Work ability and return-to-work in cancer patients

Work ability and cognitive impairments in young adult cancer patients: associated factors and changes over time-results from the AYA-Leipzig study

PURPOSE

Although young adults represent a significant portion of the working population, little is known about the work ability and cognitive impairments in adolescent and young adult (AYA) cancer patients (including the long-term course) following cancer treatment.

METHODS

As part of the AYA-Leipzig study, we surveyed AYA cancer survivors (aged 18-39 years at diagnosis; time since diagnosis ≤ 4 years, including all cancer diagnoses) at two time points (t2 = 12 months after t1). Work ability (Work Ability Index, WAI-r) and cognitive impairments (Copenhagen Psychosocial Questionnaire, COPSOQ) were compared at both time points. We analysed predictors for work ability at, on average, 2 years post cancer diagnosis (t2) by using multivariate regression analyses.

RESULTS

A total of 502 patients (74.7% women) participated in both measurements. Mean work ability increased significantly from t1 (6.0; SD = 2.3) to t2 (6.8; SD = 2.2) (t = -9.3; p < 0.001). As many as 380 (76%) AYA cancer survivors reported reduced work ability at t1; 1 year later, this still applied to 287 (57%) of them. Decreased work ability (t2) was associated with more cognitive impairment, higher effort coping with the disease, comorbidities, sick leave > 6 months (since diagnosis), and having children (adj R² = .48). Cognitive impairments occurred in approximately every fifth patient at both surveys.

CONCLUSIONS

Achieving maximum work ability is a major challenge for AYAs. Our results show the need for multimodal cancer survivorship and rehabilitation programmes with a special focus on improving cognitive and psychosocial functioning.

IMPLICATIONS FOR CANCER SURVIVORS

AYAs with cancer should receive targeted occupational counselling early in the course of the disease.

Effectiveness of a Tailored Work-Related Support Intervention for Patients Diagnosed with Gastrointestinal Cancer: A Multicenter Randomized Controlled Trial

Purpose The aim of this research was to study the effectiveness on return to work (RTW) of an early tailored work-related support intervention in patients diagnosed with curative gastrointestinal cancer. Methods A multicenter randomized controlled trial was undertaken, in which patients were assigned randomly to the intervention or the control group (usual care). The intervention encompassed three psychosocial work-related support meetings, starting before treatment. Five self-reported questionnaires were sent over twelve months of follow-up. Primary outcome was days until RTW (fulltime or partial) and secondary outcomes included work status, quality of life, work ability, and work limitations. Descriptive analysis, Kaplan-Meier analysis, relative risk ratio and linear mixed models were applied. Results Participants (N = 88) had a mean age of 55 years; 67% were male and the most common cancer type was colon cancer (66%). Of the participants, 42 were randomized to the intervention group. The median time from sick leave until RTW was 233 days (range 187-279 days) for the control group, versus 190 days (range 139-240 days) for the intervention group (log-rank p = 0.37). The RTW rate at twelve months after baseline was 83.3% for the intervention group and 73.5% for the control group. Work limitations did statistically differ between the groups over time (p = 0.01), but quality of life and work ability did not. Conclusion Patients in the intervention group seem to take fewer days to RTW, albeit not to a statistically significant extent.Trial registration Trial NL4920 (NTR5022) (Dutch Trial Register https://www.trialregister.nl ).

Assessing the relationship between patient-provider communication quality and quality of life among rural cancer survivors

PURPOSE

We explored relationships between patient-provider communication quality (PPCQ) and three quality of life (QOL) domains among self-identified rural cancer survivors: social well-being, functional well-being, and physical well-being. We hypothesized that high PPCQ would be associated with greater social and functional well-being, but be less associated with physical well-being, due to different theoretical mechanisms.

METHODS

All data were derived from the 2017-2018 Illinois Rural Cancer Assessment (IRCA). To measure PPCQ and QOL domains, we respectively used a dichotomous measure from the Medical Expenditure Panel Survey's Experience Cancer care tool (high, low/medium) and continuous measures from the Functional Assessment of Cancer Therapy-General (FACT-G).

RESULTS

Our sample of 139 participants was largely female, non-Hispanic White, married, and economically advantaged. After adjusting for demographic and clinical variables, patients who reported high PPCQ exhibited greater social well-being (Std. β = 0.20, 95% CI: 0.03, 0.35, p = 0.02) and functional well-being (Std. β = 0.20, 95% CI: 0.05, 0.35, p = 0.03) than patients with low/medium PPCQ. No association was observed between PPCQ and physical well-being (Std. β = 0.06, 95% CI: - 2.51, 0.21, p = 0.41). Sensitivity analyses found similar, albeit attenuated, patterns.

CONCLUSION

Our findings aligned with our hypotheses. Future researchers should explore potential mechanisms underlying these differential associations. Specifically, PPCQ may be associated with social and functional well-being through interpersonal mechanisms, but may not be as associated with physical well-being due to multiple contextual factor rural survivors disproportionately face (e.g., limited healthcare access, economic hardship) and stronger associations with clinical factors.

Work Personality, Core Self-evaluation and Perceived Career Barriers in Young Adult Central Nervous System Cancer Survivors

PURPOSE

The purpose of this study is to examine the relationship between work personality, core self-evaluation (CSE), and perceived internal and external barriers to employment in a group of young adult CNS survivors.

METHODS

The participants consisted of 110 young adult survivors of pediatric central nervous system (CNS) tumors aged between 18 and 30 years old (M = 23.05, SD = 3.36). Mediation analysis with structural equational modeling (SEM) technique was used to correlate a number of different measures (Work Personality [WP], Perceived Employment Barriers [PEB], and Core-Self Evaluation [CSE]).

RESULTS

Results revealed an exceptionally well-fitting model to our data with work personality predicting CSE positively: β = 0.34, SE = 0.07, 95% CI (0.18, 0.47) while CSE inversely predicts Perceived Barriers to Employment, β = - 0.60, SE = 0.06, 95% CI (- 0.70, - 0.49). There is a direct pathway from WP to PEB once CSE was accounted for β = - 0.20, SE = 0.07, 95% CI (- 0.33, - 0.06). The presence of both significant direct and indirect effects of WP on PEB implied that there was a partial mediating effect of CSE on the association between WP and PEB.

CONCLUSIONS

Work personality is a robust construct that can be applied to young adult CNS survivors in effort to gain more insight into the personality and psychological factors that impact career development and employment in this group. The major finding of this study was that work personality and CSE had a significant direct effect on perceived career barriers and that there was a significant indirect effect with CSE acting as a mediator between developmental work personality and perceived career barriers.

A Cross-Sectional Study Examining the Relationship Between Socio-Demographics and Coping Styles in a Group of Cancer Patients

OBJECTIVE

The global number of oncological patients is expected to rise worldwide. However, the increase in the number of cases is linked with an increase in life expectancy. Hence, it's worth knowing about patients' resources for managing life with chronic illness. Specifically, the present study was aimed to examine the association between socio-demographic characteristics and coping strategies.

METHOD

Participants were one-hundred and twenty-one cancer patients (70.2% females), aged 26 to 88 years (M=61.90, SD=12.16). Socio-demographic characteristics and coping styles were measured by a self-report questionnaire and the mini-Mental Adjustment to Cancer Scale. A series of standard multiple regression analyses were performed to predict coping styles based on gender, age, education level, marital status, working status, disability pension, income, and time since diagnosis at the moment of the survey.

RESULTS

The female gender showed a positive association with hopelessness/ helplessness, anxious preoccupation, fatalism, and avoidance. Being a worker seemed positively related to the fighting spirit strategy. Age, marital status, and disability pension did not reveal any association with coping. Having an active-work status was positively associated with fighting spirit. Finally, both educational level and income were negatively associated with the use of fatalism coping strategy, whereas the cancer patients with longer elapsed time since diagnosis showed tendency to fatalism style.

CONCLUSIONS

Consistent with the recognized relevance of individual differences for gathering data about patients' risk and protective factors, our findings might be useful for both research purpose and clinical practice.

[Predictive factors of maintain of employment and return to work after cancer]

BACKGROUND

Return-to-work after cancer depends on several factors related to the disease but also other socio-professional factors. The primary aim of this study was to identify socio-demographic, disease related and professional factors influencing the return-to-work process.

METHODS

It was a prospective and descriptive study reporting the return-to-work process in 89 cancer patients, in a professional activity age, who had cancer treatment and a follow up in the Oncology department in Tahar Maamouri Teaching Hospital of Nabeul, between September 2015 to December 2019.

