression Scale). Eighteen patients taking anxiolytic and/or antidepressants were not included in the analysis. The remaining 97 patients were analyzed.

RESULTS

Better emotional and cognitive functioning was seen in patients with higher meaning, peace, faith, and total FACIT scores. Meaning, peace, and total FACIT scores were also higher among patients with better global health status and quality of life. Anxiety as well as depression was significantly associated to all spiritual well-being factors.

CONCLUSION

Spirituality can improve quality of life and decrease the incidence of anxiety and depression in cancer patients. Our results highlight the need to incorporate spiritual care in healthcare systems.

Cancer-related cognitive impairment and patients' ability to work: a current perspective

PURPOSE OF REVIEW

About half of all cancer survivors are 65 years of age or younger and potentially part of the labor force. Increasing numbers of these survivors are able to return to work (RTW) or even continue working during treatment. Many factors are known to inhibit occupational reintegration of cancer survivors, and further affect job performance after RTW. However, the impact of cancer-related cognitive impairment on work-related outcomes in cancer survivors is not well understood.

RECENT FINDINGS

Previous studies exploring cancer, cognition and the ability to work reported mixed results, because of inconsistency in the definitions of work-related outcomes, the use of self-reported rather than performance-based measurements and the interaction between cognitive limitations and other symptom burden, such as fatigue or job stress. In addition, a lack of interventions to specifically target cognitive problems at work was identified.

SUMMARY

Cognitive problems because of cancer diagnosis and treatment demand action in terms of developing a better understanding of their impact on the ability to work, as well as identifying effective therapeutic interventions to diminish this impact, including innovative accommodations, changes in work tasks or organization and ergonomic adjustments. Both employers and survivors should welcome such changes, to rise to the challenge of successfully adapting from the precancer status quo.

Management of work through the seasons of cancer survivorship

PURPOSE OF REVIEW

Survival from cancer has expanded enormously over the past decades. It is estimated that 40-50% of all cancer survivors are of working age at time of diagnosis and thus potentially part of the labor force. The seasons of survivorship can be used as a steppingstone to describe issues regarding employability survivors are dealing with.

RECENT FINDINGS

The acute survival stage begins at the point of diagnosis. Disclosure of diagnosis, and flexibility of both employers and (occupational) healthcare professionals are important factors in this stage. Extended survival starts when the survivor has completed the basic course of treatment. Survivors become aware that the old normality at work will be difficult to achieve. Problems like fear of recurrence, cognitive, and physical limitations might intensify during this stage and affect work ability. Permanent survival can be called long-term remission. Prospective studies on work-related outcomes and work-related interventions in this stage are rare.

SUMMARY

It is important to improve our understanding of the seasons of survival and to explore concepts, such as employability, against the background of these seasons. This perspective may help both survivors and (occupational) healthcare professionals to develop better strategies for dealing with the difficult life event cancer represents in each specific stage.

The Return to Work Experiences of Colorectal Cancer Survivors

Abstract: During the past 15 years, the number of colorectal cancer survivors has risen dramatically. While it is unclear how many colorectal cancer survivors were employed at the time of diagnosis, it is reasonable to expect a significant proportion of these survivors were temporarily displaced from the work force. This article describes the return to work experiences of 250 colorectal cancer survivors. The majority (80%) of the survivors were employed at diagnosis and 89% returned to work. Of those who returned to work, 81% sustained employment 5 years postdiagnosis. Results indicate survivors were successful in their attempt to return to work and sustain employment. However, 34% of survivors delayed their return beyond 2 months postdiagnosis. After controlling for ethnicity, education, and disease severity, the reason for delay was related to chemotherapy treatment Prospective studies of colorectal cancer survivors to document barriers to work return can guide interventions and occupational services to keep survivors healthy and in the workplace.

Work Sustainability Among Male Cancer Survivors After Returning to Work

Background

Few studies have investigated the work continuance rate among cancer survivors after return to work (RTW). The objective of this study was to clarify work sustainability after RTW among Japanese male cancer survivors.

Methods

We collected data on male cancer survivors from an occupational health register. Inclusion criteria were as follows: employees who returned to work after an episode of sick leave due to clinically certified cancer diagnosed between January 1, 2000 and December 31, 2011.

Results

Of 1,033 male employees who were diagnosed with cancer, 786 employees (76.1%) returned to work after their first episode of sick leave due to cancer. Work continuance rates among all subjects were 80.1% 1 year after RTW and 48.5% 5 years after RTW. The mean duration of work after RTW was 4.5 years. The work continuance rates varied significantly by cancer type. The “Lung” and “Hepatic, Pancreatic” cancer groups had the shortest duration of work (0.9 year after RTW).

