101
|
Dahl AA, Bentzen AG, Fosså SD, Hess SL, Steen R, Kiserud CE. Long-term cervical cancer survivors on disability pension: a subgroup in need of attention from health care providers. J Cancer Surviv 2020; 14:578-585. [PMID: 32279150 PMCID: PMC7360663 DOI: 10.1007/s11764-020-00877-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 03/11/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Survivors of cervical cancer have an increased risk for permanently reduced work ability qualifying for disability pension (DP). Few studies describe the social and health situation of long-term survivors of cervical cancer (LSCCs) on DP as a subgroup among LSCCs. The purpose was to investigate the socio-demographic and health status of LSCCs holding DP in a population-based cohort using LSCCs holding paid work as reference. METHODS Altogether, 354 LSCCs under 67 years (age of retirement pension in Norway) at survey participated in this study. They responded to a mailed questionnaire containing social, health, and clinical issues. RESULTS Among LSCCs 24% held DP at a median of 11 years (range 6-15) after diagnosis versus 12% in the general female population. Compared to LSCCs in paid work, those on DP had significantly higher mean age at survey, short education, more comorbid somatic diseases, poorer self-rated health, higher level of neurotoxic side effects, more chronic fatigue, and higher mean levels of anxiety and depression. Increased age, presence of musculo-skeletal diseases, and increased levels of depression and pain remained significantly associated with DP in multivariate analysis. CONCLUSIONS One in four LSCCs held DP which was twice the rate of the general female population. Several somatic and psychological conditions amenable to treatment were significantly associated with holding DP. IMPLICATIONS FOR CANCER SURVIVORS LSCCs holding DP should check their health regularly since conditions that can be treated are common, and health care providers should be aware of this opportunity.
Collapse
Affiliation(s)
- Alv A Dahl
- National Advisory Unit for Late Effects After Cancer Treatment, Oslo University Hospital, The Norwegian Radium Hospital, P.O. Box 4953, Nydalen, 0424, Oslo, Norway. .,Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Anne Gry Bentzen
- Department of Oncology, University Hospital of Northern Norway, Tromsø, Norway
| | - Sophie D Fosså
- National Advisory Unit for Late Effects After Cancer Treatment, Oslo University Hospital, The Norwegian Radium Hospital, P.O. Box 4953, Nydalen, 0424, Oslo, Norway
| | - Siri Lothe Hess
- National Advisory Unit for Late Effects After Cancer Treatment, Oslo University Hospital, The Norwegian Radium Hospital, P.O. Box 4953, Nydalen, 0424, Oslo, Norway
| | - Rita Steen
- Department of Oncology, Oslo University Hospital, Oslo, Norway.,Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| | - Cecilie E Kiserud
- National Advisory Unit for Late Effects After Cancer Treatment, Oslo University Hospital, The Norwegian Radium Hospital, P.O. Box 4953, Nydalen, 0424, Oslo, Norway
| |
Collapse
|
102
|
de Rijk A, Amir Z, Cohen M, Furlan T, Godderis L, Knezevic B, Miglioretti M, Munir F, Popa AE, Sedlakova M, Torp S, Yagil D, Tamminga S, de Boer A. The challenge of return to work in workers with cancer: employer priorities despite variation in social policies related to work and health. J Cancer Surviv 2020; 14:188-199. [PMID: 31758518 PMCID: PMC7182537 DOI: 10.1007/s11764-019-00829-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 10/23/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE This study explored employer's perspectives on (1) their experience of good practice related to workers diagnosed with cancer and their return to work (RTW), and (2) their perceived needs necessary to achieve good practice as reported by employers from nine separate countries. METHODS Twenty-five semi-structured interviews were held in eight European countries and Israel with two to three employers typically including HR managers or line managers from both profit and non-profit organisations of different sizes and sectors. Interviews were recorded and transcribed verbatim. A grounded theory/thematic analysis approach was completed. RESULTS Employers' experience with RTW assistance for workers with cancer appears to be a dynamic process. Results indicate that good practice includes six phases: (1) reacting to disclosure, (2) collecting information, (3) decision-making related to initial actions, (4) remaining in touch, (5) decision-making on RTW, and (6) follow-up. The exact details of the process are shaped by country, employer type, and worker characteristics; however, there was consistency related to the need for (1) structured procedures, (2) collaboration, (3) communication skills training, (4) information on cancer, and (5) financial resources for realizing RTW support measures. CONCLUSIONS Notwithstanding variations at country, employer, and worker levels, the employers from all nine countries reported that good practice regarding RTW assistance in workers with a history of cancer consists of the six phases above. Employers indicate that they would benefit from shared collaboration and resources that support good practice for this human resource matter. IMPLICATIONS FOR CANCER SURVIVORS Further research and development based on the six phases of employer support as a framework for a tool or strategy to support workers with a history of cancer across countries and organisations is warranted.
Collapse
Affiliation(s)
- Angelique de Rijk
- Department of Social Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.
| | - Ziv Amir
- School of Health Sciences, University of Salford, Greater Manchester, UK
| | - Miri Cohen
- School of Social Work, University of Haifa, Haifa, Israel
| | | | - Lode Godderis
- Department of Public Health and Primary Care, Centre for Environment and Health, KU Leuven, Leuven, Belgium
- IDEWE, External Service for Prevention and Protection at Work, Heverlee, Belgium
| | - Bojana Knezevic
- Department of Quality Improvement in Health Care, University Hospital Centre Zagreb, Zagreb, Croatia
| | | | - Fehmidah Munir
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, UK
| | - Adela Elena Popa
- Faculty of Social Sciences and Humanities, Lucian Blaga University of Sibiu, Sibiu, Romania
| | - Maria Sedlakova
- Central European Labour Studies Institute, Bratislava, Slovakia
| | - Steffen Torp
- Department of Health, Social and Welfare Studies, University College of South-Eastern Norway, Notodden, Norway
| | - Dana Yagil
- Department of Human Services, University of Haifa, Haifa, Israel
| | - Sietske Tamminga
- Coronel Institute of Occupational Health, Amsterdam Public Health research institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Angela de Boer
- Coronel Institute of Occupational Health, Amsterdam Public Health research institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| |
Collapse
|
103
|
Mamguem Kamga A, Dumas A, Joly F, Simon J, Billa O, Poillot ML, Jolimoy G, Roignot P, Coutant C, Arveux P, Dabakuyo-Yonli TS. Socio-economic and occupational outcomes of long-term survivors of gynaecological cancer: A French population-based study. Eur J Cancer Care (Engl) 2020; 29:e13235. [PMID: 32215988 DOI: 10.1111/ecc.13235] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 02/18/2020] [Accepted: 02/18/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe socio-economic and professional outcomes in long-term survivors of cervical, endometrial or ovarian cancer, including return to work and problems related to obtaining loans and insurance. METHODS Women with cervical, endometrial or ovarian cancers diagnosed from 2006 to 2013 were selected through the French gynaecological cancer registry of Côte d'Or, in a cross-sectional survey. Using a questionnaire established with the help of sociologists and psychologists, social and cancer-related work issues were collected among women aged less than 60 years at the time of cancer diagnosis. The socio-economic status was also assessed, at the time of the survey using the EPICES questionnaire. RESULTS A total of 92 gynaecological cancer survivors (CS) participated in this survey. Gynaecological CS reported a decrease in income since cancer diagnosis, difficulties obtaining loans, and a decrease in ability to work, both in the short term after treatment and at the time of survey, on average 6 years after diagnosis. Fatigue, emotional and cognitive difficulties were the reasons cited to explain the decreased ability to work, both immediately after treatment and in the long term. CONCLUSIONS Gynaecological CS experienced many problems, such as decreased work capacity, decreased income and difficulty obtaining loans.
Collapse
Affiliation(s)
- Ariane Mamguem Kamga
- Breast and Gynaecologic Cancer Registry of Côte d'Or, Georges-François Leclerc Cancer Centre-UNICANCER, Dijon, France
| | - Agnès Dumas
- Centre for Research in Epidemiology and Population Health (CESP), INSERM U1018, Université Paris-Sud, University of Paris-Saclay, Villejuif, France.,Department of Clinical Research, Gustave Roussy, Villejuif, France
| | - Florence Joly
- Medical Oncology Department, François Baclesse Cancer Centre-UNICANCER, University Hospital Côte de Nacre, Caen, France
| | - Julien Simon
- Breast and Gynaecologic Cancer Registry of Côte d'Or, Georges-François Leclerc Cancer Centre-UNICANCER, Dijon, France
| | - Oumar Billa
- Breast and Gynaecologic Cancer Registry of Côte d'Or, Georges-François Leclerc Cancer Centre-UNICANCER, Dijon, France
| | - Marie-Laure Poillot
- Breast and Gynaecologic Cancer Registry of Côte d'Or, Georges-François Leclerc Cancer Centre-UNICANCER, Dijon, France
| | | | | | - Charles Coutant
- Medical Oncology, Georges-François Leclerc Cancer Centre-UNICANCER, Dijon, France.,Burgundy Franche-Comté University, Dijon, France
| | - Patrick Arveux
- Breast and Gynaecologic Cancer Registry of Côte d'Or, Georges-François Leclerc Cancer Centre-UNICANCER, Dijon, France
| | - Tienhan Sandrine Dabakuyo-Yonli
- Breast and Gynaecologic Cancer Registry of Côte d'Or, Georges-François Leclerc Cancer Centre-UNICANCER, Dijon, France.,National Quality of Life and Cancer Platform, Dijon, France
| |
Collapse
|
104
|
Swanberg JE, Vanderpool RC, Tracy JK. Cancer-work management during active treatment: towards a conceptual framework. Cancer Causes Control 2020; 31:463-472. [PMID: 32125547 DOI: 10.1007/s10552-020-01285-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 02/19/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE Forward progress in cancer treatment has resulted in fewer adverse consequences of cancer during and after treatment, offering employed cancer patients the possibility of continuing to work during treatment, returning to work after treatment, or implementing a combination of strategies to manage the cancer-work interface. Yet, much of the research on cancer and employment examines return to work as the primary outcome, neglecting to consider the circumstances of survivors who maintain employment while engaged in active treatment. We introduce the Cancer-Work Management Framework (CWMF), a conceptual framework for understanding the cancer and job demands survivors who continue to work during active treatment experience and how cancer and job resources and strategies could promote cancer-work fit and ultimately optimize employment and health outcomes. METHODS We provide an overview of the research describing the cancer-work management experiences of survivors who maintain employment during active treatment and summarize the theories that informed the CWMF including ecological systems, boundary-spanning, and job demands and resources theories. RESULTS The paper presents a description of the components of the CWMF which include cancer demands, cancer care resources and strategies, work demands, and workplace resources. We also describe a process-cancer-work fit-that reflects the interplay between demands and resources influence employment and health outcomes. CONCLUSIONS Future research directions for developing knowledge about the cancer-work management process are proposed with suggestions for study of how cancer and job demands influence cancer treatment and employment decisions.
Collapse
Affiliation(s)
- Jennifer E Swanberg
- Department of Health Policy and Management, School of Professional Studies, Providence College, 1 Cunningham Square, Providence, RI, 02918, USA.
