Correlates of return to work for breast cancer survivors

Work task disability in employed breast and prostate cancer patients

INTRODUCTION

Nearly 60% of cancer survivors are of working age, making inquiries into work-related disabilities particularly relevant. This paper describes work-related physical and cognitive disability estimates 12 and 18 months after diagnosis and treatment in a sample of employed breast and prostate cancer patients.

METHODS

We recruited employed, newly diagnosed patients (n=447 breast, n=267 prostate) from the Metropolitan Detroit Cancer Surveillance System for telephone interviews 12 and 18 months after diagnosis. We defined disability by work task activity limitation. Disability estimates and employment were compared using Pearson chi-square tests. Duration of hours worked was compared by disability status using t-tests.

RESULTS

Approximately 60% of women reported physical disability at 12 months which decreased to 36% at 18 months. Cognitive disability was reported by 34% and 22% of women at 12 and 18 months, respectively. Fewer men reported physical disability, only 29% at 12 months, decreasing to 17% at 18 months. Cognitive disability was reported by 12% and 7% of men at 12 and 18 months, respectively. More individuals with disability left the workforce at each timeframe than those without disability.

CONCLUSIONS

A significant proportion of breast and prostate cancer patients experienced work-related disabilities 1 year or more following treatment. Physical disability was more problematic than cognitive disability.

Returning to work after cancer: quantitative studies and prototypical narratives

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.

The role of socioeconomic status in adjustment after ductal carcinoma in situ

BACKGROUND

A large body of literature suggests that socioeconomic status (SES) is positively associated with mental and physical health. However, little research has examined the impact of SES on psychological adjustment after a major stressor. The current study examined whether SES (education and financial status) was associated with distress (anxiety and depression) in women diagnosed with ductal carcinoma in situ (DCIS). This study also explored whether social support explained the association between SES and distress and whether social support buffered the impact of low SES on distress.

METHODS

A total of 487 women with newly diagnosed DCIS were enrolled in the study. Participants completed questions about sociodemographic, psychosocial, and clinical characteristics at the time of enrollment and 9 months after their diagnosis.

RESULTS

Financial status was inversely associated with anxiety and depression at the 9-month follow-up. Financial status also predicted change in anxiety and depression. Women with high financial status reported a decline in anxiety and depression during the study period, whereas women with medium or low financial status reported an increase in anxiety and depression. In addition, the probability of exceeding the screening threshold suggestive of clinical depression increased with decreasing financial status. Education was not associated with anxiety or depression. The presence of social support did not explain the association between financial status and change in distress. Social support did not buffer the effect of low SES on anxiety and depression.

CONCLUSIONS

Women with medium or low SES were vulnerable to escalating anxiety and depression after a DCIS diagnosis.

Long-term cancer survivors experience work changes after diagnosis: results of a population-based study

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.

Factors related to return to work by women with breast cancer in northern France

INTRODUCTION

Earlier diagnosis and better treatment have increased the survival rates of breast cancer patients. This warrants research on return to work of cancer survivors, especially about subjective factors because they affect the mental desire to return to work. Moreover, knowledge in this issue is very limited in France.

OBJECTIVES

This study aims to explore the objective and subjective factors that affect whether and when women with breast cancer return to work.

METHODS

379 women with breast cancer aged 18-60 years who were working at the time of diagnosis responded to a 45 item questionnaire. The questionnaire had personal characteristics, disease-related characteristics and work-related ones. Multivariate logistic regressions were run to determine the association of these factors and return to work and time until return to work.

RESULTS

During a median follow-up of 36 months, 82.1% of the 379 women who had worked before their diagnosis returned to work after a median sick leave of 10.8 months. Older age, lower educational level, chemotherapy, radiotherapy, lymphoedema, psychological or organizational self-perceived constraints related to their former job, and the lack of moral support from work colleagues both limited and delayed return to work.

CONCLUSION

The resumption of work by women with breast cancer depends on many factors, not all of them medical. The self-perceived factors must be considered: first to help support these women during their sick leave, while taking into account elements that may hinder early return to work; second to initiate a work resumption support process which takes into account both the person and her environment.