RESULTS

Our study included 89 patients. Mean age was 45 years±8. The population was predominantly feminine (59 %). They were employees in 45 % of cases. Private professional sectors included 60 % of all patients. An open-ended contract was performed in 87 % of cases. Most frequent primary tumors were breast tumors (45 %) and colon tumors (20 %). Thirty-four patients went back to work after recovery. Seventy-nine percent of them were female patients and 70 % had breast cancer. Predictive factors identified in univariate statistical analysis and correlated to return-to-work were gender (P=0.002), occupation (P<10^-3), initial duration off sick (P=0.015), fitting out measures at work (P=0.01), primary tumor origin (P=0.01), disease stage (P=0.037), treatment (P=0.014) and disease outcome after treatment (P=0.024).

CONCLUSION

Our study underlined a need to create a pluridisciplinary platform unifying collaborators among oncologists and occupational health professionals in order to enhance professional reintegration process and to hold patient's professional equilibrium after cancer recovery.

The Relation of Readiness for Return to Work and Return to Work Among Iranian Cancer Survivors

Return to work after completion of cancer treatments has many benefits for patients, families, and society. Readiness for return to work (RRTW) seems to be an effective factor for return to work in cancer survivors. Therefore, the present study was to investigate return to work and its relation to RRTW among Iranian survivors of cancer. This descriptive-correlational study examined a total of 227 survived cancer patients with completed primary treatments and without active cancer symptoms. Data were collected by the return to work and RRTW questionnaires and analyzed with descriptive statistics and inferential statistics using SPSS software. Upon completion of initial treatment, 166 (73.2%) of survivor participants returned to work, of which 78 (34.4%) and 88 (38.4%) participants returned to full-time and part-time works, respectively. ANOVA test showed a significant difference between RRTW and the type of return to work. In addition, results of regression analysis revealed that there was a positive significant relationship between RRTW and the rate of return to work before and after the adjustment of variables (p ≤ 0.05). Considering the findings of the study, there is a necessary need planning for rehabilitation programs by nursing managers concerning these patients to facilitate their return to work.

Economic evaluation of adjuvant trastuzumab emtansine in patients with HER2-positive early breast cancer and residual invasive disease after neoadjuvant taxane and trastuzumab-based treatment in Canada

Background

In the katherine trial, adjuvant trastuzumab emtansine [T-DM1, Kadcyla (Genentech, South San Francisco, CA, U.S.A.)], compared with trastuzumab, significantly reduced the risk of recurrence or death by 50% (unstratified hazard ratio: 0.50; 95% confidence interval: 0.39 to 0.64; p < 0.0001) in patients with her2-positive early breast cancer (ebc) and residual invasive disease after neoadjuvant systemic treatment. A cost-utility evaluation, with probabilistic analyses, was conducted to examine the incremental cost per quality-adjusted life-year (qaly) gained associated with T-DM1 relative to trastuzumab, given the higher per-cycle cost of T-DM1.

Methods

A Markov model comprising a number of health states was used to examine clinical and economic outcomes over a lifetime horizon from the Canadian public payer perspective. Patients entered the model in the invasive disease-free survival (idfs) state, where they received either T-DM1 or trastuzumab. Transition probabilities between the health states were derived from the katherine trial, Canadian life tables, and published literature from other relevant clinical trials (emilia, cleopatra, and M77001). Resource use, costs, and utilities were derived from katherine, other clinical trials, published literature, provincial fee schedules, and clinical expert opinion. Sensitivity analyses were conducted for key assumptions and model parameters.

Results

Compared with trastuzumab, adjuvant T-DM1 was associated with a cost savings of $8,300 per patient and a 2.16 incremental qaly gain; thus T-DM1 dominated trastuzumab. Scenario analyses yielded similar results, with T-DM1 dominating trastuzumab or producing highly favourable incremental cost-utility ratios of less than $10,000 per qaly.

Conclusions

Adjuvant T-DM1 monotherapy is a cost-effective strategy compared with trastuzumab alone in the treatment of patients with her2-positive ebc and residual invasive disease after neoadjuvant systemic treatment.

Returning to work in lung cancer survivors-a multi-center cross-sectional study in Germany

Purpose

To investigate the work situation of lung cancer survivors and to identify the factors associated with their returning to work.

Methods

Descriptive analysis and logistic regression were used to evaluate study population characteristics and independent factors of subsequently returning to work. To analyze time to return to work, Cox regression was used.

Results

The study sample included 232 lung cancer survivors of working age from 717 enrolled participants in the multi-center cross-sectional LARIS (Quality of Life and Psychosocial Rehabilitation in Lung Cancer Survivors) study. About 67% of the survivors were not employed during the survey. More than 51% of the survivors who were employed before their illness did not return to their work. The survivors who had returned to their careers were younger, associated with higher household income, lower fatigue score, and stable relationship and vocational training. Patients who received social service counseling showed a higher chance of regaining their career.

Conclusions

Lung cancer survivors were found to be associated with a high risk of unemployment and very low professional reintegration after interruption due to illness. More comprehensive studies are needed to support lung cancer survivors and targeting of patients in need of special attention in rehabilitation that would benefit from the findings in the present study.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00520-020-05886-z.

Working after cancer: in-depth perspectives from a setting with limited employment protection policies

PURPOSE

A considerable proportion of individuals who are diagnosed with cancer are at a working age. We aimed to gain an in-depth understanding of the challenges, and arising needs related to working after cancer in a setting with limited employment protection policies.

METHODS

Focus group discussions were conducted with cancer patients who were diagnosed at least 1 year prior to recruitment, and either had paid work, were self-employed, currently unemployed, or currently retired (N = 66).

RESULTS

Three main themes were identified: (1) loss of income: While some participants were entitled for a 1-year cancer-specific sick leave, many other participants recounted having insufficient paid sick leave, forcing them to take prolonged unpaid leave to complete treatment; (2) dealing with side effects of cancer and its treatment: The need for workplace accommodations was highlighted including flexible working hours, lighter workloads, and dedicated rest areas to enable patients to cope better; (3) Discrimination and stigma at workplace: Some participants mentioned being passed over on a promotion, getting demoted, or being forced to resign once their cancer diagnosis was disclosed, highlighting an urgent need to destigmatize cancer in the workplace.

CONCLUSION

In settings with limited employment protection policies, a cancer diagnosis severely impacts the working experiences of patients, leading to financial loss. Urgent interventions and legislative reforms are needed in these settings to address the unmet employment needs of cancer survivors.

IMPLICATIONS FOR CANCER SURVIVORS

This study may facilitate planning of local solutions to fulfill the unmet employment needs following cancer, such as return-to-work navigation services.

Well-Being at Work after Return to Work (RTW): A Systematic Review

Background: Employees’ well-being at work after the return to work (RTW) is considered a key aspect of rehabilitation and maintenance of workability. This systematic review aimed at identifying the common psychosocial factors that predict the subjective and psychological well-being in RTW processes after having a long-standing health problem or disability. Objective: To evaluate the subjective and psychological well-being at work of employees with chronic or long-standing health problems or those returning to work after any cause of disability. Data source: Systematic review of articles published in English or Spanish using PsycINFO, PsycARTICLES, MEDLINE, Psychology, and Behavioral Sciences Collection, and Pubpsych. An additional study was identified by contacting expert academics in the field. The search equations used included terms such as Return to Work, Long-Standing Health Problems or Disability, Work Health Balance, and job satisfaction or subjective well-being. Eligibility criteria for the studies: Studies that included a measure of employees’ well-being at work following return to work were selected for the review. Evaluation of the studies and synthesis methods: The studies were selected using predefined fields which included quality criteria. Results: Of the 264 articles returned by the initial search, a total of 20 were finally selected. Results were organized around the three different theoretical approaches for understanding RTW and its antecedents and consequences: (a) RTW and autonomy at work have a positive effect on psychological well-being; (b) job demand is linked to less job satisfaction, whereas a higher level on the work–health balance is associated with job satisfaction and work engagement; (c) internal and external support is linked to job satisfaction in the case of a disease. Limitations: The evidence provided by the results is restricted by the limited availability of studies focusing on well-being at work following return to work. Moreover, the studies identified are of different kinds, thereby preventing comparisons. Conclusions and implications of the main findings: Employees’ subjective well-being after return to work has received very little attention to date. Given its importance in the current configuration of the labor market, it should be the object of more research.

The associations between late effects of cancer treatment, work ability and job resources: a systematic review

Objective

The aim of this review is to evaluate associations between possible late effects of cancer treatment (i.e. physical complaints, fatigue, or cognitive complaints) and work ability among workers beyond 2 years after cancer diagnosis who returned to work. The role of job resources (social support, autonomy, leadership style, coaching, and organizational culture) is also evaluated.