Conclusions

Of workers who returned to work after their first episode of leave after cancer, 50% continued to work after 5 years in large-scale companies. There was a steep decrease in work continuance rates during the first year after RTW, with considerable differences according to cancer site.

Work functioning trajectories in cancer patients: Results from the longitudinal Work Life after Cancer (WOLICA) study

More than 60% of cancer patients are able to work after cancer diagnosis. However, little is known about their functioning at work. Therefore, the aims of this study were to (1) identify work functioning trajectories in the year following return to work (RTW) in cancer patients and (2) examine baseline sociodemographic, health-related and work-related variables associated with work functioning trajectories. This longitudinal cohort study included 384 cancer patients who have returned to work after cancer diagnosis. Work functioning was measured at baseline, 3, 6, 9 and 12 months follow-up. Latent class growth modeling (LCGM) was used to identify work functioning trajectories. Associations of baseline variables with work functioning trajectories were examined using univariate and multivariate analyses. LCGM analyses with cancer patients who completed on at least three time points the Work Role Functioning Questionnaire (n = 324) identified three work functioning trajectories: "persistently high" (16% of the sample), "moderate to high" (54%) and "persistently low" work functioning (32%). Cancer patients with persistently high work functioning had less time between diagnosis and RTW and had less often a changed meaning of work, while cancer patients with persistently low work functioning reported more baseline cognitive symptoms compared to cancer patients in the other trajectories. This knowledge has implications for cancer care and guidance of cancer patients at work.

Stigma and work discrimination among cancer survivors: A scoping review and recommendations: Stigmatisation et discrimination au travail des survivants du cancer : Examen de la portée et recommandations

BACKGROUND

Stigma and workplace discrimination can hinder employment opportunities for cancer survivors.

PURPOSE

This study explored perceptions of stigma and workplace discrimination for cancer survivors to understand the impact on survivors' engagement in paid work and to identify strategies to address stigma and workplace discrimination.

METHOD

Using Arksey and O'Malley's framework, we searched Medline, Embase, PsycINFO, Scopus, and CINAHL for evidence that intersected three concepts: cancer, stigma, and employment/workplace discrimination. Of the 1,514 articles initially identified, 39 met our inclusion criteria. Findings were charted, collated, and analyzed using content analysis.

FINDINGS

Myths regarding cancer (i.e., it is contagious, will always result in death) persist and can create misperceptions regarding survivors' employability and lead to self-stigmatization. Workplace discrimination may include hiring discrimination, harassment, job reassignment, job loss, and limited career advancement. Strategies to mitigate stigma and workplace discrimination include education, advocacy, and antidiscrimination policies.

IMPLICATIONS

Occupational therapists can enhance awareness of workplace concerns and advocate on behalf of cancer survivors.

Work Experiences of Patients Receiving Palliative Care at a Comprehensive Cancer Center: Exploratory Analysis

BACKGROUND

Employment-related issues have been largely overlooked in cancer patients needing palliative care. These issues may become more relevant as cancer evolves into more of a chronic illness and palliative care is provided independent of stage or prognosis.

OBJECTIVE

To characterize the employment situations of working-age palliative care patients.

DESIGN

Cross-sectional survey setting/subjects: Consecutive sample of 112 patients followed in palliative care outpatient clinics at a comprehensive cancer center.

MEASUREMENTS

Thirty-seven-item self-report questionnaire covering demographics, clinical status, and work experiences since diagnosis.

RESULTS

The commonest cancer diagnoses were breast, colorectal, gynecological, and lung. Eighty-one percent had active disease. Seventy-four percent were on treatment. Eighty percent recalled being employed at the time of diagnosis, with 65% working full time. At the time of the survey, 44% were employed and 26% were working full time. Most participants said work was important, made them feel normal, and helped them feel they were "beating the cancer". Factors associated with being employed included male gender, self-employed, and taking less than three months off work. Respondents with pain and/or other symptoms were significantly less likely to be working. On multivariate analysis, only pain (odds ratio [OR] 8.16, p < 0.001) and other physical symptoms (OR 5.90, p = 0.012) predicted work status; gender (OR 2.07), self-employed (OR 3.07), and current chemotherapy (OR 1.81) were included in the model, but were not statistically significant in this small sample.

CONCLUSION

Work may be an important issue for some palliative care patients. Additional research is needed to facilitate ongoing employment for those who wish or need to continue working.

How to Increase the Quality of a Suffering Experience: Lessons Derived From the Diary Narratives of a Dying Adolescent Girl

Personal narratives are assumed to be primary sources of the essential meaning of lived experiences of dying. In this study, I analyzed the personal diary of Miraç Fidan, a terminally ill adolescent with advanced cancer who kept a diary until her death at the age of 15. Miraç’s Diary, also published as a book, was subjected to hermeneutic phenomenological narrative analysis. Inferences were drawn regarding the following basic elements: (a) The dynamics in which Miraç lived and (2) her perceptions of herself, her immediate environment, and her experiences. Suffering seems to be the main experience dominating Miraç’s life, which I examined with regard to two dimensions: suffering caused by inevitable factors and suffering caused by preventable/changeable factors. The results suggest that if various causes among contextual factors are neutralized, then the quality of the existential experience determined by the inevitable factors would increase.