- University of Maryland School of Social Work, Baltimore, MD, USA.
| | - Robin C Vanderpool
- Department of Health, Behavior & Society, College of Public Health, University of Kentucky, Lexington, KY, USA
| | - J Kathleen Tracy
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| |
Collapse
|
105
|
Tangka FKL, Subramanian S, Jones M, Edwards P, Flanigan T, Kaganova Y, Smith KW, Thomas CC, Hawkins NA, Rodriguez J, Fairley T, Guy GP. Insurance Coverage, Employment Status, and Financial Well-Being of Young Women Diagnosed with Breast Cancer. Cancer Epidemiol Biomarkers Prev 2020; 29:616-624. [PMID: 32132129 PMCID: PMC7909848 DOI: 10.1158/1055-9965.epi-19-0352] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 10/04/2019] [Accepted: 01/03/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The economic cost of breast cancer is a major personal and public health problem in the United States. This study aims to evaluate the insurance, employment, and financial experiences of young female breast cancer survivors and to assess factors associated with financial decline. METHODS We recruited 830 women under 40 years of age diagnosed with breast cancer between January 2013 and December 2014. The study population was identified through California, Florida, Georgia, and North Carolina population-based cancer registries. The cross-sectional survey was fielded in 2017 and included questions on demographics, insurance, employment, out-of-pocket costs, and financial well-being. We present descriptive statistics and multivariate analysis to assess factors associated with financial decline. RESULTS Although 92.5% of the respondents were continuously insured over the past 12 months, 9.5% paid a "higher price than expected" for coverage. Common concerns among the 73.4% of respondents who were employed at diagnosis included increased paid (55.1%) or unpaid (47.3%) time off, suffering job performance (23.2%), and staying at (30.2%) or avoiding changing (23.5%) jobs for health insurance purposes. Overall, 47.0% experienced financial decline due to treatment-related costs. Patients with some college education, multiple comorbidities, late stage diagnoses, and self-funded insurance were most vulnerable. CONCLUSIONS The breast cancer diagnosis created financial hardship for half the respondents and led to myriad challenges in maintaining employment. Employment decisions were heavily influenced by the need to maintain health insurance coverage. IMPACT This study finds that a breast cancer diagnosis in young women can result in employment disruption and financial decline.
Collapse
Affiliation(s)
- Florence K L Tangka
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | | | | | | | | | | | | | - Cheryll C Thomas
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nikki A Hawkins
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Juan Rodriguez
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Temeika Fairley
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Gery P Guy
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
106
|
Andrews CC, Siegel G, Smith S. Rehabilitation to Improve the Function and Quality of Life of Soft Tissue and Bony Sarcoma Patients. PATIENT-RELATED OUTCOME MEASURES 2020; 10:417-425. [PMID: 32099494 PMCID: PMC6997412 DOI: 10.2147/prom.s130183] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 12/10/2019] [Indexed: 01/02/2023]
Abstract
Sarcomas are bone and soft tissue tumors that can have significant effects on patient function and quality of life. Like most malignancies, treatment includes a combination of chemotherapy, radiation, and surgical resection, all of which also carry risks and long-term effects. A multidisciplinary rehabilitation plan can help minimize symptoms and sequelae which negatively affect the patient function and quality of life, including pain, chemotherapy-induced peripheral neuropathy, radiation fibrosis, activity restrictions following surgical excision, amputation, bowel and bladder dysfunction, and lymphedema. Patients should be evaluated by a rehabilitation specialist at any point during their diagnosis, treatment, and survivorship phase to determine appropriate interventions to minimize the impact of sarcomas and their treatment on patient function and quality of life.
Collapse
Affiliation(s)
- Cody C Andrews
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Geoffrey Siegel
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Sean Smith
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
107
|
Truant TLO, Varcoe C, Gotay CC, Thorne S. Les soins aux survivants du cancer : vers une grande qualité, en toute équité. Can Oncol Nurs J 2020; 29:163-169. [PMID: 31966016 DOI: 10.5737/23688076293163169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Tracy L O Truant
- Directrice ancienne, Recherche, Éducation et Innovation, BC Cancer, Vancouver BC,
| | - Colleen Varcoe
- Professeure, École des sciences infirmières, University of British Columbia,
| | - Carolyn C Gotay
- Professeure émérite, School of Population and Public Health, University of British Columbia,
| | - Sally Thorne
- Professeure, École des sciences infirmières, University of British Columbia,
| |
Collapse
|
108
|
A longitudinal analysis of phenotypic and symptom characteristics associated with inter-individual variability in employment interference in patients with breast cancer. Support Care Cancer 2020; 28:4677-4686. [PMID: 31955276 DOI: 10.1007/s00520-020-05312-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 01/14/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE A breast cancer diagnosis has a substantial economic impact. Study aims were to evaluate for inter-individual differences in cancer's level of interference with employment and identify phenotypic and symptom characteristics associated with higher levels of interference. METHODS Patients (n = 387) were enrolled prior to breast cancer surgery and followed for 12 months. Interference with employment was measured using a 0 (no problem) to 10 (severe problem) numeric rating scale. Hierarchical linear modeling (HLM) was used to evaluate for inter-individual differences in trajectories of employment interference and characteristics associated with employment interference at enrollment and over 12 months. RESULTS Patients' mean age was 55.0 (±11.7) years and the majority underwent breast conservation surgery (80.6%). Mean employment interference score was 3.2 (±3.7). Unconditional model for employment interference demonstrated a decreasing linear trend (-.076/month). Younger age, lower income, higher pain intensity, and having an axillary lymph node dissection were associated with higher pre-surgical interference scores. Having a sentinel lymph node biopsy was associated with ongoing employment interference scores. Higher sleep disturbance scores were associated with both initial and ongoing employment interference scores. Receipt of chemotherapy, use of complementary or alternative therapies, and re-excision or mastectomy following surgery were significant time varying covariates. CONCLUSION This study is the first to use HLM to describe inter-individual differences in the trajectories of cancer's interference with employment and associated factors prior to and for 12 months following breast cancer surgery. Patients with the identified risk factors warrant ongoing assessments of employment interference and appropriate referrals.
Collapse
|
109
|
Meernik C, Kirchhoff AC, Anderson C, Edwards TP, Deal AM, Baggett CD, Kushi LH, Chao CR, Nichols HB. Material and psychological financial hardship related to employment disruption among female adolescent and young adult cancer survivors. Cancer 2020; 127:137-148. [PMID: 33043464 PMCID: PMC7736150 DOI: 10.1002/cncr.33190] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/29/2020] [Accepted: 07/30/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND The importance of addressing adverse financial effects of cancer among adolescents and young adults (AYAs) is paramount as survival improves. In the current study, the authors examined whether cancer-related employment disruption was associated with financial hardship among female AYA cancer survivors in North Carolina and California. METHODS AYA cancer survivors identified through the North Carolina Central Cancer Registry and the Kaiser Permanente Northern/Southern California tumor registries responded to an online survey. Disrupted employment was defined as reducing hours, taking temporary leave, or stopping work completely because of cancer. Financial hardship was defined as material conditions or psychological distress related to cancer. Descriptive statistics and chi-square tests were used to characterize the invited sample and survey respondents. Marginal structural binomial regression models were used to estimate prevalence differences (PDs) and 95% confidence intervals (95% CIs). RESULTS Among 1328 women employed at the time of their diagnosis, women were a median age of 34 years at the time of diagnosis and 7 years from diagnosis at the time of the survey and approximately 32% experienced employment disruption. A substantial percentage reported financial hardship related to material conditions (27%) or psychological distress (50%). In adjusted analyses, women with disrupted employment had a 17% higher burden of material conditions (95% CI, 10%-23%) and an 8% higher burden of psychological distress (95% CI, 1%-16%) compared with those without disruption. CONCLUSIONS Financial hardship related to employment disruption among female AYA cancer survivors can be substantial. Interventions to promote job maintenance and transition back to the workforce after treatment, as well as improved workplace accommodations and benefits, present an opportunity to improve cancer survivorship.
Collapse
Affiliation(s)
- Clare Meernik
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health
| | - Anne C Kirchhoff
- University of Utah Health, Huntsman Cancer Institute
- Huntsman Cancer Institute, Department of Pediatrics, University of Utah
| | | | - Teresa P Edwards
- University of North Carolina at Chapel Hill, H.W. Odum Institute for Research in Social Science
| | - Allison M Deal
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center
| | | | | | | | - Hazel B Nichols
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health
| |
Collapse
|
110
|
Hiltrop K, Heidkamp P, Kowalski C, Ernstmann N. 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. BMJ Open 2019; 9:e033533. [PMID: 31874892 PMCID: PMC7008453 DOI: 10.1136/bmjopen-2019-033533] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Kati Hiltrop
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
- Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Bonn, Germany
| | - Paula Heidkamp
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
- Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Bonn, Germany
| | | | - Nicole Ernstmann
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
- Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Bonn, Germany
| |
Collapse
|
111
|
Sheppard DM, Frost D, Jefford M, O'Connor M, Halkett G. 'Beyond Cancer': a study protocol of a multimodal occupational rehabilitation programme to support breast cancer survivors to return work. BMJ Open 2019; 9:e032505. [PMID: 31843840 PMCID: PMC6924857 DOI: 10.1136/bmjopen-2019-032505] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION With more women working and surviving breast cancer, issues concerning sustainable employment must be addressed. Support to transition back to work is a gap in survivorship care. This paper describes the feasibility trial protocol for 'Beyond Cancer', a multimodal occupational rehabilitation programme to support breast cancer survivors' return to work. Breast cancer survivors are hypothesised to show improved work status, work capacity and perceived support at work at 6 months postintervention relative to baseline and a historical usual care group. METHODS AND ANALYSIS The prospective feasibility design allows determination of change in primary (work status) as well as secondary outcome measures work capacity and perceived support at work. PARTICIPANTS breast cancer survivors of working age, unable to work in their prediagnosis capacity for >3 months, their employers and a historical usual care group. Key intervention elements: an evidence-based biopsychosocial assessment and health coaching programme, employer education and support, and return to work (RTW) planning and monitoring. Health coaching empowers survivors to return to social function, including work. Employer education and support facilitates communication and improves workplace support. For employers, we predict change in confidence in effectively supporting employees' RTW. Multilevel regression modelling will provide indications of efficacy for primary and secondary outcomes, and thematic analysis will examine perceived efficacy and acceptability. ETHICS AND DISSEMINATION Ethics approval has been granted by Monash and Curtin University Human Research Ethics Committees (HREC: 13300, HRE2019-0280, respectively). The evaluation of this innovative programme will provide the foundation for an Randomised Controlled Trial (RCT) and national roll-out, thus improving the quality of life of those who have been directly affected by breast cancer across Australia. Results will be published in peer-reviewed journals, presented at relevant conferences and disseminated to survivorship-focused organisations. TRIAL REGISTRATION NUMBER Registered trial with the Australian New Zealand Clinical Trials Registry (ANZCTR) (ACTRN12618001985279); Pre-results.
Collapse
Affiliation(s)
| | - Dorothy Frost
- Research and Innovation, MedHealth Group, Melbourne, Victoria, Australia
| | - Michael Jefford
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Melbourne, Victoria, Australia
- Australian Cancer Survivorship Centre, a Richard Pratt legacy, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Moira O'Connor
- School of Psychology, Curtin University Bentley Campus, Perth, Western Australia, Australia
| | - Georgia Halkett
- School of Nursing, Midwifery and Paramedicine, Curtin University Bentley Campus, Perth, Western Australia, Australia
| |
Collapse
|
112
|
Dumas A, Vaz Luis I, Bovagnet T, El Mouhebb M, Di Meglio A, Pinto S, Charles C, Dauchy S, Delaloge S, Arveux P, Coutant C, Cottu P, Lesur A, Lerebours F, Tredan O, Vanlemmens L, Levy C, Lemonnier J, Mesleard C, Andre F, Menvielle G. Impact of Breast Cancer Treatment on Employment: Results of a Multicenter Prospective Cohort Study (CANTO). J Clin Oncol 2019; 38:734-743. [PMID: 31834818 PMCID: PMC7048162 DOI: 10.1200/jco.19.01726] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Agnes Dumas
- Université de Paris, ECEVE UMR 1123, INSERM (National Institute for Health and Medical Research), Paris, France.,Clinical Research Department, Gustave Roussy, Villejuif, France
| | - Ines Vaz Luis
- Breast Cancer Unit, Department of Medical Oncology, Gustave Roussy, Villejuif, France.,INSERM Unit U 981, Villejuif, France
| | - Thomas Bovagnet
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Mayssam El Mouhebb
- Clinical Research Department, Gustave Roussy, Villejuif, France.,INSERM Unit U 981, Villejuif, France
| | | | - Sandrine Pinto
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Cecile Charles
- Department of Supportive Care, Gustave Roussy, Université Paris-Saclay, Villejuif, France.,Laboratoire de Psychopathologie et Processus de Santé (EA 4057), Université de Paris, Paris, France
| | - Sarah Dauchy
- Department of Supportive Care, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Suzette Delaloge
- Breast Cancer Unit, Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - Patrick Arveux
- Clinical Research Department, Centre Georges-François Leclerc, Dijon, France.,INSERM U1018, Center for Research in Epidemiology and Population Health, Villejuif, France
| | - Charles Coutant
- Clinical Research Department, Centre Georges-François Leclerc, Dijon, France
| | - Paul Cottu
- Department of Medical Oncology, Institut Curie, Paris, France
| | - Anne Lesur
- Institut de Cancérologie de Lorraine Alexis Vautrin, Vandoeuvre les Nancy, France
| | | | | | | | | | | | | | - Fabrice Andre
- Breast Cancer Unit, Department of Medical Oncology, Gustave Roussy, Villejuif, France.,INSERM Unit U 981, Villejuif, France
| | - Gwenn Menvielle
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| |
Collapse
|
113
|
Chen YY, Wang CC, Wu WT, Lai CH, Ho CL, Hsu YY, Chen WL. Trajectories of returning to work and its impact on survival in survivors with oral cancer: A 5-year follow-up study. Cancer 2019; 126:1225-1234. [PMID: 31809559 DOI: 10.1002/cncr.32643] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 10/26/2019] [Accepted: 11/01/2019] [Indexed: 12/12/2022]
Abstract
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.