Factors influencing changes in employment among women with newly diagnosed breast cancer

BACKGROUND

Although studies have demonstrated that women are less likely to work after they are diagnosed with breast cancer, the influence of cancer treatments on employment is less clear. The authors of this report assessed whether chemotherapy or radiation therapy was associated with a disruption in employment during the year after a breast cancer diagnosis.

METHODS

Using a database of health insurance claims that covered 5.6 million US residents, 3,233 women aged <or=63 years were identified who were working full time or part time when they were diagnosed with breast cancer between 1998 and 2002. All changes in employment during the year after a breast cancer diagnosis were identified. Using a Cox proportional hazards model that incorporated time-varying treatment variables, the authors evaluated the impact of chemotherapy and radiation therapy on the likelihood of experiencing an employment disruption.

RESULTS

Although most women (93%) continued to work, chemotherapy recipients were more likely than nonrecipients to go on long-term disability, stop working, or retire (hazards ratio, 1.8; P < .01). Women aged >or=54 years were more likely to experience a change in employment than women aged <or=44 years (P < .01). Radiation therapy did not influence employment (P = .22).

CONCLUSIONS

In this population of employed, insured women, chemotherapy had a negative impact on employment. This finding may aid treatment decision making and could foster the development of interventions that support a patient's ability to continue working after treatment. It also reinforces the need to assess the impact of treatments, especially new treatments, on patient-centered outcomes such as employment.

Factors associated with return to work after breast cancer treatment

Relatively few studies have addressed problems regarding return to work after primary treatment for early-stage breast cancer. The purpose of this study was to investigate whether socio-economic and treatment-related factors were associated with problems of returning to work among pre-menopausal women included in a randomized trial of adjuvant endocrine therapy. The duration of all endocrine treatments in the trial was two years. At 24 months after randomization 35 of the 222 recurrence-free patients (16%) had not returned to work. The use of adjuvant endocrine therapy was associated with a twofold increase in the odds ratio of not having returned to work, although the confidence interval of this ratio was wide and included unity. Tumour stage was negatively associated with work status, possibly because of its association with adjuvant chemotherapy and radiotherapy to the regional nodes. Age and investigated social factors (educational level, matrimonial status and presence of under-age children) were not significantly associated with return to work. Determining the significance of other social factors such as vocational motivation, level of income and vocational rehabilitation merits further research.

Return to work of breast cancer survivors: a systematic review of intervention studies

Background

Breast cancer management has improved dramatically in the past three decades and as a result, a population of working age women is breast cancer survivor. Interventions for breast cancer survivors have shown improvements in quality of life and in physical and psychological states. In contrast, efforts aimed at stimulating re-employment and return-to-work interventions for breast cancer survivors have not kept pace. The objective of this review was to study the effects and characteristics of intervention studies on breast cancer survivors in which the outcome was return to work.

Methods

The Cochrane Controlled Trials Register (The Cochrane Library, Issue 4, 2006), Medline, Ovid, EMBASE and PsychInfo were systematically searched for studies conducted between 1970 to February 2007. Intervention studies for female breast cancer survivors that were focused on return to work were included.

Results

Our search strategy identified 5219 studies. Four studies out of 100 potentially relevant abstracts were selected and included 46–317 employed women who had had mastectomy, adjuvant therapy and rehabilitation, with the outcome return to work. The intervention programs focused on improvement of physical, psychological and social recovery. Although a substantial percentage (between 75% to 85%) of patients included in these studies returned to work after rehabilitation, it is not clear whether this proportion would have been lower for patients without counseling or exercise, or any other interventions, as three out of four studies did not include a comparison group.

Conclusion

The most important finding of this review is the lack of methodologically sound intervention studies on breast cancer survivors with the outcome return to work. Using evidence from qualitative and observational studies on cancer and the good results of intervention studies on return to work programs and vocational rehabilitation, return to work interventions for breast cancer survivors should be further developed and evaluated.

