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Roelen CAM, Koopmans PC, van Rhenen W, Groothoff JW, van der Klink JJL, Bültmann U. Trends in return to work of breast cancer survivors. Breast Cancer Res Treat 2011; 128:237-42. [PMID: 21197566 DOI: 10.1007/s10549-010-1330-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Accepted: 12/22/2010] [Indexed: 11/30/2022]
Abstract
Most women interrupt their work activities during the treatment of cancer. This study investigated return to work (RTW) after treatment of breast cancer in the period from January 2002 to December 2008. ArboNed Occupational Health Service records the sickness absence and RTW data of more than one million workers of whom approximately 40% are women. Incident cases of sickness absence due to breast cancer (ICD-10 code C50) were selected from the ArboNed register. Proportions of partial RTW, with 50% of the earnings before sickness absence, and full RTW were determined 1 year after diagnosis. Trends in partial RTW and full RTW were examined by Chi-square trend analysis. The time to partial RTW and full RTW was analysed by Cox regression and stratified by age (<40 years, 40-50 years and >50 years). The proportion of partial RTW was stable around 70% from 2002 to 2008. The proportion of full RTW decreased from 52% in 2002 to 43% in 2008 and showed a linear decline in women of all ages. The time to partial RTW and full RTW in the years 2003-2008 did not change significantly compared with 2002. In the Netherlands, the proportion of employed women who fully resumed working after breast cancer within 1 year of diagnosis has decreased since 2002. These results warrant more epidemiological research to examine the trends in RTW of breast cancer survivors across countries.
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Affiliation(s)
- C A M Roelen
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, AD, Groningen, The Netherlands.
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202
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de Boer AGEM, Bruinvels DJ, Tytgat KMAJ, Schoorlemmer A, Klinkenbijl JHG, Frings-Dresen MHW. Employment status and work-related problems of gastrointestinal cancer patients at diagnosis: a cross-sectional study. BMJ Open 2011; 1:e000190. [PMID: 22138895 PMCID: PMC3236817 DOI: 10.1136/bmjopen-2011-000190] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Objective To assess the employment status of patients with gastrointestinal cancer at diagnosis and to examine work-related problems of employed patients. Design New, consecutive patients were included at the Gastrointestinal Oncology Center Amsterdam, a one-stop, rapid access diagnostic assessment centre. Patients were interviewed on their employment status by a nurse. If (self-) employed, patients were asked to self-report on work-related problems, perceived distress (0-10), cancer-related problems, fatigue (MFI-20, range 4-20) and work ability (three WAI questions, range 0-10). Results Of all 333 included new consecutive patients (age range 32-89 years), 95 patients (28%) were (self-) employed at time of diagnosis, 179 (54%) were pensioners, and 59 were not working (18%). For the assessment of work-related problems, 45 (47%) of these 95 employed patients with cancer participated. Their mean age was 56 years, and patients had oesophageal/stomach (49%), colorectal (18%) or hepatic/pancreatic/biliary cancer (33%). Half of the employed patients (49%) were still at work, while 51% were on sick leave. The main reasons for sick leave were stress (35%), (scheduled) operation (26%), fatigue (17%) and pain (13%). Most patients on sick leave (70%) had no contact with their own occupational physician, although the majority (67%) would like to continue to work. Work-related problems were experienced by 73% of working patients. The mean work ability was 5.4, the mean general fatigue score was 11.5, and the mean distress score was 4.7. Employed patients on sick leave reported a lower work ability, more fatigue and higher distress but no more cancer-related problems compared with those still working. Conclusion A quarter of all patients with gastrointestinal cancer seen at an oncological centre are employed at time of diagnosis, and of these employed patients, 73% experience work-related problems. During diagnosis and treatment, information and support on work-related issues should be offered to patients with cancer as an essential part of high-quality oncological care.