Collapse
Affiliation(s)
- Yuan-Yuei Chen
- Department of Internal Medicine, Tri-Service General Hospital Songshan Branch and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China.,Division of Environmental Health and Occupational Medicine, Department of Family Medicine and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China.,Department of General Medicine, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Chung-Ching Wang
- Division of Environmental Health and Occupational Medicine, Department of Family Medicine and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China.,Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital Songshan Branch and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Wei-Te Wu
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan, Republic of China
| | - Ching-Huang Lai
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Ching-Liang Ho
- Division of Hematology/Oncology, Department of Medicine, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Ya-Yuan Hsu
- Division of Labor Market, Institute of Labor, Occupational Safety, and Health, Ministry of Labor, Taipei, Taiwan, Republic of China
| | - Wei-Liang Chen
- Division of Environmental Health and Occupational Medicine, Department of Family Medicine and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China.,Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital Songshan Branch and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| |
Collapse
|
114
|
Yabroff KR, Bradley C, Shih YCT. Understanding Financial Hardship Among Cancer Survivors in the United States: Strategies for Prevention and Mitigation. J Clin Oncol 2019; 38:292-301. [PMID: 31804869 DOI: 10.1200/jco.19.01564] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- K Robin Yabroff
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, GA
| | - Cathy Bradley
- University of Colorado Comprehensive Cancer Center and Colorado School of Public Health, Aurora, CO
| | | |
Collapse
|
115
|
Tamminga SJ, Verbeek JHAM, Bos MMEM, Fons G, Kitzen JJEM, Plaisier PW, Frings-Dresen MHW, de Boer AGEM. Two-Year Follow-Up of a Multi-centre Randomized Controlled Trial to Study Effectiveness of a Hospital-Based Work Support Intervention for Cancer Patients. JOURNAL OF OCCUPATIONAL REHABILITATION 2019; 29:701-710. [PMID: 30778742 PMCID: PMC6838305 DOI: 10.1007/s10926-019-09831-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
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.
Collapse
Affiliation(s)
- S J Tamminga
- Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - J H A M Verbeek
- Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Finnish Institute of Occupational Health, Kuopio, Finland
| | - M M E M Bos
- Department of Internal Medicine, Reinier de Graaf Groep, Delft, The Netherlands
| | - G Fons
- Department of Gynaecology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - J J E M Kitzen
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - P W Plaisier
- Department of Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - M H W Frings-Dresen
- Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - A G E M de Boer
- Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
| |
Collapse
|
116
|
Petersen KS, Momsen AH, Stapelfeldt CM, Nielsen CV. Reintegrating Employees Undergoing Cancer Treatment into the Workplace: A Qualitative Study of Employer and Co-worker Perspectives. JOURNAL OF OCCUPATIONAL REHABILITATION 2019; 29:764-772. [PMID: 31056724 DOI: 10.1007/s10926-019-09838-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Purpose The purpose of this study was to explore how employers and co-workers experience the return to work (RTW) process of employees undergoing cancer treatment. Methods Sixteen semi-structured individual interviews and participant observations at seven workplaces took place, involving seven employers and nine co-workers with different professions. A phenomenological-hermeneutic analytic approach was applied involving coding, identification of themes, and interpretation. Results We identified three employer themes: call for knowledge, Making decisions, and Feeling helpless. Also, three co-worker themes were identified: understanding and sympathy, extra work and burden, and Insecurity about future work tasks. Early initiated RTW, e.g. less work hours and work accommodations, did neither constitute challenges for employers nor co-workers in the beginning of the RTW process. However, when the RTW process was prolonged employers encountered difficulties in finding suitable work tasks, whereas co-workers were burdened by extra work. Conclusions Overall, cancer survivors' RTW process was welcomed and encouraged at the workplace level. However, employer and co-worker experiences suggested that RTW initiation parallel with cancer treatment raised challenges at the workplace level, when the RTW process was extended beyond the initial RTW plan; increased workload and difficulties in balancing the needs of the cancer survivor and co-workers. Mechanisms that support cancer survivors' RTW without introducing strain on co-workers should be investigated in future research. Furthermore, support for employers in their RTW management responsibilities needs to be addressed in general and in particular in future RTW interventions.
Collapse
Affiliation(s)
| | - A H Momsen
- Section of Social Medicine and Rehabilitation, Aarhus University and DEFACTUM, Central Region Denmark, P.P. Oerums Gade 9-11, Building 1B, 8000, Aarhus C, Denmark
| | - C M Stapelfeldt
- Section of Social Medicine and Rehabilitation, Aarhus University and DEFACTUM, Central Region Denmark, P.P. Oerums Gade 9-11, Building 1B, 8000, Aarhus C, Denmark
| | - C V Nielsen
- Section of Social Medicine and Rehabilitation, Aarhus University and DEFACTUM, Central Region Denmark, P.P. Oerums Gade 9-11, Building 1B, 8000, Aarhus C, Denmark
| |
Collapse
|
117
|
Self-reported depression in cancer survivors versus the general population: a population-based propensity score-matching analysis. Qual Life Res 2019; 29:483-494. [PMID: 31707694 DOI: 10.1007/s11136-019-02339-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE The purpose of the study was to evaluate health-related quality of life (HRQoL) and depression in community-dwelling cancer survivors using structured questionnaires and propensity score matching (PSM). METHODS Subjects (age ≥ 30 years) who participated in the Sixth Korean National Health and Nutritional Exam Survey completed the EuroQoL5 Dimensions (EQ-5D) and Patient Health Questionnaire (PHQ-9). For the analysis, participants were divided into a cancer survivor group and a group consisting of the general cancer-free population. We compared PHQ-9 and EQ-5D Utility Index scores between the two groups, while controlling for underlying baseline demographic and clinical differences between groups using PSM. Additionally, we divided cancer survivors into two group (< 5 vs. ≥ 5 years since cancer diagnosis), and we evaluated whether the cancer prevalence period was associated with the EQ-5D Utility Index score. RESULT Of all 4124 subjects, 208 cancer survivors were matched with 624 controls using PSM. PHQ-9 and EQ-5D scores in cancer survivors were not different from the general population. In unadjusted subgroup analyses, PHQ-9 scores and EQ-5D proportion of subjects with anxiety/depression (23.3% vs. 7.6%) were higher in cancer survivors with < 5 years since cancer diagnosis compared to those with ≥ 5 years. In multivariate analyses, predictors of depression in cancer survivors included household income and employment status, and predictors of HRQoL-included household income and subjective perceived health status. Period since the cancer diagnosis was not a predictor of either depression or HRQoL. CONCLUSIONS Depression and HRQoL in cancer survivors were similar to that experienced by the general population, and household income, perceived subjective health status and employment status were the main factors affecting depression and HRQoL in cancer survivors.
Collapse
|
118
|
Sheppard DM, Frost D, Jefford M, O'Connor M, Halkett G. Building a novel occupational rehabilitation program to support cancer survivors to return to health, wellness, and work in Australia. J Cancer Surviv 2019; 14:31-35. [PMID: 31713100 DOI: 10.1007/s11764-019-00824-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 10/15/2019] [Indexed: 01/24/2023]
Abstract
PURPOSE With a substantial increase in the population of cancer survivors of working age, issues concerning sustainable employment must be addressed. The health benefits of work are well established; however, the lack of support to transition back to work is a gap in survivorship care. Researchers, occupational rehabilitation and insurance sectors, cancer support services, and consumers have collaborated to develop a tailored, multimodal occupational rehabilitation program to support resumption of meaningful work for cancer survivors. This paper describes intervention development and refinement based on pilot results and expert- and consumer-recommendations. METHODS The pilot was conducted within the life insurance sector, a collaboration fostered by global reinsurance company Swiss Re, with cancer survivors referred to an Australian provider of occupational rehabilitation services. RESULTS Preliminary outcomes from 15 of 72 cancer survivors following adequate engagement (excluding those who withdrew or were still actively engaged) showed 10 (67%) with improved certified capacity to work, translating to 13 (87%) with improved work status. Consultant survey results indicated barriers to participation in and engagement with the program, including referral delays, health concerns, and cancer recurrence. Expert panel recommendations were used to refine the intervention and tailor to breast cancer survivors for the feasibility stage. CONCLUSIONS Strengths include an innovative model of referral and funding, through a life insurance provider, the involvement of a multidisciplinary collaborative team to design, develop and implement the pilot, and considerable consumer involvement. IMPLICATIONS FOR CANCER SURVIVORS The refined intervention will address a critical gap to improve reintegration into work and society, contributing to improved quality of life for cancer survivors in Australia. Models of referral through insurers to rehabilitation services could be adopted in other jurisdictions.
Collapse
Affiliation(s)
- D M Sheppard
- Monash University Accident Research Centre, Monash University, Building 70, 21 Alliance Way, Clayton, VIC, 3800, Australia
| | - D Frost
- MedHealth Group, Level 10/451 Little Bourke St, Melbourne, VIC, 3000, Australia
| | - M Jefford
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, Victoria, 3000, Australia.,Australian Cancer Survivorship Centre, a Richard Pratt legacy, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, Victoria, 3000, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, 3010, Australia
| | - M O'Connor
- School of Psychology, Curtin University, Kent St, Bentley, WA, 6102, Australia
| | - G Halkett
- School of Nursing, Midwifery and Paramedicine, Curtin University, Kent St, Bentley, WA, 6102, Australia
| |
Collapse
|
119
|
Aubel D. Patient-reported outcomes from a workplace intervention program for cancer survivors highlight ongoing needs to support continuation of work. Support Care Cancer 2019; 27:4377-4384. [PMID: 31281940 PMCID: PMC6803589 DOI: 10.1007/s00520-019-04964-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 06/26/2019] [Indexed: 11/11/2022]
Abstract
Purpose The aim of this study was to investigate the perceptions of cancer survivors who continue to work and provide information to evaluate and develop a supportive workplace program (Ensemble) based on the principles of navigation. Methods A mixed-methods design using surveys and open-ended questions was used to study the perceptions of two groups of cancer survivors in the same workplace: those who chose to use a workplace navigational program (Ensemble program users) and those who declined (non-users). Key outcomes were communication and attitudinal self-efficacy, measured by the Communication and Attitudinal Self-Efficacy scale for cancer (CASE-cancer); emotional and informational social support, measured by the Patient-Reported Outcomes Measurement Information System Social Support domain (PROMIS-Social Support); and satisfaction with the navigator relationship, measured using the Patient Satisfaction with Interpersonal Relationship with Navigator (PSN-I). Results The study included 7 program users and 17 non-users. There were no significant differences in attitudinal self-efficacy, emotional support, or informational support between the groups. The relationship with the Nurse Navigator was rated highly by program users. The most frequent themes to the open-ended responses included work demands, privacy, integration of life and work, and program improvement. Conclusions Successful reintegration into/continuation of work remains a key need for cancer survivors. The navigation program design for cancer survivors should be further improved and applied across work settings. Electronic supplementary material The online version of this article (10.1007/s00520-019-04964-1) contains supplementary material, which is available to authorized users.