The impact of sociodemographic, treatment, and work support on missed work after breast cancer diagnosis

Work loss is a potential adverse consequence of cancer. There is limited research on patterns and correlates of paid work after diagnosis of breast cancer, especially among ethnic minorities. Women with non-metastatic breast cancer diagnosed from June 2005 to May 2006 who reported to the Los Angeles County SEER registry were identified and asked to complete the survey after initial treatment (median time from diagnosis = 8.9 months). Latina and African American women were over-sampled. Analyses were restricted to women working at the time of diagnosis, <65 years of age, and who had complete covariate information (N = 589). The outcome of the study was missed paid work (<or=1 month, >1 month, stopped all together). Approximately 44, 24, and 32% of women missed <or=1 month, >1 month, or stopped working, respectively. African Americans and Latinas were more likely to stop working when compared with Whites [OR for stop working vs. missed <or=1 month: 3.0, 3.4, (P < 0.001), respectively]. Women receiving mastectomy and those receiving chemotherapy were also more likely to stop working, independent of sociodemographic and treatment factors [ORs for stopped working vs. missed <or=1 month: 4.2, P < 0.001; 7.9, P < 0.001, respectively]. Not having a flexible work schedule available through work was detrimental to working [ORs for stopped working 18.9, P < 0.001 after adjusting for sociodemographic and treatment factors]. Many women stop working altogether after a diagnosis of breast cancer, particularly if they are racial/ethnic minorities, receive chemotherapy, or those who are employed in an unsupportive work settings. Health care providers need to be aware of these adverse consequences of breast cancer diagnosis and initial treatment.

Limitations on work and attendance rates after employees with cancer returned to work at a single manufacturing company in Japan

OBJECTIVES

The purpose of this study was to evaluate the work limitations and attendance rates after employees diagnosed with cancer returned to work from sick leave, and to identify the related factors for the limitations and attendance rates at a single manufacturing company in Japan.

METHODS

This study retrospectively analyzed 129 men and 4 women, employed in a single manufacturing industry, who returned to work after sick leave due to newly diagnosis of cancer. Limitations on work after the return to work were enforced in the workplace based on an industrial physician's evaluation. All the employees who needed measures for work were examined by the industrial physicians every 1-6 months until the termination of such work limitations.

RESULTS

Limitations on work after the return to work were enforced for 79 (59%) employees (36 employees with alteration of work, 31 with prohibition of shift work and 55 with prohibition of overtime work). A higher degree of work limitations was significantly correlated with work-related factors before sick leave (i.e. shift work, production line) as well as disease/treatment-related factors (i.e. chemotherapy, recurrence/metastasis), while the attendance rates after the return to work were not correlated with adverse work-related factors before sick leave.

CONCLUSION

The enforcement of work limitations for employees with cancer was relatively common and was based on both disease/treatment- and work-related factors, and this phenomenon may play an important role in the return to work as well as the successful continuation of work after cancer survivors return to work.

Employment and quality of survivorship among women with cancer: domains not captured by quality of life instruments

BACKGROUND

Many quality of life instruments assess the amount of paid work in combination with role function at home in the same items and do not specifically assess social support in the workplace. The goal of this study was to obtain women's views on the relationship between employment and health-related quality of life.

METHODS

A focus group and questionnaire study was conducted among 73 women with gynecologic cancer who were employed at diagnosis and 25 people who provided them with psychosocial support.

RESULTS

The women held a variety of blue collar and white collar jobs at diagnosis. Employment provided a strong sense of accomplishment and a welcome distraction during treatment. The employment experience was described as distinct from role function at home. No one equated working more hours with better quality of life. Social support at work could be poor at the same time that support from family and friends grew stronger.

CONCLUSIONS

The contribution to their quality of life that cancer survivors feel they receive from employment may not be linearly related to the quantity of their role function in the workplace. Employment-related items could be useful as an adjunct to standard quality of life measures.

Predictors of return to work ten months after primary breast cancer surgery

BACKGROUND

The most common female cancer in Western countries is breast cancer and women diagnosed with this disease are often under 65 years old. With increasing prevalence of survivors it is important to shed light on problems facing these women after diagnosis and treatment. The aim of this study was to assess factors predicting return to work (RTW) in women with early-stage breast cancer.