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Affiliation(s)
- A G E M de Boer
- Coronel Institute of Occupational Health (Outpatient Clinic People and Work), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - D J Bruinvels
- Coronel Institute of Occupational Health (Outpatient Clinic People and Work), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - K M A J Tytgat
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Gastrointestinal Oncology Center Amsterdam (GIOCA), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - A Schoorlemmer
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Gastrointestinal Oncology Center Amsterdam (GIOCA), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - J H G Klinkenbijl
- Gastrointestinal Oncology Center Amsterdam (GIOCA), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - M H W Frings-Dresen
- Coronel Institute of Occupational Health (Outpatient Clinic People and Work), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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203
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Grunfeld EA, Cooper AF. A longitudinal qualitative study of the experience of working following treatment for gynaecological cancer. Psychooncology 2010; 21:82-9. [PMID: 21105181 DOI: 10.1002/pon.1874] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Revised: 09/23/2010] [Accepted: 10/09/2010] [Indexed: 11/12/2022]
Abstract
OBJECTIVE There are an increasing number of gynaecological cancer survivors for whom returning to work is a realistic outcome. There is little research to date specifically examining the return to work experience of survivors of gynaecological cancers. The aim of this study was to explore gynaecological cancer survivors' experience of work over a 1-year period post-treatment. METHODS A total of 55 gynaecological cancer survivors completed a semi-structured interview following completion of their treatment and of these 36 also completed a follow-up interview 12 months later. In total, 91 interviews were recorded and transcribed verbatim. Framework analysis of the transcripts was undertaken. RESULTS Three super-ordinate themes were identified and these were labelled 'Meaning of work', 'Disclosure of cancer diagnosis' and 'Readjustment'. Overall, there were few changes in working patterns between the two interview points with the majority of women returning to the same role. Although a desire to make work-related changes was expressed at baseline, few women had initiated such changes 1-year post-treatment. CONCLUSIONS Employees may experience difficulties due to residual symptoms, such as continuing fatigue, or as a result of unrealistic expectations about returning to full employment soon after treatment has completed. The results highlight the need for an intervention to support gynaecological cancer survivors to cope with long-term residual symptoms and manage expectations about returning to work.
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Affiliation(s)
- E A Grunfeld
- King's College London, Psychology Department, Institute of Psychiatry, Guy's Hospital, London, UK.
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204
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Taskila T, de Boer AGEM, van Dijk FJH, Verbeek JHAM. Fatigue and its correlates in cancer patients who had returned to work--a cohort study. Psychooncology 2010; 20:1236-41. [PMID: 20821375 DOI: 10.1002/pon.1843] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Revised: 05/06/2010] [Accepted: 07/20/2010] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Fatigue and other symptoms in cancer patients often interfere with social and occupational activities. Only a few studies, however, have examined relationship between fatigue and work-related outcomes. The aim of this study was to investigate which disease-related factors (treatment, diagnosis, cognitive dysfunction, depression, pain, and sleep disturbance) and work-related factors (work-load, work pressure, relationship to supervisor and colleagues, size of the company, and workplace accommodations) were related to fatigue in employed cancer survivors. METHODS Data was collected by questionnaire at 6 months (baseline) and 18 months (end of the follow-up) after cancer diagnosis from 135 people with different types of cancer who had returned to work at follow-up. Fatigue was measured with a four-item sub-scale of MFI. Scores ranged from 4 to 20, with higher scores indicating more fatigue. RESULTS The mean rate of general fatigue was 11.9 at baseline decreasing to 10.4 at the end of the follow-up (p<0.0001). At 6 months, higher work pressure (p = 0.02), physical workload (p<0.05) and less workplace accommodations (p = 0.03) were related to higher levels of fatigue. From disease-related factors, depression was associated with fatigue (p<0.0001) at baseline. Lack of workplace accommodations was the only factor affecting higher levels of fatigue at 18 months (p<0.001) and was also related to higher levels of depression at 6 months (p = 0.02) and at 18 months (p<0.001). CONCLUSIONS Lack of workplace accommodations was significantly related to fatigue at the end of the follow-up, which suggests that accommodations for illness can help to reduce fatigue and depression.
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Affiliation(s)
- T Taskila
- Coronel Institute of Occupational Health, Academic Medical Center, Amsterdam, The Netherlands.