Collapse
|
120
|
Brusletto B, Ihlebæk CM, Mjøsund NH, Torp S. From shaky grounds to solid foundations: A salutogenic perspective on return to work after cancer. Scand J Occup Ther 2019; 27:524-535. [PMID: 31558078 DOI: 10.1080/11038128.2019.1663922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
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.
Collapse
Affiliation(s)
- Birgit Brusletto
- Department of Health, Social and Welfare Studies, Faculty of Health and Social Sciences, University of South-Eastern Norway (USN), Kongsberg, Norway
| | - Camilla Martha Ihlebæk
- Department of Public Health Science, Faculty of Landscape and Society, Norwegian University of Life Sciences (NMBU), Ås, Norway.,Faculty of Health and Social Work Studies, Østfold University College, Halden, Norway
| | - Nina Helen Mjøsund
- Department of Mental Health Research and Development, Vestre Viken Hospital Trust, Drammen, Norway
| | - Steffen Torp
- Department of Health, Social and Welfare Studies, Faculty of Health and Social Sciences, University of South-Eastern Norway (USN), Kongsberg, Norway
| |
Collapse
|
121
|
Reed SC, Bell JF, Miglioretti DL, Nekhlyudov L, Fairman N, Joseph JG. Fear of cancer recurrence and associations with mental health status and individual characteristics among cancer survivors: Findings from a nationally representative sample. J Psychosoc Oncol 2019; 38:125-142. [PMID: 31510882 DOI: 10.1080/07347332.2019.1649338] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Purpose: To describe the prevalence of fear of cancer recurrence (FCR) and test its associations with validated mental health status measures.Design: Cross-sectional survey using the Medical Expenditure Panel Survey Experiences with Cancer Survivorship Supplement.Sample: Post-treatment cancer survivors (n = 1032).Methods: Survey-weighted U.S. population-based estimates describe the prevalence of sociodemographic, health and mental health characteristics of cancer survivors by their level of FCR. Multinomial logistic regression was used to test associations of validated measures of mental health status and individual characteristics on levels of FCR in unadjusted models and those controlling for sociodemographic and health characteristics.Findings: Overall, 34.3% of cancer survivors reported no FCR, 54.4% reported low FCR, and 11.3% reported high FCR. Cancer survivors were at increased risk of reporting high FCR relative to no FCR if they had a low 12-item Short Form Health Survey Mental Component Summary score (≤48) compared to high scores (odds ratio = 2.88; 95% confidence interval = 1.57, 5.29). Reporting depressive symptoms or psychological distress did not significantly increase the risk of reporting high or low FCR relative to no FCR.Conclusions: To our knowledge, this study is the first to provide U.S. population-based estimates of associations between FCR and individual and health characteristics.Implications for Psychosocial Providers or Policy: Our results provide valuable information about which survivors are most at-risk for FCR. Future research is needed to more clearly differentiate FCR from other constructs.
Collapse
Affiliation(s)
- Sarah C Reed
- Betty Irene Moore School of Nursing, University of California, Sacramento, CA, USA
| | - Janice F Bell
- Betty Irene Moore School of Nursing, University of California, Sacramento, CA, USA
| | - Diana L Miglioretti
- Division of Biostatistics, Department of Public Health Sciences, School of Medicine, University of California, Davis, CA, USA
| | - Larissa Nekhlyudov
- Harvard Medical School, Department of Medicine, Brigham and Women's Hospital, Boston, CA, USA
| | - Nathan Fairman
- UC Davis Comprehensive Cancer Center, Psychiatry and Behavioral Sciences, UC Davis School of Medicine, Davis, CA, USA
| | - Jill G Joseph
- Betty Irene Moore School of Nursing, University of California, Sacramento, CA, USA
| |
Collapse
|
122
|
Lo JC. Employment pathways of cancer survivors-analysis from administrative data. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2019; 20:637-645. [PMID: 30604311 DOI: 10.1007/s10198-018-1025-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 12/11/2018] [Indexed: 06/09/2023]
Abstract
The incidence of cancer and its survival rate have been increasing worldwide, resulting in a greater number of cancer survivors. Since one's job often forms a central basis for self-esteem and provides financial security, knowing whether and how cancer can affect the employment of employed cancer survivors are important issues. While the past studies generally used survey data, this study utilizes pre-existing administrative data and employs the difference-in-differences model. We take newly diagnosed cancer patients in 2012, aged from 15 to 60 years and employed upon diagnosis, as the study group (N = 12694) and the propensity-score matching-adjusted non-cancer employed population as the control group. Monthly employment information for 2011-2014 was retrieved for both groups. We define the pre-event period as the months before the diagnosis and the post-event period as the months from the diagnosis and afterwards. A pseudo-date symbolizing the index point for cancer diagnosis is assigned to the control group. The logistic regression results show that the impact of cancer on the employment status of cancer survivors is significantly negative for both genders. However, if the differences in employment status between the study and control groups prior to the incidence of cancer are significant, then some past research that used only post-period observations might have rendered biased estimates. The employment pathways indicate that 88% of female cancer survivors employed upon diagnosis continue to work during the full 12 months after diagnosis. Further analyses on earnings demonstrate the possibility of cancer survivors retaining their job, but at lower pay.
Collapse
Affiliation(s)
- Joan C Lo
- Institute of Economics, Academia Sinica, Nankang, Taipei, Taiwan.
| |
Collapse
|
123
|
Truant TLO, Varcoe C, Gotay CC, Thorne S. Toward equitably high-quality cancer survivorship care. Can Oncol Nurs J 2019; 29:156-162. [PMID: 31966022 DOI: 10.5737/23688076293156162] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Although models of cancer survivorship care are rapidly evolving, there is increasing evidence of health disparities among cancer survivors. In the current context, Canada's survivorship care systems privilege some and not others to receive high-quality care and optimize their health outcomes. The aim of this study was to improve survivorship care systems by helping clinicians and decision makers to a better understanding of how various psychosocial/political factors, survivors' health experiences and health management strategies might shape the development of and access to high-quality survivorship care for Canadians with cancer. Using a nursing epistemological approach informed by critical and intersectional perspectives, we conducted a three-phased Interpretive Description study. We engaged in critical textual analysis of documentary sources, a secondary analysis of interview transcripts from an existing database, and qualitative interviews with 34 survivors and 12 system stakeholders. On the basis of these data, we identified individual, group, and system factors that contributed to gaps between survivors' expected and actual survivorship care experiences. By understanding what shapes survivorship care systems and resources, we help illuminate and unravel the complex nature of the issue, supporting clinicians and decision makers to find multi-layered approaches for equitably high-quality survivorship care.
Collapse
Affiliation(s)
- Tracy L O Truant
- Former Director, Research, Education and Innovation, BC Cancer, Vancouver BC,
| | - Colleen Varcoe
- Professor, School of Nursing, University of British Columbia,
| | - Carolyn C Gotay
- Professor Emeritus, School of Population and Public Health, University of British Columbia,
| | - Sally Thorne
- Professor, School of Nursing, University of British Columbia,
| |
Collapse
|
124
|
Hamood R, Hamood H, Merhasin I, Keinan-Boker L. Work Transitions in Breast Cancer Survivors and Effects on Quality of Life. JOURNAL OF OCCUPATIONAL REHABILITATION 2019; 29:336-349. [PMID: 29948472 DOI: 10.1007/s10926-018-9789-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Purpose Work transitions among breast cancer survivors remain an underexplored area. We aimed to examine prevalence and determinants of changes in work status, and the effect of these changes on quality of life of breast cancer survivors. Methods A cross-sectional study of 410 female breast cancer survivors randomly drawn from a larger study sample pool (n = 2644), members of "Leumit" healthcare fund, who were diagnosed with primary nonmetastatic invasive breast cancer in the years 2002-2012. The study questionnaire included questions on work characteristics and health-related quality-of-life and was completed by all women contacted. Work transition was defined as a downgrade (from full-time to part-time), termination, or retirement, and was contrasted to no change in work status (retention of full-time or part-time). Work transition was assessed at two intervals: between breast cancer diagnosis and treatment, and between breast cancer diagnosis and time of the survey. Results A total of 206 breast cancer survivors (50%) were employed prior to their diagnosis, of whom 12% stopped working, and 79% downgraded to part-time during treatment. At the time of survey (mean 8 ± 3 years post-diagnosis), 33% of those employed prior to their diagnosis stopped working or retired, 48% downgraded to part-time, and 19% had no change in their work situation. Work transition between diagnosis and time of the survey was significantly associated with poorer quality-of-life. In multivariable analyses, work transition between diagnosis and time of the survey was positively associated with being immigrant compared to native-born Israeli (odds ratio (OR) 4.65; 95% confidence interval (CI) 1.91-11.37; P = .001), and inversely with education level of college or over compared to high school or less (OR 0.27; 95% CI 0.09-0.86; P = .026). Conclusions Breast cancer survivors with characteristics pointing at underprivileged social circumstances more often experienced changes in work status after surviving breast cancer, irrespective of diagnosis, comorbidity or treatment. Breast cancer patients with immigrant status and/or lower educational attainment need more support to be able to keep their job.
Collapse
Affiliation(s)
- Rola Hamood
- School of Public Health, University of Haifa, Haifa, Israel
| | - Hatem Hamood
- School of Public Health, University of Haifa, Haifa, Israel.
- Leumit Health Services, Haharoshet 13, Karmiel, Israel.
| | | | - Lital Keinan-Boker
- School of Public Health, University of Haifa, Haifa, Israel
- Ministry of Health, Israel Center for Disease Control, Ramat Gan, Israel
| |
Collapse
|
125
|
Greidanus MA, Tamminga SJ, de Rijk AE, Frings-Dresen MHW, de Boer AGEM. What Employer Actions Are Considered Most Important for the Return to Work of Employees with Cancer? A Delphi Study Among Employees and Employers. JOURNAL OF OCCUPATIONAL REHABILITATION 2019; 29:406-422. [PMID: 30027426 PMCID: PMC6531608 DOI: 10.1007/s10926-018-9800-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Purpose Employers are important stakeholders in the return to work (RTW) of employees with cancer. However, it is unclear what employer actions are most important to that process. The objective, therefore, was to reach consensus on what employer actions are considered most important for the RTW of employees with cancer, by employers and employees separately. Methods A two-round online Delphi study was conducted with two expert panels: one with 23 employers and one with 29 employees with cancer. The results from each panel were analysed separately. Out of 24 suggested employer actions, participants selected the 10 they considered most important for RTW in each of the following RTW phases: (1) disclosure, (2) treatment, (3) RTW plan, and (4) actual RTW. The consensus threshold was set at ≥ 80% during the second round. Results The employer and employee expert panels both reached consensus on the importance of 'emotional support', 'practical support', 'allow sufficient sick leave', 'plan return to work', 'adjust expectations', 'assess work ability', and 'show appreciation'. Employers also reached consensus on 'communicate' and 'treat normally', and employees on 'handle unpredictability'. All these employer actions were considered to be specific for one to three RTW phases. Conclusions Employers reached consensus on the importance of nine employer actions, employees on eight. Both stakeholder perspectives showed great similarities, but did vary regarding important employer actions during the employee's treatment. We recommend developing interventions targeting the employer, meeting both employer and employee needs in each RTW phase, to enhance RTW support for employees with cancer.