MATERIAL AND METHODS

A cohort of 102 women aged 18-64 with early-stage breast cancer who had undergone curative primary surgery with or without systemic adjuvant therapy were followed for 10 months using data from questionnaires and medical files.

RESULTS

Ten months after primary surgery, 59% of the women had returned to work while 41% were sick-listed part-time or full-time. After adjusting for age, health status, life satisfaction, vocational situation, and irradiation to the breast/chest wall and regional nodes, a multivariate logistic regression revealed the following factors as being negatively associated with RTW: a high-demand job (OR=0.1, 95% CI 0.0-0.8), axillary node dissection (OR=0.1, 95% CI 0.0-0.6), and treatment with chemotherapy (OR=0.1, 95% CI 0.0-0.7).

DISCUSSION

Treatment factors and high demands at work play an important role in RTW for women with early-stage breast cancer.

Hot flashes, fatigue, treatment exposures and work productivity in breast cancer survivors

INTRODUCTION

While fatigue has been associated with work limitations the combined influence of specific diagnosis and treatment exposures based on medical records on work limitations in breast cancer survivors is currently unknown. Since symptom burden and perceived health can interfere with work, the present study investigated the relationship among these variables and work outcomes.

METHODS

Medical chart abstraction, demographic measures, SF 36, the Work Limitations Questionnaire (WLQ) and measures of symptom burden, including hot flushes were obtained in 83 breast cancer survivors a mean of three years post treatment. OLS and poisson regression were used to determine the relationship of these factors to work productivity and work absences.

RESULTS

Breast cancer survivors reported a mean reduction in productivity of 3.1% below the healthy worker norm. This amounts to a loss of 2.48 hours of work over two weeks of full time employment. Stages 1 and 2 were related to work limitations. After controlling for stage, fatigue and hot flashes were each associated with work performance losses of 1.6% (p = 0.05) and 2.2% (p < 0.001), respectively. Protective factors included marriage and greater personal earned income.

CONCLUSIONS

Fatigue and hot flashes are important factors related to work productivity in breast cancer survivors even at three years post treatment. IMPLICATIONS FOR SURVIVORS: Therapy for hot flashes should be given serious consideration in breast cancer survivors who are experiencing work limitations.

Impact of breast cancer diagnosis and treatment on work-related life and factors affecting them

We investigated the impacts of breast cancer diagnosis and treatment on employment status and the ability to perform occupational and housekeeping tasks. We performed a cross-sectional study to compare Korean breast cancer survivors (n = 1,594) who had been working before cancer diagnosis with a group of 20 to 60-year-old women from the general Korean population (n = 415). Employment decreased from 47.6% to 33.2% after cancer treatment. It was significantly smaller relative to the general population (52.1%) [adjusted odds ratio (aOR) = 1.68; 95% confidence interval (CI): 1.35-2.11). There was an inverse association between employment and low levels of education, low household income, multiple comorbidities, disease stage, and mastectomy. In addition, women who lived with a spouse were more likely to quit working after treatment compared to women who had no spouse. Fatigue and exhaustion were the most frequent difficulties encountered during occupational work (by 46.8% of cancer survivors) and housework (64.6%). Our findings suggest that breast cancer has a greater impact on employment among Korean women than among women in previously studied Western populations. Our data suggest that socio-cultural factors, as well as certain clinical characteristics, influence the decisions of Korean women to return or to not return to work after surviving breast cancer.

Pattern of workplace disputes in cancer survivors: a population study of ADA claims

BACKGROUND

The Americans with Disability Act (ADA) claim patterns can provide information on sources of potential work discrimination faced by employees with various health problems. This study investigated the pattern of ADA disputes among cancer survivors and non-cancer related impairments.