Therapeutic Work as a Facilitator for Return to Paid Work in Cancer Survivors

Purpose The increase of flexible employment in European labour markets has contributed to workers' risk of job loss. For sick-listed workers with chronic illnesses, such as cancer, and especially those without an employment contract, participation in therapeutic work may be an important step towards paid employment. The purpose of this study was to determine the role of therapeutic employment as facilitator for return to paid work, in a cohort of sick-listed cancer survivors (CSs) with and without an employment contract. Methods In this longitudinal study, data were used from a cohort of Dutch CSs (N = 192), who applied for disability benefits after 2 years of sick leave. The primary outcome measure was return to paid work after 1 year. Logistic regression analysis was applied. Results Of the participating CSs (mean age 50.7 years, 33 % male), 69 % had an employment contract at baseline. CSs without an employment contract participated significantly less in therapeutic work (p < 0.001) and were less likely to return to paid work after 1 year (p = 0.001), than those with a contract. Participation in therapeutic work significantly increased the chance of return to paid work after 1 year (OR 6.97; 95 % CI 2.94-16.51), adjusted for age, gender, level of work disability and having an employment contract. Conclusions Participation in therapeutic work could be an important facilitator for return to paid work in sick-listed CSs. The effectiveness of therapeutic work as a means to return to paid employment for sick-listed workers should be studied in an experimental setting.

Cancer survivors' activation to self-management and its relationship with participation in paid work and work-related problems

OBJECTIVE

This study aimed to explore cancer survivors' level of patient activation, ie, their knowledge, skills, and confidence for self-management, and to examine its relations to their participation in paid work and work-related problems.

METHODS

A total of 524 Dutch cancer survivors, 208 younger than 65 years, completed the Patient Activation Measure (PAM-13) and the Research and Development (RAND-36) General Health scale. Cancer survivors younger than 65 years also reported on their participation in paid work and work-related problems.

RESULTS

The mean PAM-13 score of cancer survivors was 58.1, and of those younger than 65 years 58.7. Patient activation was not associated with participation in paid work. Employed cancer survivors with a low level of patient activation experienced more problems working accurately (34% vs 17%), finishing their work (47% vs 22%), and concentrating (59% vs 31%) than those with a higher level of patient activation. The former group also reported more work stress (62% vs 28%).

CONCLUSIONS

Patient activation of cancer survivors deserves more attention, as a substantial proportion of these survivors have low activation levels, which relate to more work-related problems. Longitudinal studies are needed to explore the development of patient activation over time and its potential to improve important outcomes for people living with cancer in both the health and work domains.

Sustained employability and health-related quality of life in cancer survivors up to four years after diagnosis

BACKGROUND

Most cancer survivors are able to return to work at some point after diagnosis. However, literature on sustained employability and health-related quality of life (HRQoL) is limited. Therefore, the aims of this study were to explore the influence of change in employment status on HRQoL in cancer survivors long term after diagnosis, and to identify predictors of work continuation in occupationally active survivors.

MATERIAL AND METHODS

We used prospective data (T0 = two years after diagnosis, T1 = one-year follow-up, and T2 = two-year follow-up) from a cohort of cancer survivors that had an employment contract and were of working age at T0 (N = 252, 69.8% female). Groups were formed on the basis of change in employment status: 'continuously not working' (19.8%), 'positive change in employment status' (5.6%), 'negative change in employment status' (14.7%), and 'continuously working' (59.9%). ANCOVA was used to explore the relationship between change in employment status and HRQoL at T1. Generalized estimating equations (GEE) were used to identify predictors of work continuation (at T1 and T2) in survivors that were occupationally active at T0 (N = 212).

RESULTS

'Continuously working' survivors scored significantly better on the EORTC QLQ-C30 scales: role functioning, fatigue, pain, constipation, global health/QoL and the Summary score, than 'continuously not working' survivors, and better on physical, role and emotional functioning, fatigue, financial impact, global health/QoL and the Summary score than survivors with a 'negative change in employment status' (effect size range = 0.49-0.74). In occupationally active survivors, a high score on current work ability was associated with work continuation one year later [odds ratio (OR) 1.46; 95% CI 1.11-1.92].

CONCLUSION

Cancer survivors 'continuously working' function better and have a better health and QoL than those who are not able to work. However, in occupationally active cancer survivors, one should monitor those with low self-perceived work ability, because they have an increased risk to discontinue their work.