Collapse
Affiliation(s)
- M A Greidanus
- Amsterdam UMC, University of Amsterdam, Coronel Institute of Occupational Health, Amsterdam Public Health research institute, Meibergdreef 9, Amsterdam, The Netherlands.
| | - S J Tamminga
- Amsterdam UMC, University of Amsterdam, Coronel Institute of Occupational Health, Amsterdam Public Health research institute, Meibergdreef 9, Amsterdam, The Netherlands
| | - A E de Rijk
- Department of Social Medicine, Faculty of Health, Medicine and Life Sciences, Research Institute Primary Care and Public Health (CAPHRI), Maastricht University, Universiteitssingel 40, Maastricht, The Netherlands
| | - M H W Frings-Dresen
- Amsterdam UMC, University of Amsterdam, Coronel Institute of Occupational Health, Amsterdam Public Health research institute, Meibergdreef 9, Amsterdam, The Netherlands
| | - A G E M de Boer
- Amsterdam UMC, University of Amsterdam, Coronel Institute of Occupational Health, Amsterdam Public Health research institute, Meibergdreef 9, Amsterdam, The Netherlands
| |
Collapse
|
126
|
Smith DK, Murphy BA. Lower levels of education and household income mediate lower dental care utilization among survivors of early life cancers. Prev Med Rep 2019; 14:100868. [PMID: 31024789 PMCID: PMC6475717 DOI: 10.1016/j.pmedr.2019.100868] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 02/21/2019] [Accepted: 04/03/2019] [Indexed: 02/06/2023] Open
Abstract
This study was an examination of dental care utilization among survivors of early life cancers (cancer diagnosis at 20 years of age or younger) and the extent to which socio-economic factors may present a barrier to care. Data were obtained from the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2016 (n = 28,640). Survey-weighted regression models were used to evaluate associations between early life cancers and subsequent frequency of dental care as adults. A mediation analysis was conducted to test education and household income as potential mediators of this association using a non-parametric bootstrap approach. Early life cancers were associated with a significant decrease in dental care utilization as adults (OR:0.459, 95%CI:(0.226, 0.935)). This diminished utilization was particularly pronounced with survivors in their 20s and 30s. Over time dental care utilization began a slow recovery. The association between early cancer and level of education was estimated to be negative but did not reach statistical significance (OR:0.739, 95%CI:(0.503, 1.086), p = 0.123). Survivors of early life cancers were less likely to be in a higher income bracket (OR:0.663, 95%CI:(0.452, 0.973), p = 0.036)). Decreases in education and household income (p < 0.001) mediated the association between early cancers and lower dental utilization. This pathway accounted for 41.7% (95%CI:(14.1%, 50.6%)) of the association. Survivors of early life cancers did not utilize professional oral health care at a rate commensurate with their risk of dental disease. Providers involved in the long-term care should promote routine dental maintenance. Further study into non-economic barriers in this population is warranted.
Collapse
Affiliation(s)
- Derek K. Smith
- Department of Biostatistics and Oral Maxillofacial Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Barbara A. Murphy
- Department of Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
| |
Collapse
|
127
|
Heo J, Noh OK, Chun M, Oh YT, Kim L. Psychological distress among prostate cancer survivors in South Korea: A nationwide population-based, longitudinal study. Asia Pac J Clin Oncol 2019; 16:e125-e130. [PMID: 31069946 DOI: 10.1111/ajco.13160] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 04/22/2019] [Indexed: 11/30/2022]
Abstract
AIM This time-dependent study aimed to analyze the prevalence of psychological distress in prostate cancer survivors by using claims data in South Korea. METHODS In a nationwide cohort, 32 005 patients were identified who were diagnosed with prostate cancer between January 2010 and December 2014. We referred the diagnostic codes of mental disorders as psychological distress. We categorized the prevalence of psychological distress based on age and specific times before and after the cancer diagnosis. RESULTS The median age at diagnosis of prostate cancer was 70 years. Among 32 005 patients, 3074 (9.6%) were diagnosed at least once with a mental disorder between 1 year before the cancer diagnosis and the last follow-up. Among the first diagnoses of each patient, the common mental disorders were anxiety (39.1%) and depression (33.0%). In the total cohort, there were 54 666 claims for mental disorders and over 48.0% (26 256) were for depression. The frequency of psychological distress peaked just before cancer diagnosis. Anxiety was frequent before diagnosis of prostate cancer, whereas depression was frequent after diagnosis. Although stress reaction/adjustment disorders were relatively high in the younger group, depression was relatively high in the elderly group. CONCLUSION Psychological distress in prostate cancer survivors showed different patterns of prevalence between before and after cancer diagnosis, as well as between age groups. Timely diagnosis and intervention for mental health could promote quality of life for prostate cancer survivors.
Collapse
Affiliation(s)
- Jaesung Heo
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - O Kyu Noh
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Republic of Korea.,Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Republic of Korea.,Office of Biostatistics, Ajou Research Institute for Innovation Medicine, Ajou University Medical Center, Suwon, Republic of Korea
| | - Mison Chun
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Young-Taek Oh
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Logyoung Kim
- Health Insurance Review and Assessment Service, Seoul, Republic of Korea
| |
Collapse
|
128
|
Carlson LE, Subnis UB, Piedalue KL, Vallerand J, Speca M, Lupichuk S, Tang P, Faris P, Wolever RQ. The ONE‐MIND Study: Rationale and protocol for assessing the effects of ONlinE MINDfulness‐based cancer recovery for the prevention of fatigue and other common side effects during chemotherapy. Eur J Cancer Care (Engl) 2019; 28:e13074. [DOI: 10.1111/ecc.13074] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/05/2019] [Accepted: 04/07/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Linda E. Carlson
- Department of Oncology, Cumming School of Medicine University of Calgary Calgary Alberta Canada
| | - Utkarsh B. Subnis
- Department of Oncology, Cumming School of Medicine University of Calgary Calgary Alberta Canada
| | | | - James Vallerand
- Department of Oncology, Cumming School of Medicine University of Calgary Calgary Alberta Canada
| | - Michael Speca
- Department of Oncology, Cumming School of Medicine University of Calgary Calgary Alberta Canada
| | - Sasha Lupichuk
- Department of Oncology, Cumming School of Medicine University of Calgary Calgary Alberta Canada
| | - Patricia Tang
- Department of Oncology, Cumming School of Medicine University of Calgary Calgary Alberta Canada
| | - Peter Faris
- Department of Analytics Alberta Health Services and University of Calgary Calgary Alberta Canada
| | - Ruth Q. Wolever
- Department of Physical Medicine and Rehabilitation Vanderbilt University Medical Center Nashville Tennessee
| |
Collapse
|
129
|
Arndt V, Koch-Gallenkamp L, Bertram H, Eberle A, Holleczek B, Pritzkuleit R, Waldeyer-Sauerland M, Waldmann A, Zeissig SR, Doege D, Thong MSY, Brenner H. Return to work after cancer. A multi-regional population-based study from Germany. Acta Oncol 2019; 58:811-818. [PMID: 30777496 DOI: 10.1080/0284186x.2018.1557341] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: With improving prognosis, the ability to return to work after cancer has become a realistic goal but only little is known regarding details such as sustainability, financial consequences, and potential determinants of return to work in long-term survivors in Germany. Methods: We studied return to work in a population-based sample of 1558 long-term cancer survivors, diagnosed in 1994-2004 with breast, colorectal or prostate cancer before age 60 (mean 50.1). Information regarding employment status and financial difficulties was obtained via mailed questionnaires from patients who were identified by six population-based cancer registries in Germany. Cumulative incidence of return to work was determined by time-to-event analysis with consideration of competing events. Chi2 tests and multiple logistic regression modeling were employed to identify potential sociodemographic and clinical determinants of return to work. Results: Within a mean period since diagnosis of 8.3 years, 63% of all working-age cancer survivors initially returned to their old job and another 7% took up a new job. Seventeen percent were granted a disability pension, 6% were early retired (not cancer-related), 4% became unemployed, and 1% left the job market for other reasons. Resumption of work occurred within the first 2 years after diagnosis in 90% of all returnees. Cancer-related reduction of working hours was reported by 17% among all returnees and 6% quit their job due to cancer within 5 years past return to work. The probability of return to work was strongly related with age at diagnosis, tumor stage, education, and occupational class but did not differ with respect to the tumor site, gender nor marital status. Conclusions: Most long-term survivors after breast, colorectal, or prostate cancer of working-age are able to return to work. However, financial problems might arise due to a reduction in working hours. An additional provision of targeted interventions for high-risk groups should be discussed.
Collapse
Affiliation(s)
- Volker Arndt
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lena Koch-Gallenkamp
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Heike Bertram
- Cancer Registry of North Rhine-Westphalia, Münster, Germany
| | - Andrea Eberle
- Bremen Cancer Registry, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
| | | | | | | | - Annika Waldmann
- Ministry of Health and Consumer Protection, Hamburg Cancer Registry, Hamburg, Germany
- Institute of Social Medicine and Epidemiology, University Lübeck, Lübeck, Germany
| | | | - Daniela Doege
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Melissa S. Y. Thong
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Division of Preventive Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| |
Collapse
|
130
|
Scardaville MC, Murphy KM, Liu F, Boydston S, Robert R, Shin K, Nguyen V, Frieden L. Knowledge of Legal Protections and Employment-Related Resources Among Young Adults with Cancer. J Adolesc Young Adult Oncol 2019; 8:312-319. [PMID: 31021285 DOI: 10.1089/jayao.2018.0097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Young adults (aged 18-39 years) who have received a cancer diagnosis can encounter significant barriers in their transition to employment. American young adults' familiarity with federal legislation and resources related to employment is unclear. The study questions included: (1) To what extent do young adults who have had a cancer diagnosis know about legal and programmatic supports that may help to address their employment-related needs and (2) What modes of receiving information about resources to address their employment-related concerns do young adults who have had a cancer diagnosis prefer? Methods: A cross-sectional online survey was conducted with a convenience sample composed of 203 young adults living in the United States, had a cancer diagnosis other than nonmelanoma skin cancer, and were between 18 and 39 years of age. Over half (57.6%) of respondents received a cancer diagnosis at age 24 years or older. The mean age at participation was 30.4. Results: More than half of the sample (57.0%) was familiar with the Americans with Disabilities Act yet many did not know that cancer was a covered condition. Almost 80% of the respondents were not familiar with other federal initiatives with employment protections for people with cancer. Participants preferred in-person trainings and resource fact sheets as the presentation channels, although sociodemographic factors such as employment status were related to preferred delivery methods. Conclusion: These young adults would benefit from additional outreach around federal guidelines concerning employment-related rights and services and programs applicable to young adult cancer survivors.
Collapse
Affiliation(s)
- Melissa C Scardaville
- 1 Human Services and Public Health, American Institutes for Research, Washington, District of Columbia
| | - Kathleen M Murphy
- 2 Human Services and Public Health, American Institutes for Research, Austin, Texas
| | - Feng Liu
- 2 Human Services and Public Health, American Institutes for Research, Austin, Texas
| | - Steven Boydston
- 2 Human Services and Public Health, American Institutes for Research, Austin, Texas
| | - Rhonda Robert
- 3 Department of Clinical Psychology and Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson, Houston, Texas
| | - Ki Shin
- 4 Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson, Houston, Texas
| | - Vinh Nguyen
- 5 Independent Living Research Utilization, TIRR Memorial Hermann, Houston, Texas
| | - Lex Frieden
- 6 School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, Texas
| |
Collapse
|
131
|
Gruß I, Hanson G, Bradley C, McMullen C, Ritzwoller D, Hodge S, Varga A, Banegas MP. Colorectal cancer survivors' challenges to returning to work: A qualitative study. Eur J Cancer Care (Engl) 2019; 28:e13044. [PMID: 31006931 DOI: 10.1111/ecc.13044] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 02/22/2019] [Accepted: 03/25/2019] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To assess the challenges and needs of colorectal cancer (CRC) survivors in maintaining employment and returning to work (RTW) from the perspectives of both CRC survivors and employers in the United States. METHODS Semi-structured interviews with CRC survivors (n = 10) and employers (n = 4) were transcribed, coded and thematically analysed using NVivo 12 software. RESULTS Workplace challenges for survivors included the following: inadequate availability of paid and unpaid leave, limited availability of workplace accommodations, and employers' lack of knowledge about CRC and the recovery process. Survivors were concerned about the lack of adequate financial resources to take unpaid leave and the need to relearn control of bodily functions. Workplace challenges for employers of cancer survivors included the following: limited institutional flexibility to provide individualised accommodations, communication with frontline managers about leave availability for employees and communication with employees about legal protections and limitations. Employers perceived that employees were unwilling to take leave. CONCLUSION Colorectal cancer survivors in the US face difficult, sometimes insurmountable, challenges when trying to balance their physical and financial needs within the constraints of employment. Employers recognise challenges associated with this concern. Multi-level interventions-ranging from flexible work schedules to training for frontline managers-might facilitate the RTW process.