Methods

The search for studies was conducted in PsycINFO, Medline, Business Source Premier, ABI/Inform, CINAHL, Cochrane Library and Web of Science. A quality assessment was used to clarify the quality across studies.

Results

The searches included 2303 records. Finally, 36 studies were included. Work ability seemed to decline shortly after cancer treatment and recover in the first 2 years after diagnosis, although it might still be lower than among healthy workers. No data were available on the course of work ability beyond the first 2 years. Late physical complaints, fatigue and cognitive complaints were negatively related with work ability across all relevant studies. Furthermore, social support and autonomy were associated with higher work ability, but no data were available on a possible buffering effect of these job resources on the relationship between late effects and work ability. As far as reported, most research was carried out among salaried workers.

Conclusion

It is unknown if late effects of cancer treatment diminish work ability beyond two years after being diagnosed with cancer. Therefore, more longitudinal research into the associations between possible late effects of cancer treatment and work ability needs to be carried out. Moreover, research is needed on the buffering effect of job resources, both for salaried and self-employed workers.

Electronic supplementary material

The online version of this article (10.1007/s00420-020-01567-w) contains supplementary material, which is available to authorized users.

Exploring the Needs of Cancer Survivors When Returning to or Staying in the Workforce

Purpose Cancer survivors have strong personal desires to resume work to feel productive and meet financial needs. However, they may be faced with physical and psychological challenges. This research addresses the question: "What are the needs of cancer survivors when returning to or staying in the workforce?" by (i) examining cancer survivors' perspectives on supports needed when returning to or staying in the workforce and (ii) exploring personal and employment factors that influence the return to work process. Methods An exploratory qualitative design was used. We conducted focus groups and one-on-one semi-structured interviews with cancer survivors (n = 15). Inductive thematic analysis was used to analyze the data. Results Four key themes were identified as significant aspects of the return-to-work process for cancer survivors: (1) changing perspectives on self and work; (2) managing work and social systems; (3) determining disclosure and accommodation; and (4) the importance of supports for return to work and daily life. Conclusions There is a growing interest in developing targeted interventions to improve work outcomes for cancer survivors. This study informs cancer rehabilitation research by developing an understanding of the supports and strategies that should be implemented to help cancer survivors return to work successfully and improve quality of life.

A return-to-work intervention protocol directed at cancer patients (self-assessment, tailored information & lifestyle management for returning to work among cancer patients, START): A multi-center, randomized controlled trial

Purpose

This study describes the protocol for the design and evaluation of a self-assessment based educational program supporting cancer patients’ return-to-work (RTW), prior to its complete and ongoing implementation.

Methods

We designed a multi-center, randomized controlled trial with three follow-up points. The study population (N = 239) includes recently diagnosed cancer patients who plan to receive active treatment at two university hospitals in Korea. A pre-test is conducted at the point of enrollment for both groups. The intervention group receives a leaflet clarifying misconceptions about RTW and is shown a video clip of patient interviews concerning RTW. The control group receives a booklet about cancer and nutrition, and is not provided with further intervention. After active treatment, the intervention group receives a one-time, face-to-face education session with an oncology nurse. Following the education session, both groups receive three follow-up phone calls. The first follow-up call occurs at the end of intervention and at the end of active treatment for intervention and control groups, respectively. The next two follow-up calls will be conducted one month and a year following the post-test. The primary outcome is whether the patient has RTW or has plans to RTW, and the secondary outcome is knowledge of RTW.

Results

As of April 2020, 239 patients have been enrolled in the trial. Statistical analyses will be conducted upon trial completion in December 2020.

Discussion

We hypothesize that the provision of RTW education near diagnosis will not only enhance patients’ intentions to RTW, but also effectively encourage them to RTW.

"A Good Guy" Again: Biosociality in a Cancer Self-help Organization

The notion of biosociality has been employed in the understanding of forging new forms of social groupings and other forms of social solidarity, with its feasibility and basis challenged in non-Western contexts. According to our study of a Chinese cancer self-help organization, an emergent biosociality occurs through an increasingly common diagnostic biomedical category, cancer. But what truly binds these people tighter is the pre-modern local knowledge of qi, as well as state ideology about living a useful life. A new form of biosocial citizenship, "a good guy (haoren yige)," linked to cancer, is thus endowed.

Identifying Expectations of Delayed Return to Work in Patients with Prostate Cancer at the Beginning of a Cancer Rehabilitation Program

Purpose To investigate factors associated with expectations of delayed return to work (RTW) in patients with prostate cancer recently admitted to a cancer rehabilitation program. Methods In this multicenter study, data about expected time until RTW and potential correlates (personal, medical, psychosocial and work-related factors) were obtained from 822 employed cancer rehabilitation participants at the beginning of the program. Participants expecting early RTW (≤ 3 months) and delayed RTW (> 3 months) were compared. Hierarchical multivariate logistic regression was applied to study which factors are associated with expecting delayed RTW. Results In total, 171 cancer rehabilitation participants (21%) expected delayed RTW. Group comparison showed education, type of occupation, income, number of comorbid conditions, tumor stage according to the staging system of the Union for International Cancer Control (UICC), anxiety and depression, quality-of-life functioning scales, urinary and treatment-related symptoms, duration of sick leave, subjective work ability, perceived ability to return to the former job, intention to apply for a disability pension, effort-reward-imbalance and occupational stress to be associated in bivariate analysis with participants' expectations. Multivariate analysis revealed UICC tumor stage III (compared to stages I/II, OR 2.36), lower subjective work ability (OR 0.82), perceived inability to return to the former job (OR 1.88) and intention to apply for a disability pension (OR 1.94) to increase the likelihood of expecting delayed RTW. Conclusions Negative or non-beneficial RTW expectations, which are related to self-perception and behavioral intention, seem to be key factors for expecting delayed RTW. Interventions to early identify and adjust such expectations might empower cancer rehabilitation participants to develop appropriate expectations for work recovery.

Experiences of cancer patients' return to work

PURPOSE

This study explored the experiences of cancer survivors remaining in the workforce, or transitioning back into the workforce following treatment.

METHODS

Using an exploratory qualitative design, eight individual interviews were conducted with participants undergoing treatment for various cancer diagnoses, all of whom were employed prior to their cancer diagnosis.

FINDINGS

Participants revealed that work provided them with a sense of normalcy, purpose, and personal identity. All but one participant voiced the benefits of having a supportive work environment. Many also shared they had experienced financial burden and were unaware of where to seek financial assistance.

CONCLUSION

Future research needs to further explore how the healthcare team and employer can promote supportive work environments and increase cancer survivors' awareness and access to financial resources.

Predictors of post-cancer diagnosis resignation among Japanese cancer survivors

PURPOSE

In Japan, due to the increased incidence of cancer among the working population, it has become more important to support employees to achieve a balance between cancer treatment and work. This study aimed to clarify the predictors of resigning from employment after being diagnosed with cancer (post-cancer diagnosis [PCD] resignation) among Japanese employees.

METHODS

As part of a Japanese national research project (Endo-Han), the investigators conducted a web-based survey of cancer survivors (CSs) in 2017. The investigators analyzed the risk factors for PCD resignation using a logistic regression model, including age at diagnosis, sex, cancer type, cancer stage, year of diagnosis, whether the patient held a managerial role, type of employment, and company size.

RESULTS

Of 750 employed Japanese CSs, 93 (12.4%) resigned from their jobs. The non-managers resigned more often (14.6%) than the managers (7.6%) (p = 0.007). The temporary workers exhibited the highest PCD resignation rates (22.2%), while the PCD resignation rates of the self-employed workers and permanent workers were 15.2% and 7.6%, respectively (p < 0.001). As the result of multivariate analysis, being female (odds ratio [OR], 3.67; 95%CI, 1.71-7.87), having hematological cancer (OR, 4.23; 95%CI, 1.37-13.04), having advanced cancer (OR, 2.48; 95%CI, 1.52-4.03), and being a temporary worker (OR, 2.51; 95%CI, 1.40-4.50) were identified as predictors of PCD resignation.

CONCLUSIONS

In total, 12.4% of Japanese employees quit their jobs after being diagnosed with cancer. Being female or a temporary worker and having advanced cancer were identified as predictors of PCD resignation. Regarding cancer type, hematological cancer was most strongly associated with PCD resignation.

IMPLICATION OF CANCER SURVIVORS

CSs who are females and temporary workers and have advanced cancer should be followed-up more carefully after cancer diagnosis for their work sustainability, by medical professionals, companies, and society.