Predictors of early retirement after cancer rehabilitation-a longitudinal study

This longitudinal study was designed to assess patients' desire for early retirement and investigate which cancer-related and psychosocial characteristics are associated with early retirement. We assessed 750 cancer patients at the beginning (t₀ ) and end (t₁ ) of, and 12 months after (t₂ ) inpatient cancer rehabilitation. At t₀ , 22% had a desire to retire early. These patients reported significantly longer sick leave periods, less favourable workplace environments, lower work ability, higher psychological distress and lower quality of life than other patients. At t₂ , 12.5% of patients received temporary or permanent early retirement pensions. Of all patients with a desire for early retirement at t₀ , 43% had returned to work at t₂ . This subgroup had a significantly lower physical quality of life than other patients returning to work. The most influential predictors of early retirement were being on sick leave (OR = 6.50, 95% CI = 1.97-21.47) and a desire for early retirement (OR = 5.61, 95% CI = 2.73-11.52). Inverse predictors of early retirement were cancer remission (OR = 0.23, 95% CI = 0.10-0.53), perceived productivity (OR = 0.38, 95% CI = 0.18-0.83), work satisfaction (OR = 0.36, 95% CI = 0.17-0.77) and mental quality of life (OR = 0.94, 95% CI = 0.91-0.98). This underlines the need for cancer-specific multi-professional rehabilitation and occupational therapy programmes.

Cancer survivorship: current status of research, care, and policy in Japan

Progress in early detection and treatment has been changing cancer into a chronic illness, and this has initiated an imperative shift in focus among healthcare providers, researchers and policy makers in many countries, including Japan, to cancer survivorship issues rather than mere survival. This article reviews the history of the cancer survivorship concept and examines how the concept has been integrated into cancer policy in Japan. It also discusses the characteristics of survivorship research and briefly reviews the current status of research and care, both in Japan and globally, regarding five important survivorship topics: developing measures for long-term complications and delayed effects, interpersonal relationships, lifestyle modifications and health promotion, sexuality and fertility, and work-related issues. Cooperation with practitioners and researchers in areas outside the medical fields will be indispensable to promote survivorship research and care practice. Also, the importance of collaboration with cancer survivors for developing support systems and policy measures related to survivorship cannot be emphasized enough.

Factors associated with (non-)participation of cancer survivors with job loss in a supportive return to work program

Purpose

To evaluate and implement supportive programs, it is important to understand which cancer survivors (CSs) are participating in these programs and which motives exist for declining participation. Recently, a supportive return-to-work (RTW) program was offered to CSs with job loss. The purpose of this study was to identify factors and motives associated with (non-)participation of CSs with job loss in the RTW program.

Methods

In this cross-sectional study (N = 286), information on socio-demographic, health-related, psychosocial, and work-related characteristics of CSs in the program was collected. Similar data were collected from those who declined participation. Multivariable logistic regression analyses were conducted (p < 0.05) to identify factors associated with (non-)participation. Motives for declining participation were identified using descriptive analysis.

Results

Being married (odds ratio (OR) 0.23; 95 % confidence interval (CI) 0.08–0.69) or living together (OR 0.25; 95 % CI 0.07–0.96) decreased the likelihood of participation in the RTW program. Having a temporary employment contract prior to unemployment (OR 2.60; 95 % CI 1.20–5.63), a clear intention to RTW (OR 2.65; 95 % CI 1.20–5.82), and higher scores on a readiness to RTW instrument, i.e., contemplation scale (OR 2.00; 95 % CI 1.65–2.40) and prepared for action–self-evaluative scale (OR 1.27; 95 % CI 1.04–1.54), increased the likelihood of participation. Physical (50 %) and mental problems (36 %) were leading motives for declining participation.

Conclusions

The results from this study help to distinguish CSs that may not need RTW support, from those who are most in need of RTW support. Practitioners and researchers should tailor RTW support to CSs’ socio-demographic, health-related, and work-related characteristics.

Barriers and facilitators for return to work in cancer survivors with job loss experience: a focus group study

Over 50% of cancer survivors lose their job or quit working. Cancer survivors who experience job loss may face different challenges regarding return to work, compared to cancer survivors with employers. This qualitative study aimed to explore barriers and facilitators for return to work in cancer survivors with job loss and in insurance physicians who assist cancer survivors in their return to work. We conducted five focus groups and one interview (cancer survivors, N = 17; insurance physicians, N = 23). Topics included, among others, experience of job loss and barriers and facilitators for return to work. Data were audio recorded and analysed using thematic analysis. Our main finding was that cancer survivors experienced a double loss: loss of job on top of loss of health. As a result, cancer survivors feared for job applications, lacked opportunities to gradually increase work ability, and faced reluctance from employers in hiring them. Insurance physicians expressed a need for more frequent and longer consultations with cancer survivors with job loss. We conclude that cancer survivors who experience double loss encounter specific barriers in the return to work process. This calls for a tailored approach regarding return to work support.