MATERIALS AND METHODS

Using multivariable logistic regression adjusting for demographics, employees with cancer related claims were compared to employees with other impairment related claims for alleged violations from 2000 to 2005. The impairments were grouped into orthopedic, behavioral, medical, neurological, sensory, cancer, cancer comorbid (cancer and non-cancer impairments), and comorbid "other" (non-cancer comorbid disorders). The dispute categories included: termination, reasonable accommodation, relations, terms, hiring, and a nonspecific "other" category.

RESULTS

This study analyzed 59,981 cases over a 6 year period. All comparisons were made in relation to the cancer group. There was a protective effect for any impairment other than cancer (OR = 0.29-0.63, 95% CI = 0.25-0.72) related to discharge from work. Also, orthopedic (OR = 0.81, 95% CI = 0.71-0.93), general medical (OR = 0.82, 95% CI = 0.72-0.94), and neurological (OR = 0.83, 95% CI = 0.71-0.96) impairments were found to be protective for claims related to terms of employment relative to cancer. Cancer survivors who reported a second impairment in addition to cancer were more likely to file disputes that involved relations with others at work (OR = 1.47, 95% CI = 1.16-1.87) in comparison to those with cancer only. Orthopedic (OR = 2.42, 95% CI = 2.13-2.76), neurological (OR = 1.50, 95% CI = 1.30-1.72), and sensory (OR = 1.50, 95% CI = 1.29-1.73) groups were more likely to file accommodation related disputes than the cancer group. Sensory (OR = 4.41, 95% CI = 3.45-5.63), other-comorbid (OR = 2.33, 95% CI = 1.85-2.94), medical (OR = 1.92, 95% CI = 1.51-2.44), and neurological (OR = 1.59, 95% CI = 1.23-2.05) impairment groups filed more disputes related to hiring than the cancer or the cancer-comorbid group.

CONCLUSION

Cancer survivors are more likely to file job loss claims and differential treatment related to workplace policies. Those with cancer and another impairment file more claims related to relationship problems at work than cancer only. The factors accounting for these claims need to be explored in future research in order to develop more specific evidence based policy and practice.

IMPLICATIONS FOR CANCER SURVIVORS

While the percentage of cancer survivors who file claims are relatively small, job termination and terms of employment are more likely to be concerns for cancer survivors than employees with other types of impairments. If a cancer survivor has another health problem as well relationship disputes are likely to emerge.

Employment in a cohort of breast cancer patients

BACKGROUND

Breast cancer survivors can have problems in returning to work. However, the importance of work to cancer survivors has until recently received little attention.

AIMS

To investigate employment- and work-related disability in a cohort of breast cancer patients to identify possible discrimination and other obstacles to remaining in work.

METHODS

Questionnaire study of breast cancer patients employed at diagnosis and where diagnosis had been confirmed at least 6 months before the interview. Participants completed a questionnaire concerning cancer-related symptoms and work-related factors and clinical details were obtained from their medical records.

RESULTS

The study included 96 consecutive patients with breast cancer aged between 18 and 65 years. In total, 80% of patients were unable to work after diagnosis, but 56% returned to work at the end of treatment. The sequelae of the disease or its treatment and the stage of disease were independently associated with the ability to work after the end of treatment. Only one patient did not tell his/her employers and coworkers about his/her disease. In total, 29% noticed changes in their relation with co-workers and managers, usually in the sense that they tried to be helpful. None reported job discrimination.

CONCLUSION

Breast cancer survivors in this study encountered some problems in returning to work, mainly linked to the sequelae of their disease and its treatment rather than to discrimination by employers or colleagues.

Is cancer survivorship associated with reduced work engagement? A NOCWO Study

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.

State vocational services and employment in cancer survivors

BACKGROUND

This study investigated the association of state vocational rehabilitation services in the USA and work outcomes of cancer survivors who were unemployed prior to receipt of services.

METHODS

Administrative data obtained during fiscal year 2005 from the Rehabilitation Services Administration (RSA) database consisting of 1,201 closed cases with the diagnosis of cancer formed the sample of this study. All cancer survivors were unemployed at the time of application. Data on demographic characteristics, employment and vocational service variables were extracted and analyzed in relation to employment outcome data. Multivariate logistic regression was used to examine the relationship among services provided and work outcomes accounting for demographic characteristics of the participants.