Type of cancer treatment and cognitive symptoms in working cancer survivors: an 18-month follow-up study

PURPOSE

Cognitive symptoms are reported to affect cancer survivors' functioning at work. However, little is known about the type of cancer treatment and cognitive symptoms in working cancer survivors. We examined the longitudinal association between type of cancer treatment and cognitive symptoms in cancer survivors post return to work, and whether the course of cognitive symptoms over 18 months differed per type of cancer treatment.

METHODS

Data from the Dutch longitudinal "Work-Life after Cancer" study were used. The study population consisted of 330 working cancer survivors who completed questionnaires at baseline, and 6, 12, and 18 months follow-up. Cognitive symptoms were assessed with the cognitive symptom checklist-work and linked with cancer treatment data from the Netherlands Cancer Registry. Data were analyzed using generalized estimating equations.

RESULTS

Cancer survivors who received chemotherapy reported comparable memory symptom levels (b: - 2.3; 95% CI = - 7.1, 2.5) to those receiving locoregional treatment. Executive function symptom levels (b: - 4.1; 95% CI = - 7.8, - 0.4) were significantly lower for cancer survivors who received chemotherapy, compared with those receiving locoregional treatment. In cancer survivors who received other systemic therapy, memory (b: 0.4; 95% CI = 0.1, 0.7) and executive function symptom levels (b: 0.4; 95% CI = 0.0, 0.7) increased over time. In cancer survivors who received chemotherapy and locoregional treatment, memory and executive function symptom scores were persistent during the first 18 months after return to work.

CONCLUSIONS

The contradictory finding that cancer patients receiving chemotherapy report fewer cognitive symptoms warrants further research.

IMPLICATIONS FOR CANCER SURVIVORS

Working cancer survivors may have cognitive symptom management needs irrespective of the type of cancer treatment they received.

Retour au travail de patients atteints de cancer

BUT

Cette étude s'est intéressée à l'expérience de survivants du cancer qui sont demeurés sur le marché du travail pendant leurs traitements ou y sont retournés après.

MÉTHODOLOGIE

À l'aide d'un devis exploratoire qualitatif, huit entrevues individuelles ont été réalisées auprès de patients traités pour différents cancers qui occupaient tous un emploi avant de recevoir le diagnostic.

RÉSULTATS

Les participants ont exprimé que le travail leur procurait un sentiment de normalité et d'identité personnelle, qu'il leur donnait un objectif. Sauf pour une participante, tous ont formulé les avantages de fréquenter un milieu de travail compréhensif. Plusieurs participants ont admis avoir vécu un stress financier, ignorant où trouver de l'aide financière.

CONCLUSION

D'autres recherches sont nécessaires afin de mieux explorer comment l'équipe soignante et l'employeur peuvent promouvoir des milieux de travail favorables et faciliter l'accès des personnes cancéreuses aux ressources financières.

Long-term work retention after treatment for cancer: a systematic review and meta-analysis

PURPOSE

Almost half of people diagnosed with cancer are working age. Survivors have increased risk of unemployment, but little is known about long-term work retention. This systematic review and meta-analysis assessed work retention and associated factors in long-term cancer survivors.

METHODS

We searched Medline/Pubmed, Embase, PsychINFO, and CINAHL for studies published 01/01/2000-08/01/2019 reporting work retention in adult cancer survivors ≥ 2 years post-diagnosis. Survivors had to be in paid work at diagnosis. Pooled prevalence of long-term work retention was estimated. Factors associated with work retention from multivariate analysis were synthesized.

RESULTS

Twenty-nine articles, reporting 21 studies/datasets including 14,207 cancer survivors, were eligible. Work retention was assessed 2-14 years post-diagnosis. Fourteen studies were cross-sectional, five were prospective, and two contained both cross-sectional and prospective elements. No studies were scored as high quality. The pooled estimate of prevalence of long-term work retention in cancer survivors working at diagnosis was 0.73 (95%CI 0.69-0.77). The proportion working at 2-2.9 years was 0.72; at 3-3.9 years 0.80; at 4-4.9 years 0.75; at 5-5.9 years 0.74; and 6+ years 0.65. Pooled estimates did not differ by cancer site, geographical area, or study design. Seven studies assessed prognostic factors for work retention: older age, receiving chemotherapy, negative health outcomes, and lack of work adjustments were associated with not working.

CONCLUSION

Almost three-quarters of long-term cancer survivors working at diagnosis retain work.

IMPLICATIONS FOR CANCER SURVIVORS

These findings are pertinent for guidelines on cancer survivorship care. Professionals could focus support on survivors most likely to have poor long-term work outcomes.

Trajectories of sickness absence and disability pension in the 2 years before and 3 years after breast cancer diagnosis: A Swedish longitudinal population-based cohort study

BACKGROUND

After breast cancer (BC) diagnosis, work incapacity often occurs among working-age women. We investigated the trajectories of previous and subsequent sickness absence and/or disability pension (SA/DP) days, and risk factors for consistently high levels of future SA/DP among these women.

METHODS

This longitudinal cohort study included all 3536 women in Sweden aged 19-64 years who received a first BC diagnosis in 2010. Their annual SA/DP net days from 2 years before to 3 years after diagnosis were calculated. SA/DP patterns were depicted by a group-based trajectory model. Logistic regressions were used to calculate odds ratios (ORs) with 95% CIs of >90 or >180 SA/DP days/year.

RESULTS

Three trajectories of SA/DP days/year were identified: increasing only in year₊₁ (61% of all), increasing then decreasing in year₊₃ (30%), and constantly very high (9%). The risk factors associated with annual SA/DP days >90 (long) and >180 days (extreme long) were similar. Factors associated with having >90 SA/DP days for years 1-3 were: stage II (OR, 4.59; 95% CI, 2.98-7.07), stage III+IV (OR, 26.57; 95% CI, 13.52-52.22), prediagnosis SA 1-30 days (OR, 2.73; 95% CI, 1.30-5.70), prediagnosis SA >90 days (OR, 24.52; 95% CI, 12.25-49.08), and prediagnosis DP (OR, 659.97; 95% CI, 292.52->999.99). Conversely, adjusting for prediagnosis SA/DP and stage, sociodemographic factors were not associated with high levels of SA/DP.

CONCLUSION

After BC diagnosis, SA/DP increased significantly but then decreased. The absolute majority had no SA/DP during year 3. Advanced cancer stage and previous high SA/DP rendered the greatest risk for future high SA/DP. More knowledge is needed for applying the information in rehabilitation and return-to-work planning.

Return to work after oropharyngeal cancer treatment-Highlighting a growing working-age population

BACKGROUND

To describe the frequency of patients returning to work after treatment for oropharyngeal cancer and to identify predictors and physical barriers that might interfere with the return to work process.

METHODS

Cross-sectional study including 295 patients. Data were collected regarding work/sick leave situation at 1 month before diagnosis and 15 months after diagnosis. The situation before diagnosis was retrospectively recalled by the patients. Two subscales and two single items from the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-H&N35 were used. Data were analyzed with multivariate logistic regression.

RESULTS

Fifteen months after diagnosis, 212 patients (72%) were working. To be working 15 months after diagnosis was associated with working before diagnosis. Swallowing difficulties, problems talking on the telephone, and physical appearance were negatively associated with returning to work.

CONCLUSIONS

The large number of individuals returning to work is encouraging for patients diagnosed with oropharyngeal cancer.

Factors associated with return to work in breast cancer survivors treated at the Public Cancer Hospital in Brazil

PURPOSE

To evaluate the impact of return to work on the quality of life of breast cancer patients and to identify factors related to nonreturn to work.

METHODS

An observational, cross-sectional study was performed in breast cancer survivors who had worked before their breast cancer diagnosis. We evaluated factors related to return to work (patient perspective, disease, and work), EORTC quality of life questionnaires (general: EORTC QLQ-C30; and breast cancer-specific: EORTC QLQ-BR23), the Shoulder Pain and Disability Index (SPADI), and the Anxiety and Depression Scale (HADS). Half of the patients underwent a physical therapy examination (shoulder goniometry, hand dynamometry, and limb volume). Univariate and multivariate analysis were performed.

RESULTS

We included 304 patients, 163 of whom underwent physiotherapy evaluation. Approximately 54.0% (164) of the patients returned to work after treatment. The women who returned to work presented lower age, higher education levels, higher incomes, and smaller initial tumor size. The women who returned to work had higher scores related to body image and sexual function, lower scores in relation to disability and pain, and lower scores related to anxiety and depression. In the multivariate model to evaluate nonreturn to work, pretreatment variables were age, education level, and clinical staging. Sequelae related to loss of strength increased the risk of nonreturn to work.