Work or welfare after cancer? Explorations of identity and stigma

With increasing numbers of people living with cancer, a greater focus is required on the social consequences of the disease. This article explores the connections between cancer and employment and the constraints imposed by ill health and wider structural conditions. Narrative data from 23 people of working age with cancer in north-east England collected longitudinally over 16 months highlight the impact of financial strain caused by temporary or permanent interruption to employment, and the positive benefits of an upstream welfare rights intervention in enabling participants to claim benefit entitlements and boost incomes. Returning to work, for those who were able, helped repair the disruption caused by the illness. For those unable to work, reliance on welfare benefits, while necessary, conferred a stigmatised identity that compounded the disruption wrought by cancer. While stigma occurs at the individual level, the structural dimensions of stigma need to be acknowledged in order to analyse the forces that cause, maintain and perpetuate the stigma associated with claiming welfare while ill. We conclude that current UK policies and welfare reforms to reduce sickness-related welfare claims will lead to greater hardship during periods of ill health and increase inequalities.

Quality of working life of cancer survivors: development of a cancer-specific questionnaire

Purpose

The aim of this study was to generate, and select quality of working life issues for the development of an initial version of the Quality of Working Life Questionnaire for Cancer Survivors (QWLQ-CS).

Methods

Quality of working life issues were generated through focus groups with cancer survivors and oncological occupational physicians, and interviews with employers, supervisors, and organization officers. A selection of these quality of working life issues was made based on relevance and importance by conducting an online questionnaire among the cancer survivors and oncological occupational physicians. Researchers formulated the issues into items for the QWLQ-CS.

Results

A total of 24 cancer survivors, six oncological occupational physicians and 11 employers, supervisors, and organization officers participated. The 222 quality of working life issues identified through the focus groups, interviews, and literature were converted into an online questionnaire. Cancer survivors (N = 20) found 44 issues not relevant or important with respect to their quality of working life. The researchers reviewed the remaining 178 issues and formulated them into 102 items classified by five categories: work perception, job characteristics, the social structure and environment, organizational characteristics, and the effect of the disease and treatment.

Conclusions

The initial version of the QWLQ-CS exists out of 102 items which cover the experiences and perceptions of cancer survivors in the work environment. All items were indicated by working cancer survivors as relevant and important.

Implications for cancer survivors

This initial version of the QWLQ-CS may increase awareness of the potential problems or emotional difficulties working cancer survivors face during the work continuation process.

Effects of social activity on health-related quality of life according to age and gender: an observational study

Background

The aim of this study was to examine the relationship between types and amount of social activity and health-related quality of life according to gender and age group.

Methods

This study used data from the Community Health Survey (CHS), which was collected in 2011 and consisted of 229,226 participants aged 19 or older. A linear mixed effects model was used to evaluate the factors influencing health-related quality of life among individuals tracked in the CHS and, in particular, to analyze the associations between the amount and types of social activities participated in and the EuroQol EQ-5D assessment.

Results

We found that the average quality of life increased according to the amount of social activities individuals participated in (zero = 89.30, one = 93.28, two = 95.25, three = 96.27, four = 96.85). When people participated in one social activity, social activity was more strongly associated with EQ-5D in the elderly age group (males: 19–34 years = 0.195, 35–49 years = 0.642, 50–64 years = 1.716, ≥65 years = 4.408; females: 19–34 years = 0.170, 35–49 years = 0.502, 50–64 years = 1.411, ≥65 years = 4.180). More participation was positively associated with higher EQ-5D (one = 1.939, two = 2.377, three = 2.439, four = 2.515, p for trend < 0.0001). In females, those who participated in relationship organizations had a higher EQ-5D than those who participated in other types of social activities (Females ≥65 age group; Relationship = 4.373, Leisure = 2.620, Religion = 1.842, Charity = 1.544).

Conclusion

There was a positive association between the increase in the number of social activities and increase in health-related quality of life, especially when evaluated in terms of type of social activities and health-related quality of life according to gender and age group.

Supporting cancer patients with work-related problems through an oncological occupational physician: a feasibility study

To evaluate the feasibility of an oncological occupational physician (OOP) who is trained in oncological work-related problems, and in providing work-related support to cancer patients within the curative setting. We assessed facilitators and barriers that affect the activities of an OOP, and the satisfaction of the OOPs and patients with this new form of health care. Interviews were held with (1) OOPs (N = 13) to assess facilitators, barriers and their satisfaction with their ability to give supportive care and (2) cancer patients (N = 8) to assess their satisfaction concerning consulting an OOP. The main facilitators were positive feedback from health care providers and patients about the received care and support that the OOP had given, and the additional knowledge of the OOPs about cancer and work-related problems. Major barriers for being active as an OOP were lack of financial support for the OOP and the unfamiliarity of patients and health care providers with the specialised occupational physician. Both OOPs and the specialised knowledge and additional training of the OOPs facilitated providing support to cancer patients and survivors with work-related problems. Familiarity with the specialised occupational physician and financial support should be improved.