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205
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Lindbohm ML, Kuosma E, Taskila T, Hietanen P, Carlsen K, Gudbergsson S, Gunnarsdottir H. Cancer as the cause of changes in work situation (a NOCWO study). Psychooncology 2010; 20:805-12. [PMID: 20623820 DOI: 10.1002/pon.1797] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Revised: 06/01/2010] [Accepted: 06/01/2010] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To investigate the frequency of changes in work situation due to cancer and to analyze the association of physically demanding work, social support from supervisors, colleagues or occupational health services, and disease-related factors, with changing employers due to cancer. METHODS Working-aged patients with breast, testicular or prostate cancer, or lymphoma with a good prognosis between 1997 and 2002 were identified from a hospital or cancer registry in four Nordic countries. The registers provided data on the disease-related factors. Information on changes in work situation, received support, and other work-related factors was collected using a questionnaire (response rate 72%). The frequency of changes in work situation was evaluated among a total of 2030 survivors. Further analyses were carried out among 688 survivors using a multivariable logistic regression model, to investigate factors affecting the risk of changing employers due to cancer. RESULTS Altogether, 5-10% of cancer survivors had changed employers, occupations or work tasks, 5% had been unemployed, and 9% had retired due to cancer. The physical demands of previous work were the most important reason behind changing employers after cancer. Among women, weak support from supervisors and occupational health personnel increased the risk of changing employers because of cancer. CONCLUSIONS A minority of cancer survivors changed employers, occupations, or work tasks because of cancer. Supervisors' support in the form of lightening physically demanding jobs and taking illness into consideration when planning work tasks, and health-care workers' advice on coping at work may help survivors to maintain their jobs.
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Affiliation(s)
- M-L Lindbohm
- Centre of Expertise for Health and Work Ability, Finnish Institute of Occupational Health, Helsinki, Finland.
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206
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Tamminga SJ, de Boer AGEM, Verbeek JHAM, Taskila T, Frings-Dresen MHW. Enhancing return-to-work in cancer patients, development of an intervention and design of a randomised controlled trial. BMC Cancer 2010; 10:345. [PMID: 20594347 PMCID: PMC2907345 DOI: 10.1186/1471-2407-10-345] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2010] [Accepted: 07/01/2010] [Indexed: 01/22/2023] Open
Abstract
Background Compared to healthy controls, cancer patients have a higher risk of unemployment, which has negative social and economic impacts on the patients and on society at large. Therefore, return-to-work of cancer patients needs to be improved by way of an intervention. The objective is to describe the development and content of a work-directed intervention to enhance return-to-work in cancer patients and to explain the study design used for evaluating the effectiveness of the intervention. Development and content of the intervention The work-directed intervention has been developed based on a systematic literature review of work-directed interventions for cancer patients, factors reported by cancer survivors as helping or hindering their return-to-work, focus group and interview data for cancer patients, health care professionals, and supervisors, and vocational rehabilitation literature. The work-directed intervention consists of: 1) 4 meetings with a nurse at the treating hospital department to start early vocational rehabilitation, 2) 1 meeting with the participant, occupational physician, and supervisor to make a return-to-work plan, and 3) letters from the treating physician to the occupational physician to enhance communication. Study design to evaluate the intervention The treating physician or nurse recruits patients before the start of initial treatment. Patients are eligible when they have a primary diagnosis of cancer, will be treated with curative intent, are employed at the time of diagnosis, are on sick leave, and are between 18 and 60 years old. After the patients have given informed consent and have filled out a baseline questionnaire, they are randomised to either the control group or to the intervention group and receive either care as usual or the work-directed intervention, respectively. Primary outcomes are return-to-work and quality of life. The feasibility of the intervention and direct and indirect costs will be determined. Outcomes will be assessed by a questionnaire at baseline and at 6, 12, 18, and 24 months after baseline. Discussion This study will provide information about the effectiveness of a work-directed intervention for cancer patients. The intention is to implement the intervention in normal care if it has been shown effective. Trial registration NTR1658