CONCLUSION

Return to work was influenced by age, education level, previous activity types, axillary treatment, and physical sequelae related to loss of hand strength. Breast cancer treatment decreased the women's work capacity. Return to work improved the patients' quality of life.

Trajectories of returning to work and its impact on survival in survivors with oral cancer: A 5-year follow-up study

BACKGROUND

A return to work (RTW) is a challenge for survivors of oral cancer. Further light could be shed on the RTW of patients with oral cancer, which remains largely uninvestigated. The objective of this study was to investigate the trajectories of RTW and their impact on survival in workers with oral cancer.

METHODS

In total, 12,222 workers who were newly diagnosed with oral cancer were identified during the period from 2004 to 2015 and were included in this cohort study. The associations between independent variables and RTW were analyzed using Cox proportional hazard models.

RESULTS

Overall, 8793 workers returned to work in the first years after a diagnosis of oral cancer. Chemotherapy (hazard ratio [HR], 0.88; 95% CI, 0.78-0.99) and radiation therapy (HR, 0.83; 95% CI, 0.75-0.92) were inversely associated with RTW. Patients who had received surgical treatment (HR, 1.24; 95% CI, 1.01-1.53) were more likely to RTW. Employees with stage I (HR, 1.66; 95% CI, 1.47-1.87), stage II (HR, 1.52; 95% CI, 1.35-1.72), and stage III (HR, 1.32; 95% CI, 1.16-1.51) disease were associated with an increased likelihood of RTW in the fifth year after diagnosis. Kaplan-Meier survival analysis demonstrated better survival for the RTW group versus the non-RTW group in patients with stage III and IV oral cancer (P < .001). The fully adjusted HR indicated that the RTW group had significantly better outcomes than the non-RTW group in all-cause mortality (P < .001; HR, 0.36; 95% CI, 0.33-0.39).

CONCLUSIONS

Sociodemographic and medical factors affect the RTW of cancer survivors. RTW may have a beneficial effect on survival of patients with oral cancer.

Two-Year Follow-Up of a Multi-centre Randomized Controlled Trial to Study Effectiveness of a Hospital-Based Work Support Intervention for Cancer Patients

Purpose Purpose is to: (1) study effectiveness of the hospital-based work support intervention for cancer patients at two years of follow-up compared to usual care and (2) identify which early factors predict time to return-to-work (RTW). Methods In this multi-center randomised controlled trial (RCT), 106 (self-)employed cancer patients were randomized to an intervention group or control group and provided 2 years of follow-up data. The intervention group received patient education and work-related support at the hospital. Primary outcome was RTW (rate and time) and quality of life (SF-36), and secondary outcomes were, work ability (WAI), and work functioning (WLQ). Univariate Cox regression analyses were performed to study which early factors predict time to full RTW. Results Participants were diagnosed with breast (61%), gynaecological cancer (35%), or other type of cancer (4%). RTW rates were 84% and 90% for intervention versus control group. They were high compared to national register-based studies. No differences between groups were found on any of the outcomes. Receiving chemotherapy (HR = 2.43, 95% CI 1.59-3.73 p < 0.001), low level of education (HR = 1.65, 95% CI 1.076-2.52 p = 0.02) and low work ability (HR = 1.09 [95% CI 1.04-1.17] p = 0.02) were associated with longer time to full RTW. Conclusions We found high RTW rates compared to national register-based studies and we found no differences between groups. Future studies should therefore focus on reaching the group at risk, which consist of patients who receive chemotherapy, have a low level of education and have a low work ability at diagnosis. TRIAL REGISTRATION: Netherlands Trial Registry (NTR) (http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1658): NTR1658.

Predicting return to work among patients with colorectal cancer

BACKGROUND

The increase in prevalence of colorectal cancer among young patients coupled with an older retirement age in developed countries means that more patients are being diagnosed with colorectal cancer while still at work. The aim of this study was to develop prediction models for return to work by 1 and 2 years after the start of sick leave.

METHODS

This was a retrospective registry-based cohort study of data from a nationwide occupational health service in the Netherlands. Only employed patients with colonic or rectal cancer treated with curative intent were included. Two predictor variable models were developed using multivariable logistic regression with backward selection. Calibration, discrimination and explained variance were used to assess model performance, and internal validation by bootstrapping was performed.

RESULTS

Median time to return to work for 317 included patients was 423 (95 per cent c.i. 379 to 467) days. Two-thirds of patients had returned to work by 2 years after the start of the sick leave. Presence of metastases, adjuvant treatment, stoma, emotional distress and postoperative complications were predictors of not returning to work in the 1-year model. In the 2-year model, presence of metastases, emotional distress, postoperative complications, company size and the trajectory of the return-to-work process were predictors.

CONCLUSION

Almost 70 per cent of patients with colorectal cancer in this population returned to work within 2 years after the start of sick leave. The models can be used to guide patients early in colorectal cancer treatment about the likelihood of returning to work, and to identify and modify barriers that could facilitate this.

Recommendations for Research and Practice to Improve Work Outcomes Among Cancer Survivors

Major knowledge gaps limit the development and implementation of interventions to improve employment outcomes among people with cancer. To identify research priorities to improve employment outcomes after cancer, the National Cancer Institute sponsored the meeting "Evidence-Based Approaches for Optimizing Employment Outcomes among Cancer Survivors." This article describes research recommendations stemming from the meeting. At the patient level, longitudinal studies are needed to better understand how patient sociodemographic and clinical characteristics and their experiences at work shape employment outcomes. Interventions that mitigate the impact of cancer and its treatment on employment are critical. At the provider-level, future research is needed to characterize the extent to which physicians and other healthcare providers talk to their patients about employment concerns and how that information is used to inform care. Additionally, there is a need to test models of care delivery that support routine screening of employment concerns, the capture of employment outcomes in electronic health records, and the effective use of this information to improve care. At the employer level, evidence-based training programs are needed to prepare supervisors, managers, human resources staff, and occupational health professionals to address health issues in the workplace; and future interventions are needed to improve patient -employer communication and facilitate workplace accommodations. Importantly, research is needed that reflects the perspectives and priorities of patients and their families, providers and healthcare systems, and employers. Transdisciplinary partnerships and stakeholder engagement are essential to ensure that employment-focused interventions and policies are developed, implemented, and sustained in real-world healthcare delivery and workplace settings.

From shaky grounds to solid foundations: A salutogenic perspective on return to work after cancer

Background: Almost a third of employed individuals of working age fall out of work after cancer treatment.Aim: To explore cancer survivors' successful return to work, focusing on assets and resources utilized to resolve cancer- and work-related obstacles to achieve long-term employment.Methods: We interviewed eight cancer survivors who had remained at work for at least 3 years after cancer treatment. We performed interpretative phenomenological analysis and applied Antonovsky's salutogenic model of health as a framework.Results: The participants experienced uncertainty regarding cancer recurrence, impairments, and long-lasting effects on work ability. They utilized a wide range of resistance resources at personal, interpersonal, and social levels. Their determination to return to work was generally strong, but the time needed to find sustainable work and strategies to return to work varied. All participants prioritized activities that energized them and adapted actively to their new situation. When unsure about outcomes, they focused on the best alternative and controlled fear cognitively.Conclusions/Significance: Finding meaningful activities, testing actual work ability, and focusing on the best possible outcome seemed important to remain in work after cancer. It may be helpful to identify available resources and utilize them to resolve tensions resulting from cancer and cancer treatment.

Recurrent sick leave and resignation rates among female cancer survivors after return to work: the Japan sickness absence and return to work (J-SAR) study

BACKGROUND

To date, there have not been any workforce-based Japanese cohort studies investigating work sustainability after return to work (RTW). The objective of this study was to investigate the post-RTW cumulative recurrent sick leave rate and cumulative resignation rate among female cancer survivors.

METHODS

Among Japanese employees who were registered in the Japan sickness absence and return to work (J-SAR) study, the subjects were those female employees who returned to work after sick leave due to newly clinically diagnosed cancer (C01-C99; ICD-10), based on a physician's certificate, between 2000 and 2011. The last day of the follow-up period was December 31, 2012. The recurrent sickness leave rate and resignation rate were calculated using competing risk survival analysis.