Collapse
Affiliation(s)
- Inga Gruß
- Kaiser Permanente Center for Health Research, Portland, Oregon
| | - Ginger Hanson
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Cathy Bradley
- Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado
| | - Carmit McMullen
- Kaiser Permanente Center for Health Research, Portland, Oregon
| | - Debra Ritzwoller
- Kaiser Permanente Colorado Institute for Health Research, Aurora, Colorado
| | - Stephanie Hodge
- Kaiser Permanente Center for Health Research, Portland, Oregon
| | - Alexandra Varga
- Kaiser Permanente Center for Health Research, Portland, Oregon
| | | |
Collapse
|
132
|
Rottenberg Y, Amir Z, De Boer AGEM. Work cessation after cancer diagnosis: a population-based study. Occup Med (Lond) 2019; 69:126-132. [PMID: 30882861 DOI: 10.1093/occmed/kqz013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Long-term work maintenance among cancer survivors is important for patients, their families and society. AIMS To assess the risk of work cessation among workers at baseline in cancer survivors at 2 and 4 years after diagnosis compared with a matched cancer-free control group. METHODS Baseline measurements for this historical prospective study were drawn from the Israeli Central Bureau of Statistics 1995 National Census, followed up until 2011. Patients who died before the end of 2011 were excluded from the study. Adjusted odds ratios (ORs) for the study outcome were assessed by binary logistic regression analyses, controlled for age, sex, ethnicity, years of education and socioeconomic position. RESULTS Cancer was associated with not working at 2 years after diagnosis (adjusted OR = 1.71, 95% confidence interval [CI] 1.59-1.84, P < 0.001), while only mild attenuation was seen at 4 years after diagnosis (adjusted OR = 1.57, 95% CI 1.46-1.68, P < 0.001). Analysis by cancer type revealed that patients diagnosed with central nervous system (adjusted OR = 3.42, 95% CI 2.41-4.86, P < 0.001), renal (adjusted OR = 2.10, 95% CI 1.38-3.16, P < 0.001), breast (adjusted OR = 2.05, 95% CI 1.76-2.38, P < 0.001) and haematologic malignancies (adjusted OR = 2.04, 95% CI 1.59-2.61, P < 0.001) showed the greatest magnitude effect at 2 years. CONCLUSIONS These results emphasize the need for tailored interventions in order to enhance work maintenance, even among patients who are working at baseline and with very long-term survivors.
Collapse
Affiliation(s)
- Y Rottenberg
- The Department of Oncology, Hadassah-Hebrew University Medical Center, The Faculty of Medicine, Jerusalem, Israel
- The Jerusalem Institute of Aging Research, Hadassah-Hebrew University Medical Center Mount Scopus, and Hebrew University-Hadassah Medical School, Mount Scopus, Jerusalem, Israel
| | - Z Amir
- School of Health Sciences, Salford University, Greater Manchester, UK
| | - A G E M De Boer
- Coronel Institute of Occupational Health, Academic Medical Center, Meibergdreef, AZ Amsterdam, the Netherlands
| |
Collapse
|
133
|
McLennan V, Ludvik D, Chambers S, Frydenberg M. Work after prostate cancer: a systematic review. J Cancer Surviv 2019; 13:282-291. [PMID: 30900159 DOI: 10.1007/s11764-019-00750-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 03/09/2019] [Indexed: 01/30/2023]
Abstract
PURPOSE Research in the field of vocational rehabilitation, specifically for prostate cancer, remains rare despite increasing recognition of the role of vocational interventions in other cancer groups. The aim of this review was to compile and evaluate current trends, facilitators and barriers associated with returning to work after a prostate cancer diagnosis. METHOD The literature search was conducted in March 2018 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Forty-seven original research papers published in English in peer-reviewed journals were identified. The included studies comprised a total of 20,083 prostate cancer patients with a mean age of 61 years. RESULTS The studies implied a good overall return to work prognosis in prostate cancer patients; however, these findings are not generalisable to those with physically demanding or low paid jobs, comorbid conditions or poor physical functioning. CONCLUSION The limited research investigating the long-term implications of prostate cancer indicates that there may be problems related to job retention and early unwanted retirement. Facilitators and barriers to employment after prostate cancer are identified and implications for vocational interventions and further research are discussed. IMPLICATIONS FOR CANCER SURVIVORS This review helps to shed light on the barriers and facilitators to employment among prostate cancer survivors, as well as the need for further research and development in vocational rehabilitation interventions for this population.
Collapse
Affiliation(s)
- Vanette McLennan
- Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia. .,School of Allied Health Sciences, Griffith University, Southport, QLD, Australia.
| | - Dominika Ludvik
- Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia
| | - Suzanne Chambers
- Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia.,University of Technology Sydney, Sydney, NSW, Australia.,Exercise Medicine Research Institute, Edith Cowan University, Perth, WA, Australia.,Institute for Resilient Regions, University of Southern Queensland, Toowoomba, QLD, Australia
| | - Mark Frydenberg
- Department of Surgery, Monash University, Clayton, Australia
| |
Collapse
|
134
|
Kiasuwa-Mbengi RL, Nyaga V, Otter R, de Brouwer C, Bouland C. The EMPCAN study: protocol of a population-based cohort study on the evolution of the socio-economic position of workers with cancer. Arch Public Health 2019; 77:15. [PMID: 30937166 PMCID: PMC6427850 DOI: 10.1186/s13690-019-0337-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 02/12/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The improvements in cancer control led to an increase in the number of cancer survivors, notably, in the working age population (16-64 years). There is a strong need to assess and understand their reintegration on the labour market, which underlines and ensures their social integration and quality of life. The objectives of the EMPCAN study is therefore to measure the scale of return-to-work after cancer and to identify the determining factors, allowing for the implementation of an adequate socio-professional support. METHODS We requested data from the Belgian Cancer Registry and the Crossroad Bank for Social Security. We included all socially insured Belgian workers diagnosed between 2004 and 2011 with colorectal, breast, head & neck, prostate, testis, lung and corpus uteri cancer. The end of (administrative) follow-up was 31st December 2012. We include demographic, health-related and work-related factors in the analysis and observed how these factors interplay to determine the working status. After having solved legal, ethical and technical issues for the coupling, we will perform survival analysis with competing risks using the Fine and Gray model; we will also perform a multistate model using transitions probabilities; and finally, a group-based modeling for longitudinal data using the 'proc traj' package in SAS. DISCUSSION The results of the EMPCAN study will allow the provision of an evidence-based support to professional reintegration policies. It will also bring some key features for the prediction of the cancer-related social security needs. Besides the raise of awareness among health professionals and policy makers, this study could lead to a better planning and organization of vocational rehabilitation programs.
Collapse
Affiliation(s)
- Régine L. Kiasuwa-Mbengi
- Belgian Cancer Centre, Department of Public Health and Epidemiology, Sciensano, Brussels, Belgium
- Research Centre for Environmental and Occupational Health, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| | - Victoria Nyaga
- Belgian Cancer Centre, Department of Public Health and Epidemiology, Sciensano, Brussels, Belgium
| | - Renée Otter
- Belgian Cancer Centre, Department of Public Health and Epidemiology, Sciensano, Brussels, Belgium
| | - Christophe de Brouwer
- Research Centre for Environmental and Occupational Health, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| | - Catherine Bouland
- Research Centre for Environmental and Occupational Health, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| |
Collapse
|
135
|
Fitch MI, Nicoll I. Returning to work after cancer: Survivors', caregivers', and employers' perspectives. Psychooncology 2019; 28:792-798. [PMID: 30720242 DOI: 10.1002/pon.5021] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 01/30/2019] [Accepted: 01/31/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The Return to Work Initiative was launched to build a comprehensive understanding of issues, needs, current resources, and available supports for Canadian cancer survivors returning to work as the basis for developing a national action plan. METHODS This Initiative drew on perspectives of stakeholders through a survey and consultations with cancer survivors and caregivers to learn about challenges regarding return to work and interviews and focus groups with workplace representatives and employers to determine issues encountered in the workplace. Common perspectives across stakeholder groups were identified. RESULTS Cancer survivors (n = 410) described reduction in income, positive and negative experiences returning to work, and work-related issues regarding side effects. Caregivers (n = 60) described loss of concentration and productivity, stress, and lack of support from coworkers. Employer representatives (n = 68) revealed challenges for managers knowing how best to support cancer survivors as there are few of them of which they are aware. All stakeholders agreed that returning to work for cancer survivors is challenging. Multiple strategies are needed to achieve success: in-depth understanding of the issues, consideration of accommodation, communication among stakeholders, education, resources, and financial support. CONCLUSIONS The work provided a foundation for making decisions about how to proceed to improve return to work for Canadian cancer survivors.
Collapse
Affiliation(s)
- Margaret I Fitch
- Cancer Journey Advisory Group, Canadian Partnership Against Cancer, University of Toronto Lawrence S Bloomberg Faculty of Nursing, Canadian Association of Nurses in Oncology, Toronto, Ontario
| | - Irene Nicoll
- Cancer Journey Advisory Group, Canadian Partnership Against Cancer, University of Toronto Lawrence S Bloomberg Faculty of Nursing, Canadian Association of Nurses in Oncology, Toronto, Ontario
| |
Collapse
|
136
|
de Lorenzo F, Apostolidis K. The European Cancer Patient Coalition and its central role in connecting stakeholders to advance patient-centric solutions in the mission on cancer. Mol Oncol 2019; 13:653-666. [PMID: 30657631 PMCID: PMC6396363 DOI: 10.1002/1878-0261.12448] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 01/06/2019] [Indexed: 11/08/2022] Open
Abstract
There is an urgent need for solutions to the economic and social inequalities in cancer care that still exist in many European countries. Patient preferences, ‘big data’, mobile digital technology and molecular and genomic profiling are among the innovative research topics that connect cancer patients to comprehensive cancer centres, and link translational research to cancer diagnosis, treatment and care. The question is whether Europe can deliver the complex infrastructure needed for universal coverage and equitable access to cancer care. The European Cancer Patient Coalition (ECPC), the leading ‘umbrella’ cancer patient organisation in Europe, has a central role in bringing the unmet needs of patients with cancer to the forefront of cancer policy, care and research. The ECPC is a respected and reliable partner in the oncology community and has effectively collaborated with institutional stakeholders and organisations, as well as with the European Commission, on cancer research projects and in the development of tools to advance health care and cancer policies at the European and national level. The ECPC believes that innovation cannot emerge and grow without patient involvement and is fully committed to increasing patient education and contribution in cancer research through its active participation in various European cancer research programmes and educational resources. The ECPC is expected to play a major role in the mission on cancer, given its previous achievements in policy and research to help overcome the inequalities in cancer prevention, treatment, rehabilitation and survivorship care. The mission on cancer will be facilitated by active collaboration between patient organisations and scientists, clinicians, politicians and industry, with the aim of identifying important research questions regarding quality of life and social issues for cancer patients of all ages.
Collapse
|
137
|
Rottenberg Y, de Boer AGEM. Higher incidence of screening-related cancers in the employed population. Occup Med (Lond) 2019; 68:273-278. [PMID: 29635423 DOI: 10.1093/occmed/kqy055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Employment may confound the risk of a cancer diagnosis in both directions. We hypothesized that a higher baseline rate of employment among cancer patients may explain the lack of association between a cancer diagnosis and later unemployment in many studies. Aims To assess the unemployment rate among cancer patients before diagnosis compared with a matched cancer-free control group. Methods Using data from the Israeli National Central Bureau of Statistics 1995 census (persons aged between 15 and 60 years old), the Israeli Tax Authority database and the Israel Cancer Registry, cancer patients (diagnosed between the years 2000 and 2007 and alive at 2011) were compared with matched cancer-free controls. Results There were 8797 cancer patients and 26166 cancer-free controls. We found that, in general, cancer was not associated with unemployment 2 years before diagnosis (adjusted odds ratio [OR] = 0.96, 95% confidence interval [CI] 0.90-1.009, P = NS) after adjustment for age, gender, ethnicity, educational years and residential socioeconomic position. However, the diagnoses associated with screening (breast, prostate, colorectal and cervix cancers) were inversely associated with unemployment 2 years before diagnosis (adjusted OR = 0.90, 95% CI 0.84-0.97, P < 0.01). Conclusions The results from the current study suggest that a higher baseline rate of employment among cancer patients, mainly those who were diagnosed with screening-associated cancers, explains false negative results in previous studies assessing cancer survivors' work issues.