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Affiliation(s)
- Sietske J Tamminga
- Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
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207
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Munir F, Burrows J, Yarker J, Kalawsky K, Bains M. Women’s perceptions of chemotherapy-induced cognitive side affects on work ability: a focus group study. J Clin Nurs 2010; 19:1362-70. [DOI: 10.1111/j.1365-2702.2009.03006.x] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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208
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Steiner JF, Nowels CT, Main DS. Returning to work after cancer: quantitative studies and prototypical narratives. Psychooncology 2010; 19:115-24. [PMID: 19507264 DOI: 10.1002/pon.1591] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE A combination of quantitative data and illustrative narratives may allow cancer survivorship researchers to disseminate their research findings more broadly. We identified recent, methodologically rigorous quantitative studies on return to work after cancer, summarized the themes from these studies, and illustrated those themes with narratives of individual cancer survivors. METHODS We reviewed English-language studies of return to work for adult cancer survivors through June 2008, and identified 13 general themes from papers that met methodological criteria (population-based sampling, prospective and longitudinal assessment, detailed assessment of work, evaluation of economic impact, assessment of moderators of work return, and large sample size). We drew survivorship narratives from a prior qualitative research study to illustrate these themes. RESULTS Nine quantitative studies met four or more of our six methodological criteria. These studies suggested that most cancer survivors could return to work without residual disabilities. Cancer site, clinical prognosis, treatment modalities, socioeconomic status, and attributes of the job itself influenced the likelihood of work return. Three narratives-a typical survivor who returned to work after treatment, an individual unable to return to work, and an inspiring survivor who returned to work despite substantial barriers-illustrated many of the themes from the quantitative literature while providing additional contextual details. CONCLUSION Illustrative narratives can complement the findings of cancer survivorship research if researchers are rigorous and transparent in the selection, analysis, and retelling of those stories.
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Affiliation(s)
- John F Steiner
- Colorado Health Outcomes Program, University of Colorado Denver, CO, USA.
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209
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Mols F, Thong MSY, Vreugdenhil G, van de Poll-Franse LV. Long-term cancer survivors experience work changes after diagnosis: results of a population-based study. Psychooncology 2010; 18:1252-60. [PMID: 19156675 DOI: 10.1002/pon.1522] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Although cancer survivorship is increasing with improved diagnosis and treatments, few studies have explored employment changes and the factors related to this change among cancer survivors. Therefore, we aim to explore the prevalence of employment problems in long-term cancer survivors. In addition, we explored what patient or tumour characteristics predicted employment changes. METHODS All 1893 long-term survivors of prostate cancer, endometrial cancer, non-Hodgkin's lymphoma, and Hodgkin's lymphoma diagnosed between 1989 and 1998 in the area of the Comprehensive Cancer Centre South, The Netherlands were included in a population-based cross-sectional survey. RESULTS Response rate was 80% (n=1511). After excluding survivors without a job before diagnosis, 403 survivors remained; 197 (49%) experienced no changes in their work situation following cancer diagnosis, 69 (17%) were working fewer hours, and 137 (34%) stopped working or retired. A medium educational level was significant in reducing the risk of work changes. Being older, having more than one comorbid condition, being treated with chemotherapy, and disease progression were significant independent predictors of work changes after cancer. Experiencing work changes was associated with lower physical functioning but positively associated with social well-being. DISCUSSION Long-term cancer survivors experience work changes after diagnosis and treatment, and clinical factors significantly predicted work change after cancer. As such, our study underscores the importance of rehabilitation programs in improving the return to work after cancer.
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Affiliation(s)
- Floortje Mols
- CoRPS-Center of Research on Psychology in Somatic diseases, Department of Medical Psychology, Tilburg University, 5000 LE Tilburg, The Netherlands.