RESULTS

Of 223 cancer survivors, 61 took further physician-certified sick leave after their RTW. The median duration of the post-RTW work period among all cancer survivors was 10.6 years. The work continuance rates of the female cancer survivors were 83.2 and 60.4% at 1 and 5 years after they returned to work, respectively. There was a steep reduction in the work continuance rate during the first post-RTW year. There were considerable differences in the work continuance rate according to the primary cancer site. Cumulative recurrent sick leave rates of 11.8 and 28.9% were seen at 1 and 5 years after the subjects returned to work. The cumulative resignation rate was 5.0 and 10.7% at 1 and 5 years after the subjects returned to work. Most recurrent sick leave occurred in the first year after the subjects returned to work, followed by the second year.

CONCLUSIONS

Sixty percent of female cancer survivors were still working at 5 years after returning to work, although the work continuance rates for different types of cancer varied significantly.

Socio-economic impact on women diagnosed and treated for breast cancer: a cross-sectional study

INTRODUCTION

The increase in breast cancer survival poses a challenge for patients to be able to rejoin their professional and social life in very similar conditions to those before diagnosis. The aim of this study is to assess short- and medium-term social, economic and professional impact of BC among women diagnosed with it.

METHODS

A cross-sectional descriptive study using QLQ-C30, QLQ-BR23, and MOS-SSS instruments and a semi-structured interview in women diagnosed in years 2011, 2014, and 2016 in Hospital de la Santa Creu i Sant Pau in Barcelona (Spain).

RESULTS

175 patients were included with a mean age of 55. About 62.8% were married or coupled, 76% were living with their family unit, and 52.6% denied changes in their living situation. The mean Support Global Index was 74.7% and 78.8% before and after diagnosis, respectively. The mean global quality of life (QOL) was 67.3%, outstanding insomnia as the main symptom (X > 30%) and sexual function as the most affected dimension. At the moment of diagnosis, two-thirds of patients were working. After diagnosis, 87.5% stopped working, 39.4% were off work for 7-12 months, and only 50% returned to work. Multivariate analysis identified working as the most associated variable with a good QOL.

CONCLUSIONS

QOL among women diagnosed with breast cancer is quite high and stable. Nevertheless, there are some very relevant aspects to QOL that need to be considered whilst caring for patients with BC to achieve rehabilitation as complete and comprehensive as possible.

Study protocol of a prospective multicenter study comparing (cost-)effectiveness of a tailored interdisciplinary head and neck rehabilitation program to usual supportive care for patients treated with concomitant chemo- or bioradiotherapy

BACKGROUND

Since 2011, a tailored, interdisciplinary head and neck rehabilitation (IHNR) program, covered by the basic healthcare insurance, is offered to advanced head and neck cancer (HNC) patients in the Netherlands Cancer Institute (NKI). This program is developed to preserve or restore patients' functioning, and to optimize health-related quality of life (HRQoL). It applies an integrated approach to define patients' individual goals and provide rehabilitation care throughout the cancer care continuum. The aim of the current study is to assess the (cost-) effectiveness of the IHNR approach compared to usual supportive care (USC) consisting of monodisciplinary and multidisciplinary care in advanced HNC patients.

METHODS

This multicenter prospective observational study is designed to compare (cost-)effectiveness of the IHNR to USC for advanced HNC patients treated with chemoradiotherapy (CRT) or bioradiotherapy (BRT). The primary outcome is HRQoL represented in the EORTC QLQ-C30 summary score. Functional HRQoL, societal participation, utility values, return to work (RTW), unmet needs (UN), patient satisfaction and clinical outcomes are secondary outcomes, assessed using the EORTC QLQ-H&N35, USER-P, EQ-5D-5 L, and study-specific questionnaires, respectively. Both patient groups (required sample size: 64 per arm) are requested to complete the questionnaires at: diagnosis (baseline; T0), 3 months (T1), 6 months (T2), 9 months (T3) and 12 months (T4) after start of medical treatment. Differences in outcomes between the intervention and control group will be analyzed using mixed effects models, Chi-square test and descriptive statistics. In addition, a cost-effectiveness analysis (CEA) will be performed by means of a Markov decision model. The CEA will be performed using a societal perspective of the Netherlands.

DISCUSSION

This prospective multicenter study will provide evidence on the effectiveness and cost-effectiveness of IHNR compared to USC. RTW and societal participation, included as secondary outcomes, have not been studied sufficiently yet in cancer rehabilitation. Interdisciplinary rehabilitation has not yet been implemented as usual care in all centers, which offers the opportunity to perform a controlled clinical study. If demonstrated to be (cost-)effective, national provision of the program can probably be advised.

TRIAL REGISTRATION

The study has been retrospectively registered in the Netherlands Trial Registry on April 24th 2018 ( NTR7140 ).

Factors influencing return to work of cancer survivors: a population-based study in Italy

PURPOSE

Little is known about return to work (RTW) of cancer survivors (CSs) in Central and Southern Europe. This study investigates the RTW rate of Italian CSs, describes their sick leave (SL) pattern, and explores factors affecting their RTW process.

METHODS

A population-based cross-sectional survey involving CSs registered at the Cancer Registry of Reggio Emilia Province (Italy) was launched in July 2016. Eligibility was restricted to individuals with first diagnosis of cancer in 2012 (stages I-III), aged 20-59, and employed at the time of diagnosis.

RESULTS

Of the 266 individuals interviewed, 140 (52.6%) were reintegrated without difficulty, 113 (42.5%) returned to work with some difficulty, and 13 did not RTW (4.9%). The majority of CSs (56%) took SL for some periods during treatment. Age > 50 years and higher income seemed to facilitate RTW (RR = 0.65, 95% CI 0.49-0.88 and RR = 0.72, 95% CI 0.54-0.97, respectively), while being divorced acted as a barrier compared to being married (RR = 1.45, 95% CI 1.04-2.01). Individuals uncertain about the type of company they were working for reported greater difficulty in RTW (RR = 1.68, 95% CI 1.03-2.72). Individuals who had undergone chemotherapy and those perceiving physical limitations had a higher risk of difficulty in the RTW process (RR = 1.79, 95% CI 1.42-2.24 and RR = 1.59, 95% CI 1.25-2.02, respectively).

CONCLUSIONS

Most CSs did RTW, with 2/3 combining work and treatment. However, almost half reported difficulty in RTW process. Factors affecting this process should be addressed throughout context-specific social and healthcare pathways aimed at preventing difficulties and potential job loss in this population.

Financial Toxicity After Cancer in a Setting With Universal Health Coverage: A Call for Urgent Action

BACKGROUND

Financial toxicity negatively affects the well-being of cancer survivors. We examined the incidence, cost drivers, and factors associated with financial toxicity after cancer in an upper-middle-income country with universal health coverage.

METHODS

Through the Association of Southeast Asian Nations Costs in Oncology study, 1,294 newly diagnosed patients with cancer (Ministry of Health [MOH] hospitals [n = 577], a public university hospital [n = 642], private hospitals [n = 75]) were observed in Malaysia. Cost diaries and questionnaires were used to measure incidence of financial toxicity, encompassing financial catastrophe (FC; out-of-pocket costs ≥ 30% of annual household income), medical impoverishment (decrease in household income from above the national poverty line to below that line after subtraction of cancer-related costs), and economic hardship (inability to make necessary household payments). Predictors of financial toxicity were determined using multivariable analyses.

RESULTS

One fifth of patients had private health insurance. Incidence of FC at 1 year was 51% (MOH hospitals, 33%; public university hospital, 65%; private hospitals, 72%). Thirty-three percent of households were impoverished at 1 year. Economic hardship was reported by 47% of families. Risk of FC attributed to conventional medical care alone was 18% (MOH hospitals, 5%; public university hospital, 24%; private hospitals, 67%). Inclusion of expenditures on nonmedical goods and services inflated the risk of financial toxicity in public hospitals. Low-income status, type of hospital, and lack of health insurance were strong predictors of FC.

CONCLUSION

Patients with cancer may not be fully protected against financial hardships, even in settings with universal health coverage. Nonmedical costs also contribute as important drivers of financial toxicity in these settings.

Labor market situation after an episode of sickness absence due to malignant neoplasia. Evidence from a Spanish cohort

BACKGROUND

Due to the progress in screening and cancer treatments, survivor's prognosis has improved enabling a more likely return to work. However, return to work after a cancer diagnosis may be complex because of an unbalanced health status and work demands relationship that may push them out of the labor market. The aim of this study is to assess the risk of dropping out of the labor market due to unemployment, partial retirement, and permanent disability during the year following an episode due to a malignant neoplasm compared to other non-malignant pathologies.