Collapse
Affiliation(s)
- Y Rottenberg
- The Department of Oncology, Hadassah-Hebrew University Medical Center, and Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - A G E M de Boer
- Coronel Institute of Occupational Health, Academic Medical Center, Meibergdreef, AZ Amsterdam, The Netherlands
| |
Collapse
|
138
|
Musti MA, Collina N, Stivanello E, Bonfiglioli R, Giordani S, Morelli C, Pandolfi P. Perceived work ability at return to work in women treated for breast cancer: a questionnaire-based study. LA MEDICINA DEL LAVORO 2018; 109:407-419. [PMID: 30556532 PMCID: PMC7682187 DOI: 10.23749/mdl.v110i6.7241] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 11/08/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Breast cancer survivors often perceive reduced work ability upon returning to work. OBJECTIVES To identify predictors of perceived reduced work ability following return to work among women treated for breast cancer and to describe workplace interventions and support after returning to work. METHODS A questionnaire was sent to 18-65 years-old women (no. 1578) treated for breast cancer and residing in the catchment area of the Bologna Local Health Authority between 2010 and 2012. The study population was identified through a Hospital Discharge Database. The questionnaires included items about personal characteristics, cancer and work-related factors, perceived work ability and the return to work process. A multivariable logistic regression analysis was performed to identify predictors of reduced work ability upon returning to work. RESULTS Among the 841 respondents, 503 questionnaires were evaluable. In the study, 43.5% of the respondents reported reduced work ability with respect to the pre-diagnosis period. Reduced work ability was more common in non-cohabiting (OR=1.81, 95%CI 1.10-2.98) than in cohabiting/married women, and after mastectomy (OR=2.77, 95%CI 1.26-6.11) than after breast-conserving surgery. Office staff/sales assistants and managers were less likely to report reduced work ability (OR=0.51, 95%CI 0.30-0.88 and OR=0.21, 95%CI 0.06-0.76, respectively) than labourers. Women who perceived reduced work ability reported more frequently adjustment of work assignments, consultation of an occupational physician, insufficient support from employers and colleagues and discrimination. CONCLUSIONS Reduced work ability is commonly perceived among women who return to work after treatment for breast cancer. Occupational physicians and general practitioners should be aware of a wide range of factors influencing this perception in order to facilitate a successful return to work.
Collapse
Affiliation(s)
- Muriel Assunta Musti
- Unit of Epidemiology, Health Promotion and Risk Communication, Department of Public Health, Bologna Local Health Authority, Bologna, Italy.
| | | | | | | | | | | | | |
Collapse
|
139
|
Yabroff KR, Zhao J, Zheng Z, Rai A, Han X. Medical Financial Hardship among Cancer Survivors in the United States: What Do We Know? What Do We Need to Know? Cancer Epidemiol Biomarkers Prev 2018; 27:1389-1397. [DOI: 10.1158/1055-9965.epi-18-0617] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 07/19/2018] [Accepted: 09/07/2018] [Indexed: 11/16/2022] Open
|
140
|
Teckle P, Peacock S, McBride ML, Bentley C, Goddard K, Rogers P. Long-term effects of cancer on earnings of childhood, adolescent and young adult cancer survivors - a population-based study from British Columbia, Canada. BMC Health Serv Res 2018; 18:826. [PMID: 30382843 PMCID: PMC6211561 DOI: 10.1186/s12913-018-3617-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 10/10/2018] [Indexed: 11/25/2022] Open
Abstract
Background The patterns and determinants of long-term income among young people surviving cancer, and differences compared to peers, have not yet been fully explored. The objectives of this paper are to describe long-term income among young survivors of cancer, the impact of socio-demographic, disease, and treatment factors on long-term income, and income relative to the general population. Methods Retrospective cohort study with comparison group from the general population, using linked population-based registries, clinical data, and tax-records. Multivariate random effects regression models were used to determine survivor income, compare long-term income between survivors and comparators, and assess income determinants. Subjects included all residents of British Columbia (BC), Canada, diagnosed with cancer before 25 years of age and surviving 5 years or more. Comparators were selected from the BC general population matched by gender and birth year. Results Young cancer survivors earned significantly less than the general population. In addition, survivors of central nervous system tumors have significantly lower incomes than lymphoma survivors. Survivors who received radiation therapy have significantly lower income. Results should be interpreted with caution as the comparator group was matched by gender and date of birth. Conclusions Depending on original diagnosis, treatment, and other characteristics, survivors face significantly lower income than peers and may require supports to gain and retain paid employment. Lower income will affect their opportunity for independent living, and will reduce productivity in the labour force.
Collapse
Affiliation(s)
- Paulos Teckle
- Canadian Centre for Applied Research in Cancer Control (ARCC), 675 West 10th Avenue, Vancouver, BC, V5Z 1L3, Canada. .,Cancer Control Research, British Columbia Cancer Agency, Vancouver, BC, Canada. .,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
| | - Stuart Peacock
- Canadian Centre for Applied Research in Cancer Control (ARCC), 675 West 10th Avenue, Vancouver, BC, V5Z 1L3, Canada.,Cancer Control Research, British Columbia Cancer Agency, Vancouver, BC, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Mary L McBride
- Canadian Centre for Applied Research in Cancer Control (ARCC), 675 West 10th Avenue, Vancouver, BC, V5Z 1L3, Canada.,Cancer Control Research, British Columbia Cancer Agency, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Colene Bentley
- Canadian Centre for Applied Research in Cancer Control (ARCC), 675 West 10th Avenue, Vancouver, BC, V5Z 1L3, Canada.,Cancer Control Research, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Karen Goddard
- Radiation Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Paul Rogers
- Pediatric Oncology and Hematology, BC Children's Hospital, Vancouver, BC, Canada
| |
Collapse
|
141
|
Bradley CJ, Brown KL, Haan M, Glasgow RE, Newman LS, Rabin B, Ritzwoller DP, Tenney L. Cancer Survivorship and Employment: Intersection of Oral Agents, Changing Workforce Dynamics, and Employers’ Perspectives. J Natl Cancer Inst 2018; 110:1292-1299. [DOI: 10.1093/jnci/djy172] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 08/24/2018] [Indexed: 11/13/2022] Open
|
142
|
Noll KR, Bradshaw ME, Rexer J, Wefel JS. Neuropsychological Practice in the Oncology Setting. Arch Clin Neuropsychol 2018; 33:344-353. [PMID: 29718081 DOI: 10.1093/arclin/acx131] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 12/04/2017] [Indexed: 11/14/2022] Open
Abstract
Oncology has experienced positive shifts in survival curves for many cancers largely due to the development of earlier diagnostics and better therapeutics. This has increased the visibility and need for survivorship services, including clinical neuropsychology. Patients with cancer frequently experience cognitive dysfunction related to the presence of cancer itself and treatment neurotoxicity. These cognitive difficulties can profoundly impact patient functioning and autonomy with accompanying declines in quality of life. Clinical neuropsychologists are uniquely positioned to evaluate the cognitive and affective sequelae of cancer and treatment and provide interventions and recommendations that can benefit well-being and potentially alter the disease course. Despite increasing recognition of the importance of neuropsychological issues to cancer survivorship, many neuropsychologists have limited training and guidance regarding navigating and implementing services within the oncology setting. This article provides the basic rationale for neuropsychological practice and research activities in oncology, as well as the experience of the Section of Neuropsychology at The University of Texas MD Anderson Cancer Center.
Collapse
Affiliation(s)
- Kyle R Noll
- Department of Neuro-Oncology, Section of Neuropsychology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA
| | - Mariana E Bradshaw
- Department of Neuro-Oncology, Section of Neuropsychology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA
| | - Jennie Rexer
- Department of Neuro-Oncology, Section of Neuropsychology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA
| | - Jeffrey S Wefel
- Department of Neuro-Oncology, Section of Neuropsychology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA
| |
Collapse
|
143
|
Tamminga SJ, de Jong M, Frings-Dresen MHW, de Boer AGEM. The Quality of Working Life Questionnaire for Cancer Survivors: Sufficient responsiveness for use as a patient-reported outcome measurement. Eur J Cancer Care (Engl) 2018; 27:e12910. [DOI: 10.1111/ecc.12910] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 07/20/2018] [Accepted: 07/24/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Sietske J. Tamminga
- Department: Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
| | - Merel de Jong
- Department: Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
| | - Monique H. W. Frings-Dresen
- Department: Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
| | - Angela G. E. M. de Boer
- Department: Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
| |
Collapse
|
144
|
Armaou M, Schumacher L, Grunfeld EA. Cancer Survivors' Social Context in the Return to Work Process: Narrative Accounts of Social Support and Social Comparison Information. JOURNAL OF OCCUPATIONAL REHABILITATION 2018; 28:504-512. [PMID: 28980114 DOI: 10.1007/s10926-017-9735-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Purpose Returning to work is a process that is intertwined with the social aspects of one's life, which can influence the way in which that person manages their return to work and also determines the support available to them. This study aimed to explore cancer patients' perceptions of the role of their social context in relation to returning to work following treatment. Methods Twenty-three patients who had received a diagnosis of either urological, breast, gynaecological, or bowel cancer participated in semi-structured interviews examining general perceptions of cancer, work values and perceptions of the potential impact of their cancer diagnosis and treatment on work. Interviews were analysed using the iterative process of Framework Analysis. Results Two superordinate themes emerged as influential in the return to work process: Social support as a facilitator of return to work (e.g. co-workers' support and support outside of the workplace) and Social comparison as an appraisal of readiness to return to work (e.g. comparisons with other cancer patients, colleagues, and employees in other organisations or professions). Conclusions Two functions of the social context of returning to work after cancer were apparent in the participants' narrative: the importance of social support as a facilitator of returning to work and the utilisation of social comparison information in order to appraise one's readiness to return to work. The role of social context in returning to work has largely been absent from the research literature to date. The findings of this study suggest that social support and social comparison mechanisms may have a significant impact on an individual's successful return to the workplace.
Collapse
Affiliation(s)
- M Armaou
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK.
| | - L Schumacher
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | - E A Grunfeld
- Department of Psychological Sciences, Birkbeck, University of London, Malet Street, London, WC1E 7HX, UK
| |
Collapse
|
145
|
Fort E, Pélissier C, Fanjas A, Charnay P, Charbotel B, Bergeret A, Fontana L, Hours M. Road casualties in work-related and private contexts: occupational medical impact. Results from the ESPARR cohort. Work 2018; 60:117-128. [PMID: 29843295 DOI: 10.3233/wor-182720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Road accidents may impact victims' physical and/or mental health and socio-occupational life, notably including return to work. OBJECTIVES To assess whether the occupational medical consequences sustained by subjects injured in road accidents occurring in a work-related context differ from those associated with private accidents. METHODS 778 adults who were in work or occupational training at the time of their accident were included. Two groups were distinguished: 354 (45.5%) injured in road accidents occurring in a work-related context (commuting or on duty) and 424 (54.5%) injured in a private accident. The groups were compared on medical and occupational factors assessed on prospective follow-up at 6 months and 1 and 3 years. Multivariate analysis explored for factors associated at 6 months and 1 year with sick leave following the accident and duration of sick leave. RESULTS There were no significant differences between groups for demographic data apart from a slightly higher injury severity in private accidents (32.5% of private accidents with MAIS3+(Maximum Abbreviated Injury Scale greater or equal to 3) vs. 23.7% for work-related accidents, p = 0.007). Victims of work-related accidents were more often on sick leave (OR = 1.8; 95% CI, 1.1-2.9). Although the length of sick leave is higher for work-related accidents that for private accidents, multivariate analysis showed that the injury severity and the post-traumatic stress disorder (PTSD) are significant factors to explain the time to return to work. There were no significant differences according to occupational impact during follow-up, notably including sick-leave duration, number of victims returning to work within 3 years and number of victims out of work due to incapacity. CONCLUSIONS In the ESPARR (follow-up study of a road-accident population in the Rhône administrative county: Etude de Suivi d'une Population d'Accidentés de la Route dans le Rhône) cohort, the fact that a road accident occurred in a work-related context did not affect the occupational consequences.