Psychosocial Information Requirements for Multimorbid Breast Cancer Patients in Breast Centres in North Rhine Westphalia

Introduction: The importance of breast cancer patients (BPs) being supplied with sufficient information is well known. This study investigated the unfulfilled psychosocial information requirements of multimorbid BPs. Methods: This study records the unfulfilled psychosocial information requirements of 4166 patients, who were treated at one of the fifty breast centres in North Rhine Westphalia. The Cologne patient questionnaire for breast cancer 2.0 included in the postal survey following hospital stays records the information requirements using an adapted version of the "Cancer patient information needs" scale. Through a univariate analysis using the χ² test, it was investigated whether multimorbid BPs had significantly different psychosocial information requirements than BPs without further concomitant illnesses. Results: In general, it transpired that BPs had relatively low unfulfilled information requirements regarding work (20.7 %), everyday life (26.8 %), illness (27.4 %) and treatment (35.7 %), though such requirements were higher when it came to health-related behaviour (54.2 %). Multimorbid BPs had significantly lower unfulfilled information requirements regarding work and significantly larger ones regarding treatment in comparison to BPs without concomitant illnesses. Renal diseases and concomitant mental illnesses were associated with particularly high information requirements (p < 0.05). Conclusion: The results of our study should clarify the complexity and heterogeneity of information requirements of breast cancer patients in oncological care and should help to design the supply of information to be more patient-oriented.

Municipal return to work management in cancer survivors undergoing cancer treatment: a protocol on a controlled intervention study

Background

Cancer survivors are often left on their own to deal with the challenges of resuming work during or after cancer treatment, mainly due to unclear agreements between stakeholders responsible for occupational rehabilitation. Social inequality exists in cancer risk, survival probability and continues with regard to the chance of being able to return to work.

The aim is to apply an early, individually tailored occupational rehabilitation intervention to cancer survivors in two municipalities parallel with cancer treatment focusing on enhancing readiness for return to work.

Methods/Design

In a controlled trial municipal job consultants use acceptance and commitment therapy dialogue and individual-placement-and-support-inspired tools with cancer survivors to engage them in behaviour changes toward readiness for return to work. The workplace is involved in the return to work process.

Patients referred to surgery, radiotherapy or chemotherapy at the Oncology Department, Aarhus University Hospital, Denmark for the diagnoses; breast, colon-rectal, head and neck, thyroid gland, testicular, ovarian or cervix cancer are eligible for the study. Patients must be residents in the municipalities of Silkeborg or Randers, 18–60 years of age and have a permanent or temporary employment (with at least 6 months left of their contract) at inclusion. Patients, for whom the treating physician considers occupational rehabilitation to be unethical, or who are not reading or talking Danish are excluded. The control group has identical inclusion and exclusion criteria except for municipality of residence.

Return to work is the primary outcome and is indentified in a social transfer payment register. Effect is assessed as relative cumulative incidences within 52 weeks and will be analysed in generalised linear regression models using the pseudo values method. As a secondary outcome; co-morbidity and socio-economic status is analysed as effect modifiers of the intervention effect on return to work.

Discussion

The innovative element of this intervention is the timing of the occupational rehabilitation which is much earlier initiated than usual and the active involvement of the workplace. We anticipate that vulnerable cancer survivors will benefit from this approach and reduce the effects of social inequality on workability.

Trial registration

Current Controlled Trials ISRCTN50753764. Registered August 21^st, 2014.

Associations of health behaviours with return to work outcomes after colorectal cancer

PURPOSE

Engaging in positive health behaviours can improve quality of life amongst cancer survivors, whether this facilitates return to work is unknown. We examined associations of health behaviours with return to work outcomes following a diagnosis of colorectal cancer in middle-aged men and women (45-64 years).

METHODS

We recruited 239 participants through the Queensland Cancer Registry between January 2010 and September 2011. Data were collected through telephone-administered interviews and postal questionnaires at 6 and 12 months post-diagnosis. Logistic regression examined likelihood of ceasing or reducing work, and Cox regression examined factors associated with time to return to work.