METHODS

Cohort study of 9699 workers affiliated with the Social Security System in Catalonia, who had a sickness absence episode between 2012 and 2013 due to malignant neoplasm, mental, musculoskeletal disorders, cardiovascular diseases and injuries. Competing risk regression models were applied to assess the risk of dropping out of the labor market, by calculating subhazard ratios (SHR) in both sexes. Models were adjusted for age, occupational category, type of contract, economic activity, annual median salary and duration of the SA episode as potential confounders.

RESULTS

Sickness absence due to malignant neoplasia represented 1.7% out of the 9699 episodes included between 2012 and 2013. Although, 80% of individuals continued working in the year following an episode due to malignant neoplasm, women showed a trend towards exiting the labor market because of partial retirement [SHR = 8.4(1.5-45.5)] and permanent disability [SHR = 5.8(1.5-22.9)] compared to non-malignant pathologies. There were no significant differences for unemployment either in women [SHR = 0.4(0.2-0.9)] and in men [SHR = 0.2(0.1-0.6)].

CONCLUSIONS

Although return to work is a common pathway among cancer survivors, partial retirement and permanent disability seem to be potential pathways to exit the labor market among women.

Recent Status and Methodological Quality of Return-to-Work Rates of Cancer Patients Reported in Japan: A Systematic Review

Cancer patients’ return-to-work rates in Japan and their methodological quality have been little reported. We conducted a systematic review to explore the recent return-to-work rates and to assess the methodological quality of the existing literature. We selected 13 papers (2 in English and 11 in Japanese) published between 2005 and 2017. The return-to-work rates ranged from 53.8% to 95.2%. Of the selected papers, 12 papers employed a cross-sectional design, possessing high risk of selection bias due to participant selection. A total of 8 papers did not fully report the subjects’ sex, age, employment status at cancer diagnosis, cancer site, stage, and treatment, suggesting high risk of selection bias due to confounding variables. High or unclear risk of attrition bias due to incomplete outcome data was detected in 12 papers in which data on return to work were not collected from all participants. High risk of reporting bias due to selective outcome reporting was pointed out in 6 studies in which the subjects’ employment status at return to work or the duration between cancer diagnosis and assessment of return to work was unclear. Future studies must reduce the risk of selection, attrition, and reporting biases for specifying accurate return-to-work rates.

High-intensity exercise during chemotherapy induces beneficial effects 12 months into breast cancer survivorship

Purpose

Whether the benefits of exercise during chemotherapy continue into survivorship is not well-known. Here, the aim was to examine the effects of two exercise interventions on self-reported health-related and objectively measured physiological outcomes 12 months following commencement of chemotherapy.

Methods

Two hundred and forty women with breast cancer stage I–IIIa were randomized to 16 weeks of high-intensity aerobic interval training combined with either resistance training (RT-HIIT), or moderate-intensity aerobic training (AT-HIIT), or to usual care (UC). Primary outcome: cancer-related fatigue (CRF); secondary outcomes: quality of life (QoL), symptom burden, muscle strength, cardiorespiratory-fitness, body mass, and return to work.

Results

Compared to UC, both RT-HIIT and AT-HIIT significantly counteracted increases in total CRF (ES = − 0.34; ES = − 0.10), daily life CRF (ES=-0.76; ES=-0.50, and affective CRF (ES=-0.60; ES=-0.39). Both RT-HIIT and AT-HIIT reported significantly lower total symptoms (ES = − 0.46, ES = − 0.46), and displayed gains in lower limb (ES = 0.73; ES = 1.03) and handgrip muscle strength (surgery side ES = 0.70, ES = 0.71; non-surgery side ES = 0.57, ES = 0.59). AT-HIIT displayed significant reductions in body mass (ES = − 0.24), improved QoL: role (ES = 0.33) and emotional functioning (ES = 0.40), and a larger proportion had returned to work (p = 0.02) vs UC.

Conclusion

These findings emphasize the beneficial effects of supervised high-intensity exercise during chemotherapy to improve the health and to reduce societal costs associated with prolonged sick leave for patients with breast cancer several months following chemotherapy.

Implications for Cancer Survivors

These findings provide important information with substantial positive consequences for breast cancer survivorship. High-intensity exercise programs during chemotherapy and support to maintain physical activity can be a powerful strategy to manage or prevent many of the short- and long-term adverse effects of treatment for the increasing cohort of cancer survivors.

Returning to work after breast cancer: A systematic review of reviews

BACKGROUND

Due to improvements in breast cancer diagnosis and treatment, the healthcare system faces a growing number of cancer survivors. Breast cancer survivors experience many difficulties when returning to work, including discrimination at work and lack of support by employers and colleagues.

OBJECTIVE

To point out the knowledge in literature up to date about return to work (RTW) after breast cancer, the factors influencing it and the interventions to facilitate it.

METHODS

A literature search was conducted in January 2017 using the databases Medline (PubMed) and Scopus. Studies were included if they analyzed the problem of RTW in women treated for breast cancer.

RESULTS

Twenty-six articles met the inclusion criteria. The studies were divided into four themes: factors facilitating or impeding RTW; interventions to enhance RTW; lived experiences of RTW; economic aspects related to cancer survivors and RTW.

CONCLUSIONS

The heterogeneity of the interventions suggests the need for a better definition of the concept of RTW. To compare interventions, studies should use a rigorous approach and better outcome measures should be identified to evaluate RTW.

Insights in work rehabilitation after minimally invasive esophagectomy

BACKGROUND

Little is known about work rehabilitation after totally minimally invasive esophagectomy. The goal of this study was to further objectify the postoperative work rehabilitation. Not only duration of sick leave, but also the extent of return to work will be assessed.

METHODS

This retrospective multicenter study was conveyed between January 2009 and April 2014. Eighty-six preoperatively employed patients were included. Data regarding patients' preoperative occupation, actual job status, and postoperative duration until return to work were retrieved. Potential prognostic factors for work rehabilitation were analyzed. Complaints that could impede rehabilitation were questioned (based on EORTC QLQ-C30 and QLQ-OES18). Work activity, defined as either partially or fully resumed professional activity as compared to the preoperative status, was measured at 3, 6, 12, and 18 months postoperatively.

RESULTS

At 6-month follow-up, 40.2% of patients reached partial and 14.6% had full professional recovery and after 12 months 28.2% and 40.8%, respectively. After 18 months, a stagnation was seen (19.0% partial; 43.1% full recovery). Median follow-up was 18 months (IQR 12-18). Self-employment was a significant predictor for full professional recovery (p = 0.005, OR 2.45 95% CI 1.32-4.56). The median time to full professional recovery was shorter for this group. The most common complaint among all patients was fatigue. This complaint did not significantly differ between working (fully and partially) and non-working groups (p = 0.727).

CONCLUSIONS

Only approximately 40% of patients reached full professional recovery 1 year after totally minimally invasive esophagectomy. Barely any progression toward return to work was seen after 1 year postoperatively. Roughly 30% of patients never returned to work. Self-employed workers had a higher percentage of restoration to full professional activity, as well as shorter duration to return. These findings highlight the importance of adequate counseling of patients in order to prepare them for the impact of this procedure on professional activities.

Respectful encounters from healthcare professionals and return to work among 9032 long-term sick-listed due to cancer or due to other diagnoses: results from a Swedish population-based survey

Purpose

To examine whether experiences of positive respectful encounters and negative disrespectful encounters differ between sickness absentees with a cancer diagnosis and sickness absentees with other diagnoses, especially in relation to their ability to return to work (RTW).

Methods

A total of 9032 long-term sickness absentees in Sweden responded to a questionnaire (response rate 52%) about experiences of positive and negative encounters with healthcare professionals. The association between different types of such encounters and participants feeling respected or disrespected were calculated with population attributable risk with 95% confidence intervals (CI). The perceived impact on ability to RTW was also examined.

Results

Significantly, larger proportions among those who experienced a positive encounter and also felt respected stated that those encounters facilitated their ability to RTW, compared to those who experienced a positive encounter without feeling respected: among cancer absentees the difference in proportions were 21% (CI, 7–34) versus 50% (CI, 45–55); among absentees with other diagnoses 42% (CI, 37–47) versus 63% (CI, 61–64). Similar comparisons among sick-listed who experienced negative encounters indicated that also feeling disrespected impeded ability to RTW among a significantly larger proportion of those with other diagnoses [51% (CI, 48–54) versus 35% (CI, 31–39) of those not feeling disrespected]. Among cancer absentees, the corresponding proportions were 20% (CI, 9–30) versus 25% (CI, 9–41).

Conclusions

Compared to sickness absentees with other diagnoses, a larger proportion of cancer sickness absentees stated that they were facilitated by respectful encounters and not impeded by disrespectful encounters, regarding self-estimated ability to RTW. More research is needed to examine whether these differences can be associated with use of a patient-centered encountering approach.