RESULTS

Cancer survivors represented 0.4% of the total population that received vocational services in the state-federal vocational rehabilitation program. Of the unemployed cancer survivors who received services, 903 (57%) achieved successful employment while 670 (43%) were not employed following receipt of services. Gender (women; OR = 0.77, 95% CI = 0.61-0.97), lower educational levels (OR = 0.52, 95% CI = 0.33-0.81), provision of cash or medical benefits (e.g., Social Security Disability Insurance benefits; OR = 0.64, 95% CI = 0.50-0.82) were all associated with a greater likelihood of being unemployed at the end of vocational services. Counseling (OR = 1.33, 95% CI = 1.02-1.73), miscellaneous training (OR = 1.61, 95% CI = 1.06-2.44), rehabilitation technology services (OR = 1.22, 95% CI = 0.72-2.08), job placement services (OR = 2.37, 95% CI = 1.72-3.27), job search assistance (OR = 1.43; 95% CI = 1.02-2.01) maintenance services (OR = 1.92, 95% CI = 1.29-2.86), and other services (OR = 1.43, 95% CI = 1.07-1.90) were found to be significantly associated with increased odds for employment.

CONCLUSION

Vocational rehabilitation services were found to be associated with employment status. Future studies investigating the specific effects of certain vocational services for unemployed cancer survivors who qualify for these services are warranted.

IMPLICATIONS FOR CANCER SURVIVORS

Cancer survivors who are seeking employment or experiencing problems maintaining employment who can qualify should be encouraged to pursue services from state vocational rehabilitation agencies. Medical providers should also become familiar with services offered by state vocational rehabilitation agencies and consider the use of these services..

Cancer's impact on employment and earnings--a population-based study from Norway

INTRODUCTION

Increased attention is being paid to the long-term health and well-being of people living with a history of cancer. Of particular concern is cancer's effect on productivity and work ability, which in turn is important for persons' financial situation, life satisfaction, and social relationships. We explored the extent to which Norwegian cancer survivors stay affiliated to working life compared to the cancer-free population, and quantified cancer-associated earning declines.

METHODS AND RESULTS

Logistic regression models were estimated to explore the impact of cancer on employment using register data covering the entire Norwegian population in 2001, 567,000 men and 549,300 women 40-59 years old, of whom 34,000 were diagnosed with cancer. These analyses revealed that a cancer diagnosis was strongly associated with not being employed. Log-linear regression models were used to estimate the effect of cancer on labor earnings in 2001 for those employed. Cancer was associated with a 12% decline in earnings overall. Leukemia, lymphomas, lung, brain, bone, colorectal, and head-and-neck cancer resulted in the largest reductions in employment and earnings. Earning declines were strongly associated with educational level. In addition, linear regression models were used to estimate differentials in earnings before and after cancer. These results accorded well with those from cross-sectional models.

CONCLUSION AND IMPLICATIONS FOR CANCER SURVIVORS

Cancer survivors are less likely to be employed than the cancer-free population, and undertake modifications in their employment, e.g. reduce work-hours or hold lower-wage jobs, which result in reduced earnings. A social class gradient is present and must be addressed to accommodate appropriate intervention from welfare societies.

Work ability and return-to-work in cancer patients

The extent to which self-assessed work ability collected during treatment can predict return-to-work in cancer patients is unknown. In this prospective study, we consecutively included employed cancer patients who underwent treatment with curative intent at 6 months following the first day of sick leave. Work ability data (scores 0–10), clinical and sociodemographic data were collected at 6 months, while return-to-work was measured at 6, 12 and 18 months. Most of the 195 patients had been diagnosed with breast cancer (26%), cancer of the female genitals (22%) or genitourological cancer (22%). Mean current work ability scores improved significantly over time from 4.6 at 6 months to 6.3 and 6.7 at 12 and 18 months, respectively. Patients with haematological cancers and those who received chemotherapy showed the lowest work ability scores, while patients with cancer of urogenital tract or with gastrointestinal cancer had the highest scores. Work ability at 6 months strongly predicted return-to-work at 18 months, after correction for the influence of age and treatment (hazard ratio=1.37, CI 1.27–1.48). We conclude that self-assessed work ability is an important factor in the return-to-work process of cancer patients independent of age and clinical factors.