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210
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Raterman HG, Hoving JL, Nurmohamed MT, Herenius MMJ, Sluiter JK, Lems WF, Tak PP, Dijkmans BAC, Twisk J, Frings-Dresen MHW, Voskuyl AE. Work ability: a new outcome measure in rheumatoid arthritis? Scand J Rheumatol 2010; 39:127-31. [DOI: 10.3109/03009740903447044] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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211
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Verdonck-de Leeuw IM, van Bleek WJ, René Leemans C, de Bree R. Employment and return to work in head and neck cancer survivors. Oral Oncol 2010; 46:56-60. [DOI: 10.1016/j.oraloncology.2009.11.001] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2009] [Revised: 11/02/2009] [Accepted: 11/03/2009] [Indexed: 11/25/2022]
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212
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de Boer AGM, Taskila T, Tamminga SJ, Frings-Dresen MHW, Feuerstein M, Verbeek JH. Interventions to enhance return-to-work for cancer patients. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2009. [DOI: 10.1002/14651858.cd007569] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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213
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Amir Z, Wynn P, Whitaker S, Luker K. Cancer survivorship and return to work: UK occupational physician experience. Occup Med (Lond) 2008; 59:390-6. [PMID: 19073991 DOI: 10.1093/occmed/kqn150] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Survivorship following diagnosis of cancer is increasing in prevalence. However, cancer survivors continue to report difficulty re-entering the workplace after diagnosis and treatment. AIMS To survey UK occupational health physicians (OHPs) regarding their role in rehabilitation of employed survivors of cancer. METHODS Following a pilot study, a questionnaire exploring opinions of OHPs regarding supporting cancer survivors' return to work was posted to all members of the UK Society of Occupational Medicine, with a repeat posting 2 months later. Responses were analyzed for significant correlations with OHP age, sex, qualification level, size of businesses advised and years of experience. RESULTS There were 797 respondents (response rate 51%). Responses suggested opportunities for developing the knowledge base in relation to prognosis and functional outcomes in patients with a cancer diagnosis; instituting information resources on cancer and work for OHPs and developing communications skills training. Most respondents felt managers treated referral to occupational health (OH) differently for employees with cancer compared with management referral for employees with other diagnoses, with 45% of respondents indicating referral may take place too late to be effective in securing a return to work. A significant lack of understanding of the information requirements of employers and the role of OH by treating doctors was identified. CONCLUSIONS This survey raises several possible significant barriers to return to work by cancer survivors. Recommendations to ameliorate these are made.
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Affiliation(s)
- Ziv Amir
- Macmillan Research Unit, School of Nursing, Midwifery and Social Work, University of Manchester, University Place, Manchester, UK.
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214
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Berg Gudbergsson S, Fosså SD, Dahl AA. Is cancer survivorship associated with reduced work engagement? A NOCWO Study. J Cancer Surviv 2008; 2:159-68. [PMID: 18654861 DOI: 10.1007/s11764-008-0059-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2008] [Accepted: 06/13/2008] [Indexed: 11/28/2022]
Abstract
INTRODUCTION This study explores work engagement in employed tumor-free cancer survivors (CSs) compared to matched controls from the general population (NORM). METHODS The sample consisted of 446 CSs tumor-free after primary treatment [226 females with breast cancer and 220 males (166 testicular cancer and 54 prostate cancer)] diagnosed 2-6 years prior to the study. All had returned to work and had favourable prognosis. NORM sample consisted of 588 employed controls (319 females, 269 males). All CSs and NORM filled in a mailed questionnaire covering demography, morbidity, and work-related issues including work engagement which was self-rated by the Utrecht Work Engagement Scale (UWES). RESULTS No differences in work engagement were observed between the CSs and NORM measured by the UWES total scale score or by the Dedication and Absorption domain scores. The Vigor domains score was statistically lower among CSs (p = .03), but the effect size was only 0.19. The CSs reported significantly poorer work ability, poorer health status, greater numbers of disease symptoms, more anxiety, and reduced physical quality of life, and scored significantly higher on both neuroticism and extraversion. CONCLUSIONS/IMPLICATIONS FOR CSS: In spite of poorer health CSs who had returned to work after their treatment for breast, prostate, and testicular cancer showed similar work engagement as individuals without cancer. In such CSs employers have no reason to expect reduced work engagement. Future research should preferably have a prospective and comparative design.
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Affiliation(s)
- Saevar Berg Gudbergsson
- Department of Clinical Cancer Research, The Norwegian Radium Hospital, Rikshospitalet University Hospital, Montebello, Oslo, Norway.
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215
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Terugkeer naar werk na behandeling voor kanker: ervaringen van patiënten en leidinggevenden. ACTA ACUST UNITED AC 2008. [DOI: 10.1007/bf03078039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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