Collapse
Affiliation(s)
- E Fort
- University of Lyon, Université Claude Bernard Lyon 1, Ifsttar, UMR T_9405, F-69373, Lyon, France
| | - C Pélissier
- University of Lyon, Université Claude Bernard Lyon 1, Ifsttar, Université Jean Monnet, UMR T_9405, F-42100 St Etienne, France
| | - A Fanjas
- University of Lyon, Université Claude Bernard Lyon 1, Ifsttar, Université Jean Monnet, UMR T_9405, F-42100 St Etienne, France
| | - P Charnay
- University of Lyon, Université Claude Bernard Lyon 1, Ifsttar, UMR T_9405, F-69500, Bron, France
| | - B Charbotel
- University of Lyon, Université Claude Bernard Lyon 1, Ifsttar, UMR T_9405, F-69373, Lyon, France
| | - A Bergeret
- University of Lyon, Université Claude Bernard Lyon 1, Ifsttar, UMR T_9405, F-69373, Lyon, France
| | - L Fontana
- University of Lyon, Université Claude Bernard Lyon 1, Ifsttar, Université Jean Monnet, UMR T_9405, F-42100 St Etienne, France
| | - M Hours
- University of Lyon, Université Claude Bernard Lyon 1, Ifsttar, UMR T_9405, F-69500, Bron, France
| |
Collapse
|
146
|
Arfi A, Baffert S, Soilly AL, Huchon C, Reyal F, Asselain B, Neffati S, Rouzier R, Héquet D. Determinants of return at work of breast cancer patients: results from the OPTISOINS01 French prospective study. BMJ Open 2018; 8:e020276. [PMID: 29776920 PMCID: PMC5961575 DOI: 10.1136/bmjopen-2017-020276] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Return to work (RTW) after breast cancer (BC) is still a new field of research. The factors determining shorter sick leave duration of patients with BC have not been clearly identified. The aim of this study was to describe work during BC treatment and to identify factors associated with sick leave duration. MATERIALS AND METHODS An observational, prospective, multicentre study was conducted among women with operable BC. A logbook was given to all working patients to record sociodemographic and work-related data over a 1-year period. RESULTS Work-related data after BC were available for 178 patients (60%). The median age at diagnosis was 50 years (27-77), 87.9% of patients had an invasive form of BC and 25.3% a lymph node involvement. 25.9% had a radical surgery and 24.2% had an axillary dissection. Radiotherapy was performed in 90.9% of patients and chemotherapy in 48.1%. Sick leave was prescribed for 165 patients (92.7%) for a median of 155 days. On univariate analysis, invasive BC (p=0.025), lymph node involvement (p=0.005), radical surgery (p=0.025), axillary dissection (p=0.004), chemotherapy (p<0.001), personal income <€1900/month (p=0.03) and not having received the patient information booklet on RTW (p=0.047) were found to be associated with a longer duration of sick leave. On multivariate analysis, chemotherapy was found to be associated with longer sick leave (OR: 3.5; 95% CI 1.6 to 7.9; p=0.002). The cost of sick leave to French National Health Insurance was fourfold higher in the case of chemotherapy (p<0.001). CONCLUSION Advanced disease and chemotherapy are major factors that influence sick leave duration during the management of BC. TRIAL REGISTRATION NUMBER NCT02813317.
Collapse
Affiliation(s)
- Alexandra Arfi
- Department of Surgical Oncology, Institut Curie-Centre René Huguenin, Paris, France
| | | | - Anne-Laure Soilly
- Health Economics Department, Bourgogne Franche-Comté University, Dijon, France
| | - Cyrille Huchon
- Department of Obstetrics and Gynecology, Hôpital de Poissy-St Germain, Paris, France
- Equipe d’Accueil 7285, Risk and Safety in Clinical Medicine for Women and Perinatal Health, University Versailles-Saint-Quentin, Paris, France
| | - Fabien Reyal
- Department of Surgical Oncology, Institut Curie-Centre René Huguenin, Paris, France
- Residual Tumor and Response to Treatment Lab, Translational Research Department, Institut Curie, Paris, France
| | - Bernard Asselain
- Department of Biostatistics, Institut Curie-Centre René Huguenin, Saint-Cloud, France
| | - Souhir Neffati
- Clinical Research and Innovation Department, Sponsorship Division, Institut Curie, Saint-Cloud, France
| | - Roman Rouzier
- Department of Surgical Oncology, Institut Curie-Centre René Huguenin, Paris, France
- Inserm U900 – Bioinformatics, Biostatistics, Epidemiology and Computational Systems. Cancer Biology, René-Huguenin hospital, Institut Curie, Saint-Cloud, France
| | - Delphine Héquet
- Department of Surgical Oncology, Institut Curie-Centre René Huguenin, Paris, France
- Inserm U900 – Bioinformatics, Biostatistics, Epidemiology and Computational Systems. Cancer Biology, René-Huguenin hospital, Institut Curie, Saint-Cloud, France
| |
Collapse
|
147
|
Liu L, Meunier F. Research on cancer survivorship needs a timely frameshift, in Europe and worldwide. J Cancer Policy 2018. [DOI: 10.1016/j.jcpo.2018.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
148
|
Di Salvo F, Baili P, Vicentini M, Tumino R, Vercelli M, Pirino D, Contiero P, Foschi R, Minicozzi P, Rossi PG, de Lorenzo F, Micheli A, Marani E, Orengo MA, Rossi PG, Mangone L, Pellegri C, Di Felice E, Cascone G, Cilia S, Morana G, Nicita C, Rollo C, Sigona A, Spata E, Spata G, Budroni M, Cesaraccio R, Contiero P, Maghini A, Tagliabue G, De Lorenzo F, Del Campo L, Polacchi F, Aurora F, Vittone D, Compagni A, Fattore G, Casella I, Cifalà A, Sant M, Gatta G, Trama A, Anselmi V, Casoli C. Cancer Rehabilitation Services: An Italian Population-based Cohort Study. TUMORI JOURNAL 2018. [DOI: 10.1177/1578.17224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Francesca Di Salvo
- Analytical Epidemiology and Health Impact Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - Paolo Baili
- Analytical Epidemiology and Health Impact Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | | | | | - Marina Vercelli
- Liguria Region Cancer Registry, IRCCS AOU S Martino - Istituto Nazionale per la Ricerca sul Cancro, Genoa
- Department of Health Sciences, University of Genoa, Genoa
| | | | | | - Roberto Foschi
- Evaluation Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - Pamela Minicozzi
- Analytical Epidemiology and Health Impact Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - Paolo Giorgi Rossi
- Servizio Interaziendale di Epidemiologia, AUSL Reggio Emilia, Reggio Emilia
| | | | - Andrea Micheli
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
149
|
Kent EE, Davidoff A, de Moor JS, McNeel TS, Virgo KS, Coughlan D, Han X, Ekwueme DU, Guy GP, Banegas MP, Alfano CM, Dowling EC, Yabroff KR. Impact of sociodemographic characteristics on underemployment in a longitudinal, nationally representative study of cancer survivors: Evidence for the importance of gender and marital status. J Psychosoc Oncol 2018; 36:287-303. [PMID: 29634413 DOI: 10.1080/07347332.2018.1440274] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND We examined the longitudinal association between sociodemographic factors and an expanded definition of underemployment among those with and without cancer history in the United States. METHODS Medical Expenditure Panel Survey data (2007-2013) were used in multivariable regression analyses to compare employment status between baseline and two-year follow-up among adults aged 25-62 years at baseline (n = 1,614 with and n = 39,324 without cancer). Underemployment was defined as becoming/staying unemployed, changing from full to part-time, or reducing part-time work significantly. Interaction effects between cancer history/time since diagnosis and predictors known to be associated with employment patterns, including age, gender/marital status, education, and health insurance status at baseline were modeled. RESULTS Approximately 25% of cancer survivors and 21% of individuals without cancer reported underemployment at follow-up (p = 0.002). Multivariable analyses indicated that those with a cancer history report underemployment more frequently (24.7%) than those without cancer (21.4%, p = 0.002) with underemployment rates increasing with time since cancer diagnosis. A significant interaction between gender/marital status and cancer history and underemployment was found (p = 0.0004). There were no other significant interactions. Married female survivors diagnosed >10 years ago reported underemployment most commonly (38.7%), and married men without cancer reported underemployment most infrequently (14.0%). A wider absolute difference in underemployment reports for married versus unmarried women as compared to married versus unmarried men was evident, with the widest difference apparent for unmarried versus married women diagnosed >10 years ago (18.1% vs. 38.7%). CONCLUSION Cancer survivors are more likely to experience underemployment than those without cancer. Longer time since cancer diagnosis and gender/marital status are critical factors in predicting those at greatest risk of underemployment. The impact of cancer on work should be systematically studied across sociodemographic groups and recognized as a component of comprehensive survivorship care.
Collapse
Affiliation(s)
- Erin E Kent
- a Division of Cancer Control and Population Sciences, Healthcare Delivery Research Program, National Cancer Institute , Rockville , Maryland , USA.,b ICF International , Fairfax , VA
| | - Amy Davidoff
- c Department of Health Policy & Management , School of Public Health, Yale University , New Haven , Connecticut , USA
| | - Janet S de Moor
- a Division of Cancer Control and Population Sciences, Healthcare Delivery Research Program, National Cancer Institute , Rockville , Maryland , USA
| | - Timothy S McNeel
- d Information Management Services, Inc. , Rockville , Maryland , USA
| | - Katherine S Virgo
- e Department of Health Policy and Management , Rollins School of Public Health, Emory University , Atlanta , Georgia , USA
| | - Diarmuid Coughlan
- f Division of Cancer Control and Population Sciences, Surveillance Research Program, National Cancer Institute , Rockville , Maryland , USA
| | - Xuesong Han
- g American Cancer Society , Atlanta , Georgia , USA
| | - Donatus U Ekwueme
- h Centers for Disease Control and Prevention, Division of Cancer Prevention and Control , Atlanta , Georgia , USA
| | - Gery P Guy
- h Centers for Disease Control and Prevention, Division of Cancer Prevention and Control , Atlanta , Georgia , USA
| | - Matthew P Banegas
- i Kaiser Permanente Center for Health Research , Portland , Oregon , USA
| | | | - Emily C Dowling
- j Massachusetts General Hospital , Boston , Massachusetts , USA
| | | |
Collapse
|
150
|
Brusletto B, Torp S, Ihlebæk CM, Vinje HF. A five-phase process model describing the return to sustainable work of persons who survived cancer: A qualitative study. Eur J Oncol Nurs 2018; 34:21-27. [PMID: 29784134 DOI: 10.1016/j.ejon.2018.03.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 02/26/2018] [Accepted: 03/01/2018] [Indexed: 11/28/2022]
Abstract
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.
Collapse
Affiliation(s)
- Birgit Brusletto
- Department of Health, Social and Welfare Studies, Faculty of Health and Social Sciences, University College of Southeast Norway (USN), P.O. Box 235, NO-3603, Kongsberg, Norway.
| | - Steffen Torp
- Department of Health, Social and Welfare Studies, Faculty of Health and Social Sciences, University College of Southeast Norway (USN), P.O. Box 235, NO-3603, Kongsberg, Norway.
| | - Camilla Martha Ihlebæk
- Department of Public Health Science, Faculty of Landscape and Society, Norwegian University of Life Sciences (NMBU), Universitetstunet 1, NO-1433, Ås, Norway; Faculty of Health and Social Work Studies, Østfold University College, P.O.Box 700, NO-1757, Halden, Norway.
| | - Hege Forbech Vinje
- Department of Health, Social and Welfare Studies, Faculty of Health and Social Sciences, University College of Southeast Norway (USN), P.O. Box 235, NO-3603, Kongsberg, Norway.
| |
Collapse
|