Cancer survivors' views of work 3 years post diagnosis: a UK perspective

The impact of cancer on people's working lives is an increasingly important concern but knowledge on this issue is very limited in the UK. Forty-one people of working age were purposively selected from the North Western Cancer Intelligence Service and interviewed by telephone to describe their experiences to returning to work following diagnosis and treatment. The data was subject to qualitative thematic analysis using NVIVO software. The results indicated the importance of returning to work from diagnosis and through treatment which was then followed by a re-assessment of work-life balance when people recovered from primary treatment and were back in employment. The principle motivations for returning to work were a quest for normality and financial pressures. One barrier to returning to work was the lack of medical advice from cancer specialists and general practitioners regarding the appropriate time to get back to work. A good relationship with their employer/manager was a major influence on returning to work and appeared to be related to duration of service rather than occupational status. These findings demonstrate the importance of paid work to people diagnosed with cancer and highlight the need to improve the support from medical professionals, especially oncology nurses.

Factors affecting cancer survivors' employment and work ability

PURPOSE

Due to the improved prognosis of many forms of cancer, an increasing number of cancer survivors are both willing and able to return to work after their treatment. This has increased interest in studying work and cancer-related issues. The purpose of this paper is to give an overview of research on the impact of cancer on employment and work ability, on the effect of psychosocial factors on survivors' well-being, and to indicate research needs for the future.

RESULTS

Studies have shown that the majority of cancer survivors are able to continue working. There is, however, a group of cancer survivors who suffer from impaired health as a result of their illness, and this impairment sometimes leads to a decreased ability to work, or even disability. Employment and impaired work ability has most commonly been found to be associated with cancer type, type of treatment, health status, education and physical workload. The few studies that have focused on the effects of psychosocial factors in work life suggest that social support from occupational health services, and workplace accommodations for illness affect cancer survivors' return to work.

CONCLUSIONS

More research is needed on the impact of social factors at work, which seem to play an important role in cancer survivors' ability to continue working.

Employment status and work-related difficulties in stomach cancer survivors compared with the general population

Little was known about work situation and work-related difficulties, including housework after stomach cancer diagnosis. We aimed to compare employment status and work-related difficulties between stomach cancer survivors and the general population. We enrolled 408 stomach cancer survivors from two hospitals 28 months after diagnosis and 994 representative volunteers from the general population from 15 geographic districts. Working was defined as being employed (including self-employed) and nonworking as being retired or a homemaker. Nonworking was significantly higher among stomach cancer survivors (46.6%) than in the general population (36.5%). Compared with the general population, the survivors had more fatigue in performing both housework (adjusted odds ratio (aOR)=2.08; 95% confidence interval (95% CI)=1.01-4.29) and gainful work (aOR=4.02; 2.55-6.33). More cancer survivors had reduced working hours (aOR=1.42; 95% CI=4.60-28.35) and reduced work-related ability (aOR=6.11; 95% CI=3.64-10.27) than did the general population. The association of nonworking with older age and being female was significantly more positive for survivors than for the general population. Among survivors, poorer Eastern Cooperation Oncology Group Performance Status and receiving total gastrectomy were positively associated with nonworking. Stomach cancer survivors experienced more difficulties in both housework and gainful employment than did the general population. Our findings on stomach cancer survivors' work-related difficulties and the predictors of nonworking will help physicians guide patients towards more realistic postsurgical employment plans.