RESULTS

No significant associations were observed between health behaviours (fruit and vegetables consumption, alcohol consumption, smoking status, physical activity or sitting time) at 6 months and ceasing or reducing work at 12 months post-diagnosis. Participants who reported excessive sleep (≥9 h/day) were 2.69 times more likely to reduce work time or retire (relative to those sleeping the recommended 7 to <9 h/day; 95 % CI 1.06, 6.87, adjusted for cancer treatment). In Cox regression analysis, excessive sleep was associated with a longer work re-entry time (relative to sleeping 7 to <9 h/day; HR = 0.47; 95 % CI 0.22, 1.00, adjusted for education and cancer treatment).

CONCLUSIONS

Further research into how excessive sleep might be related to return to work amongst colorectal cancer survivors is warranted. Interventions focused on achieving optimal sleep patterns may assist colorectal cancer survivors to return to work and should be tested in future studies.

Factors affecting the quality of life of Korean cancer survivors who return to the workplace

BACKGROUND

Although the prevalence of cancer is increasing, it is no longer synonymous with death. The number of cancer survivors is estimated to be increasing due to development in medical treatments and social programs; cancer survivors are increasingly returning to work after long-term unemployment. Thus, we examined the quality of life (QOL) and the factors associated with return of cancer survivors to the workplace.

MATERIALS AND METHODS

This study was performed using the 2008 Community Health Survey administered by the Korea Centers for Disease Control and Prevention (N=548). We used Chi-square tests to compare demographic variables based on self-perceived health status, and analysis of variance (ANOVA) to compare QOL scores among groups. We also performed a mixed-model analysis of the relationship between QOL and factors at the workplaces of cancer survivors.

RESULTS

Based on the results of our study, the overall QOL of cancer survivors was associated with 'mutual respect', 'free emotional expression', occupation, and age. Moreover, different trends of QOL according to self-perceived health were identified on additional analysis. In the 'bad' self-perceived health group, QOL was significantly different according to income. The QOL of cancer survivors in the low-income group was lower than in the other groups. Conversely, the 'normal' group had a lower QOL caused by 'no mutual respect' and "no free emotional expression" in the workplace. The QOL in the 'good' group based on self-perceived health was higher in the younger age group.

CONCLUSIONS

There may be a significant relationship between QOL and workplace factors for cancer survivors, although further study is needed to investigate this relationship in detail. This may facilitate formulation of policy and efforts to prevent and manage the decline in the QOL of cancer survivors returning to work.

Factors influencing work functioning after cancer diagnosis: a focus group study with cancer survivors and occupational health professionals

PURPOSE

Cancer survivors (CSs) frequently return to work, but little is known about work functioning after return to work (RTW). We aimed to identify barriers and facilitators of work functioning among CSs.

METHODS

Three focus groups were conducted with CSs (n = 6, n = 8 and n = 8) and one focus group with occupational health professionals (n = 7). Concepts were identified by thematic analysis, using the Cancer and Work model as theoretical framework to structure the results.

RESULTS

Long-lasting symptoms (e.g. fatigue), poor adaptation, high work ethics, negative attitude to work, ambiguous communication, lack of support and changes in the work environment were mentioned as barriers of work functioning. In contrast, staying at work during treatment, open dialogue, high social support, appropriate work accommodations and high work autonomy facilitated work functioning.

CONCLUSIONS

Not only cancer-related symptoms affect work functioning of CSs after RTW but also psychosocial and work-related factors. The barriers and facilitators of work functioning should be further investigated in studies with a longitudinal design to examine work functioning over time.

Effect of Low-Intensity Physical Activity and Moderate- to High-Intensity Physical Exercise During Adjuvant Chemotherapy on Physical Fitness, Fatigue, and Chemotherapy Completion Rates: Results of the PACES Randomized Clinical Trial

PURPOSE

We evaluated the effectiveness of a low-intensity, home-based physical activity program (Onco-Move) and a moderate- to high-intensity, combined supervised resistance and aerobic exercise program (OnTrack) versus usual care (UC) in maintaining or enhancing physical fitness, minimizing fatigue, enhancing health-related quality of life, and optimizing chemotherapy completion rates in patients undergoing adjuvant chemotherapy for breast cancer.

PATIENTS AND METHODS

We randomly assigned patients who were scheduled to undergo adjuvant chemotherapy (N = 230) to Onco-Move, OnTrack, or UC. Performance-based and self-reported outcomes were assessed before random assignment, at the end of chemotherapy, and at the 6-month follow-up. We used generalized estimating equations to compare the groups over time.

RESULTS

Onco-Move and OnTrack resulted in less decline in cardiorespiratory fitness (P < .001), better physical functioning (P ≤ .001), less nausea and vomiting (P = .029 and .031, respectively) and less pain (P = .003 and .011, respectively) compared with UC. OnTrack also resulted in better outcomes for muscle strength (P = .002) and physical fatigue (P < .001). At the 6-month follow-up, most outcomes returned to baseline levels for all three groups. A smaller percentage of participants in OnTrack required chemotherapy dose adjustments than those in the UC or Onco-Move groups (P = .002). Both intervention groups returned earlier (P = .012), as well as for more hours per week (P = .014), to work than the control group.