Predictors of fatigue and work ability in cancer survivors

Background

Workers diagnosed with cancer are at risk for job loss or work disability.

Aims

To determine predictors of fatigue and work ability at 36 months after diagnosis in a population of cancer survivors.

Methods

Individuals diagnosed with cancer and who applied for work disability benefit at 24 months of sick leave were surveyed at the time of application and again 12 months later. Fatigue was measured using the Functional Assessment of Chronic Illness-Fatigue scale questionnaire and work ability was measured using the work ability index. Linear regression analyses were applied to identify predictors.

Results

There were 336 participants. Participants who were divorced or widowed had more physical limitations, more depressive symptoms and were more fatigued at baseline, and who worked in health care demonstrated higher levels of fatigue. Lower fatigue was predicted by having received chemotherapy. A higher level of work ability was predicted by having received chemotherapy, better global health and better work ability at baseline. Lower work ability was predicted by being principal wage earner, insecurity about being free of disease, having more physical limitations and having greater wage loss.

Conclusions

Socio-demographic, health- and work-related factors were associated with fatigue and work ability in cancer survivors on long-term sick leave. As fatigue and poor work ability are important risk factors for work disability, addressing the identified predictive factors may assist in mitigation of work disability in cancer survivors.

Patient and provider communication about employment following a cancer diagnosis

PURPOSE

Cancer treatment can precipitate functional limitations that restrict survivors' ability to work. Yet, it is unclear whether healthcare providers discuss the potential for employment limitations with their patients. We assessed the frequency of patient-provider communication about employment, from the perspectives of survivors, and examined whether receiving a treatment summary was associated with employment communication.

METHODS

Cancer survivors who were working at diagnosis were identified from the Health Information National Trends Survey-4, conducted in 2014 (n = 290). Separate multivariable regression analyses examined the associations between survivor characteristics and employment communication and receipt of a treatment summary and employment communication.

RESULTS

Among cancer survivors who were working at diagnosis, 62.69% (95% CI 54.42-70.95) reported discussing employment with any healthcare provider at any time since diagnosis. Younger cancer survivors and those more recently treated were more likely to ever have employment discussions. Survivors who received a treatment summary were also more likely to ever discuss employment with any healthcare provider than survivors who did not receive a treatment summary (OR = 3.47, 95% CI 1.02-11.84).

CONCLUSIONS

Approximately two thirds of cancer survivors who were working at diagnosis ever discussed employment with a healthcare provider. Thus, for a sizable portion of cancer survivors, the potential impact of cancer on employment is never discussed with any healthcare provider.

IMPLICATIONS FOR CANCER SURVIVORS

Efforts are needed to proactively screen patients for cancer-related work limitations, empower patients to discuss employment concerns with their healthcare providers, and develop interventions that support survivors' goals for working throughout treatment and recovery.

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.

Differences of Four Work-Related Behavior and Experience Patterns in Work Ability and Other Work-Related Perceptions in a Finance Company

The present study applies a salutogenetic approach to psycho-social stress and wellbeing at work and for the first time analyzes the relation of an extended model of four work-related behavior and experience patterns to work related perceptions, like work ability, job satisfaction and turnover intention, or engagement. Employees of an international financial services company (N = 182) completed the questionnaire Work-related behavior and experience pattern (Arbeitsbezogenes Verhaltens- und Erlebensmuster; AVEM). The AVEM has oftentimes been used for research in helping professions, but research in non-helping professions is scarce. In addition to the AVEM, measures of job satisfaction, work ability, work engagement, presenteeism, and turnover intention were included in this study. Almost half (46.2%) of the sample showed a rather unambitious attitude towards work, followed by a burnout-related risk pattern (22.0%), a healthy pattern (19.8%), and a pattern at risk for overexertion (12.1%). Significantly more favorable scores were found for all work-related perceptions in participants with the healthy pattern compared to those with the burnout-related risk pattern, except for turnover intention where no significant differences were found. For work ability and vigor, those with a healthy pattern also had significantly higher scores than those with an unambitious pattern and a pattern at risk for overexertion. Being at risk for burnout not only affects job-related wellbeing and coping resources, but also work ability and work engagement. A need for personnel and organizational development and health promotion is indicated by a high number of individuals with reduced working motivation and risk patterns for overexertion or burnout.

Common Psychosocial Factors Predicting Return to Work After Common Mental Disorders, Cardiovascular Diseases, and Cancers: A Review of Reviews Supporting a Cross-Disease Approach

Purpose This systematic review aimed at identifying the common psychosocial factors that facilitate or hinder the return to work (RTW) after a sick leave due to common mental disorders (CMDs), cardiovascular diseases (CVDs), or cancers (CAs). Methods We conducted a review of reviews searching 13 databases from 1994 to 2016 for peer-reviewed, quantitative, cohort studies investigating factors influencing RTW after a CMD, CVD, or CA. Then, for each disease we identified additional cohort studies published after the date of the latest review included. Data were extracted following a three steps best-evidence synthesis method: the extraction of results about each predictor from studies within each single review and in the additional papers; the synthesis of results across the reviews and additional papers investigating the same disease; and the synthesis of results across the diseases. Results The search strategy identified 1029 unique records from which 27 reviews and 75 additional studies underwent comprehensive review. 14 reviews and 32 additional cohort studies met eligibility criteria. Specific predictors of RTW with different levels of evidence are provided for each disease. We found four common facilitators of RTW (job control, work ability, perceived good health and high socioeconomic status), and six barriers of RTW (job strain, anxiety, depression, comorbidity, older age and low education). Conclusion This is the first review to systematically analyze commonalities in RTW after CMDs, CVDs, or CAs. The common factors identified indicate that the RTW process presents many similarities across various diseases, thus supporting the validity of a cross-disease approach.

Breast cancer survivors: return to work and wage loss in selected hospitals in Malaysia

PURPOSE

This study aimed, firstly, to assess the determinants of return to work (RTW), secondly, to explore the amount of annual wage loss, and finally, to discover the determinants of wage loss among breast cancer (BC) survivors.

METHODS

A cross-sectional study design was used in this research. The data was collected via interview using a validated questionnaire. Logistic regression models were developed to discover the significant determinants of RTW and of wage loss among BC survivors.

RESULTS

A total of 256 BC survivors were included in this study. The analysis showed that there was a 21% loss of or reduction in mean income within 1 year after diagnosis. The significant predictors of RTW are being a government employee, having reduced wages or wage loss, and if the case had been diagnosed 1 year or more ago. Being a private sector employee and having a late stage of cancer was a barrier to RTW. The main risk factors for reduced wages or wage loss were belonging to the age group of 40-59 years, being of Chinese or Indian ethnicity, having low educational status, and not returning to work. However, belonging to the higher monthly income group (earning > RM 2000) is a protective factor against the risk of reduced wages or wage loss.

CONCLUSIONS

Non-RTW and wage loss after diagnosis of BC may result in the survivors experiencing a significant financial burden. Assessment of these patients is becoming more crucial because more women participate in the workforce in Malaysia nowadays and because BC is managed using multiple treatment modalities with their consequences could lead to long absences from work.

A five-phase process model describing the return to sustainable work of persons who survived cancer: A qualitative study

PURPOSE

We investigated persons who survived cancer (PSC) and their experiences in returning to sustainable work.

METHODS

Videotaped, qualitative, in-depth interviews with previous cancer patients were analyzed directly using "Interpretative Phenomenological Analysis" (IPA). Four men and four women aged 42-59 years participated. Mean time since last treatment was nine years. All participants had worked for more than 3 years when interviewed. An advisory team of seven members with diverse cancer experiences contributed as co-researchers.

RESULTS

The entire trajectory from cancer diagnosis until achievement of sustainable work was analog to a journey, and a process model comprising five phases was developed, including personal situations, treatments, and work issues. The theme "return-to-work" (RTW) turned out to be difficult to separate from the entire journey that started at the time of diagnosis. PSCs were mainly concerned about fighting for life in phases 1 and 2. In phase 3 and 4, some participants had to adjust and make changes at work more than once over a period of 1-10 years before reaching sustainable work in phase 5. Overall, the ability to adapt to new circumstances, take advantage of emerging opportunities, and finding meaningful occupational activities were crucial.

CONCLUSIONS

Our process model may be useful as a tool when discussing the future working life of PSCs. Every individual's journey towards sustainable work was unique, and contained distinct and long-lasting efforts and difficulties. The first attempt to RTW after cancer may not be persistent.