Targeted therapy in chronic myeloid leukemia

Chronic myeloid leukemia (CML) is characterized by the formation of the Philadelphia chromosome and oncogenic signaling by the resulting Bcr-Abl fusion protein. Understanding the molecular basis of CML has led to the development of highly effective targeted therapies that block Bcr-Abl tyrosine kinase activity. Imatinib, the current first-line therapy for CML, induces durable treatment responses in most patients. However, patients may develop imatinib resistance, which is often due to BCR-ABL mutations. With the availability of second generation tyrosine kinase inhibitors, an effective therapeutic option other than stem cell transplantation is available following imatinib failure. Randomized trial data suggest that dasatinib treatment is superior to imatinib dose escalation in patients with imatinib resistance. Nilotinib, a recently approved analogue of imatinib, has also demonstrated encouraging treatment responses in patients with imatinib-resistant CML. Other agents (including bosutinib and INNO-406) are in clinical development. With the potential availability of multiple treatment options for patients with CML, it may be possible to tailor treatment according to individual patient or disease characteristics, for example, BCR-ABL mutations. Future CML treatment may involve combination strategies. Overall, targeted agents have significantly improved the prognosis of patients diagnosed with CML.

Current and emerging treatment options in chronic myeloid leukemia

Treatments for chronic myeloid leukemia (CML) represent a success story in molecular medicine. The development of imatinib, a tyrosine kinase inhibitor (TKI) targeted against the causative Bcr-Abl oncoprotein in CML, has resulted in hematologic and cytogenetic remissions in all phases of CML. A significant proportion of patients are resistant to imatinib or develop resistance during treatment. This is often a result of mutated forms of the Bcr-Abl oncoprotein to which imatinib is unable to bind. Several strategies have been developed to overcome the problem of imatinib resistance, including high-dose imatinib, novel targeted agents, and combination treatments. Novel agents include dasatinib, a potent TKI that inhibits several critical oncogenic proteins and which has recently been approved for patients with CML who are resistant or intolerant to imatinib; and nilotinib, a potent selective Bcr-Abl kinase inhibitor currently in clinical development. Other agents in development include SKI-606 and INNO-406. Stem cell transplantation remains a useful option, although it is not generally used as first-line treatment. Overall, there are an increasing number of treatment options available for patients with CML.

Employment and cancer: findings from a longitudinal study of breast and prostate cancer survivors

We discuss how cancer affected the employment of almost 800 employed patients who participated in a longitudinal study. The greatest reduction in patients' labor supply (defined as employment and weekly hours worked) was observed 6 months following diagnosis. At 12 and 18 months following diagnosis, many patients returned to work. Based on these and other findings related to patients' employment situations, we suggest 4 areas for future research: 1) collection of employment information in cancer studies; 2) research into racial and ethnic minority patients and employment outcomes; 3) interventions to reduce the effects of cancer and its treatment on employment; and 4) investigations into the influence of employment-contingent health insurance on cancer treatment and recovery.

Comparative study of work ability between cancer survivors and their referents

Even though cancer survivors are often able to continue working after they have been diagnosed, they may have health impairments resulting in reduced work ability. We studied the current work ability of 591 employed people with an early-stage of breast cancer, lymphoma, testicular or prostate cancer, and 757 referents. We also investigated whether the survivors perceived that cancer had impaired their work ability, and which disease-related, socio-demographic and social factors at work had an impact on their work ability. The work ability of the cancer survivors did not differ from that of their referents. Among the survivors, 26% reported that their physical work ability, and 19% that their mental work ability had deteriorated due to cancer. The survivors who had other diseases or had had chemotherapy, most often reported impaired work ability, whereas survivors with a strong commitment to their work organisation, or a good social climate at work, reported impairment less frequently.

Responding to Employment Concerns of Cancer Survivors

The report on cancer survivorship recently released by the Institute of Medicine called on providers to become familiar with the employment rights of survivors, to offer them information about employment rights and programs, and to help minimize the adverse effects of cancer on employment. This review is designed to help providers respond to the Institute of Medicine's recommendations by describing relevant employment and health insurance protections, nationally accessible services and information sources for survivors, functional limitations that may affect survivors' work, and a variety of rehabilitation services that may be helpful for survivors with disabling residual effects of cancer and its treatment. It also suggests directions for further efforts on the part of public and private cancer organizations, researchers, and clinicians to address the employment concerns of survivors.