CONCLUSION

A supervised, moderate- to high-intensity, combined resistance and aerobic exercise program is most effective for patients with breast cancer undergoing adjuvant chemotherapy. A home-based, low-intensity physical activity program represents a viable alternative for women who are unable or unwilling to follow the higher intensity program.

Return to work and its relation to financial distress among Iranian cancer survivors

BACKGROUND

Return to work after treatment completion is important for both cancer survivors and society. Financial distress is one of the factors that may influence the return to work in cancer survivors. However, this relationship has not been well investigated. This study aimed to determine the rate of return to work and its relation to financial distress among Iranian cancer survivors.

MATERIALS AND METHODS

This descriptive-correlational study was undertaken among 165 cancer survivors who completed their initial treatments and had no signs of active cancer. The Return to Work questionnaire and Financial Distress/Financial Well-Being Scale were used for data collection. Data were analyzed using SPSS statistical software.

RESULTS

After initial treatments, 120 cancer survivors (72%) had returned to work, of which 50 patients (42%) had returned to full-time work and 70 (58%) reduced their work hours and returned to part-time work. Cancer survivors also reported high levels of financial distress. In addition, the financial distress was lower among patients who had returned completely to work, in comparison to patients who had quit working for cancer-related reasons (p=0.001) or returned to work as part-time workers (p=0.001).

CONCLUSIONS

The findings showed that a high percent of Iranian cancer survivors had not returned to their jobs or considerably reduced working hours after treatment completion. Accordingly, due to high levels of financial distress experienced by participants and its relation to return to work, designing rehabilitation programs to facilitate cancer survivor return to work should be considered.

Employment status among non-retired cancer survivors in Japan

Employed cancer patients confront some challenges as they attempt to return to work after treatment. We aimed to identify correlates of return to work for cancer survivors in Japan, with an emphasis on employment status. Participants were 260 patients (aged <65 years) who had received a cancer diagnosis ≥ 1 year previously and who were employed at the time of diagnosis. Participants completed questionnaires at consultations at any Regional Cancer Center Hospitals in Yamagata, Japan between 28 November 2011 and 9 December 2011. Logistic regression analysis was used to identify correlates of return to work. Data cross-tabulation was used to evaluate relationships to workplace and income-changes by employment status. A high proportion of patients (75.8%) had returned to work. Non-regularly employed survivors were less likely to return to work (odds ratio = 5.03; 95% confidence interval, 1.18-21.35). Individuals with poor health, advanced-stage tumours, of advanced age and women were significantly less likely to return to work. Only 52.8% of non-regular employees continued to be employed, and their income decreased by as much as 61.1%. Social and financial support policies should be organised based on more intensive study of employment circumstances.

Return to work in sick-listed cancer survivors with job loss: design of a randomised controlled trial

BACKGROUND

Despite long-term or permanent health problems, cancer survivors are often motivated to return to work. For cancer survivors who have lost their job, return to work can be more challenging compared to employed survivors, as they generally find themselves in a more vulnerable social and financial position. Cancer survivors with job loss may therefore be in need of tailored return to work support. However, there is a lack of return to work intervention programs specifically targeting these cancer survivors. The number of cancer survivors with job loss in developed countries is rising due to, amongst others, increases in the incidence and survivor rate of cancer, the retirement age and the proportion of flexible employment contracts. Hence, we consider it important to develop a tailored return to work intervention program for cancer survivors with job loss, and to evaluate its effectiveness compared to usual care.

METHODS/DESIGN

This study employs a two-armed randomised controlled trial with a follow-up period of 12 months. The study population (n = 164) will be recruited from a national sample of cancer survivors (18-60 years), who have been sick-listed for 12-36 months. Participants will be randomised by using computerized blocked randomisation (blocks of four). All participants will receive usual care as provided by the Dutch Social Security Agency. Additionally, participants in the intervention group will receive a tailored return to work intervention program, which includes vocational rehabilitation and supportive psychosocial components, as well as (therapeutic) placement at work. The primary outcome measure is duration until sustainable return to work; the secondary outcome measure is rate of return to work. Other parameters include, amongst others, fatigue, coping strategy and quality of life. We will perform Cox regression analyses to estimate hazard ratios for time to sustainable return to work.

DISCUSSION

The hypothesis of this study is that a tailored approach for cancer survivors with job loss is more effective, regarding return to work, compared to usual care. The results of this study will provide insight into the ways in which return to work can be facilitated for cancer survivors with job loss.

TRIAL REGISTRATION

Netherlands Trial Register: NTR3562 .