A longitudinal qualitative study of the experience of working following treatment for gynaecological cancer

Turning a Curve: How People Use Everyday Resources to Negotiate Recovery From Cancer Treatment With Curative Intent

Many more cancers are treated with intent to cure now than in previous decades, but for most, this involves significant effects from which people need to recover psychologically and socially, as well as physically. This longitudinal photo-elicitation interview study uses grounded theory to explain how people discharged from specialist care made use of everyday social and material resources to manage this process at home. Recovery is presented as a curve in life's pathway requiring gradual reorientation, drawing on social worlds and domestic resources to calibrate this process. Findings are described in three stages: (1) responding to diagnosis and treatment, (2) using social resources for meaning-making, and (3) developing assets for recovery. During treatment, participants drew on past identities to reinforce their sense of self, and personalized health care communication supported this process. In the weeks after treatment, new frameworks of understanding were constructed from perspectives on cancer encountered in the family, workplace, and outpatient clinics. Recovery processes included the negotiation of personal change, the renegotiation of close relationships, and the use of everyday resources to regain three sensations: control, comfort, and continuity. Supportive care would benefit from an individualized exploration of the assets that can help people to negotiate this challenging phase as treatment comes to a close. Possibilities for self-care (the maintenance of health and well-being in the context of everyday life) can be explored and assessed through personalized discussion around the identities, social worlds, and everyday resources available to each individual.

Factors associated with cancer disclosure in adolescent and young adult cancer survivors: An integrative review from the social-ecological model perspective

PURPOSE

Young cancer survivors ("young survivors") may need to disclose their cancer experiences to reintegrate into society. In such cases, the recognition of social support through the disclosure of cancer experiences may prevent potential social disadvantages． This review aimed to describe the motivations, strategies and outcomes, and benefits and disadvantages of disclosure in young survivors based on the social-ecological model (SEM) to identify the support survivors need when disclosing their cancer experiences.

METHODS

Using the integrated review methodology, we systematically searched six databases in English and Japanese as well as searched the reference lists of the selected studies. The themes identified via thematic analysis were categorized within the SEM levels.

RESULTS

This review analyzed 14 studies and identified four themes, including "Motivation for Cancer Disclosure," "Barriers to Cancer Disclosure," "Consequences of Cancer Disclosure: Benefits," and "Consequences of Cancer Disclosure: Disadvantages." Motivations for young survivors to disclose their cancer involved post-cancer differences, perceptions, relationships, and social context. In navigating barriers, including self-stigma, peer exclusion, and discrimination, they employed strategies such as reassurance and information limitation. Tailored disclosure strategies at each SEM level offered social and psychological benefits, however, disadvantages, including stress, vulnerability, employment issues, and limited insurance coverage, were experienced by young survivors due to cancer disclosure.

CONCLUSIONS

To optimize the benefits of cancer disclosure for young survivors, addressing psychological burdens, enhancing disclosure skills, offering familial psychological support, and fostering public awareness of cancer are essential.

Return to work in head and neck cancer survivors: a systematic review

PURPOSE

Cancer survivors face higher rates of unemployment compared with individuals without a history of cancer. Compared to other cancer types, head and neck cancer (HNC) survivors face unique disease and treatment-specific issues that may limit return to work (RTW). This review aimed to determine employment outcomes of HNC survivors post-treatment and identify factors associated with RTW.

METHODS

A systematic search was conducted in MEDLINE, CINAHL and PsycINFO in December 2021. Inclusion criteria included adults (≥ 18 years); completed treatment for HNC; data available on RTW post-treatment. Both quantitative and qualitative studies were considered. Studies were critically appraised and data synthesised narratively.

RESULTS

Twenty-nine publications were included: 22 quantitative, four qualitative and three mixed methods. The proportion of HNC survivors who RTW ranged from 32 to 90%, with participants taking 3.6-11 months to RTW. Working in a professional role and having a supportive work environment were positively associated with RTW.

CONCLUSIONS

The proportion of HNC survivors who RTW varies significantly which may be due to the heterogeneity between the studies including difference in clinical characteristics of the participants and/or sample size. Future studies that are longitudinal, adequately powered and measure a range of clinical and demographic variables are needed to better understand the RTW experience and assist development of effective RTW strategies.

IMPLICATIONS FOR CANCER SURVIVORS

This review suggests potential areas for intervention, including enhanced symptom management and engaging with employers to foster supportive work environments to support RTW of HNC survivors.

[Investigation the contents of employment consultation and support in a cancer center hospital]

OBJECTIVES

This study aimed to analyze and categorize the actual situation of employment consultation and support according to consultation times or employment status at the Consultation Support Center of the National Cancer Center Hospital of Japan.

METHODS

We retrospectively analyzed the patient backgrounds, consultation contents, and the number of employment consultation cases conducted at the Consultation Support Center of the National Cancer Center Hospital during a 6-month period from May to December 2018.

RESULTS

During the study period, 117 patients (male: female = 46:71) visited the Consultation Support Center. The median age of patients was 48 years old. The most common primary cancer site was the breast in 28 patients followed by the lung in 16 patients, and then gynecologic cancer in 10 patients. The most common cancer treatment was chemotherapy in 53 patients (45.3%), and 12 patients (10.2%) were recurrent patients. Fifty-two patients were in regular employment, 24 were unemployed, 17 were of unknown employment status, 16 were in non-regular employment, and 8 were classified/categorized as other. In terms of working status, 40 were on leave, 35 were working, 15 were seeking work, 8 were unemployed, and 19 were categorized as other. The median number of consultations was 1 (1,11). The content of consultations was the social security system in 44 cases (37.6%) job seeking in 24 cases (20.5%), how to inform the workplace in 14 cases (12%), and workplace environment adjustment in 13 cases (11.1%).

CONCLUSIONS

We conducted a survey on the actual status of employment consultation in a cancer center hospital. The majority of consultations were completed in one session. In terms of the content of consultations, there was a high need for consultations on the social security system and job seeking. Further study is needed on the characteristics of employment consultations according to employment status and other attributes.

Moving beyond the patients’ views on the process of return to work after cancer: A qualitative evidence synthesis on articles published between 2008 and 2017

BACKGROUND: Important qualitative findings have accumulated on return to work after cancer from the perspective of various stakeholders. OBJECTIVE: The aim of this paper was to critically appraise the evidence produced between 2008–2017 on several key stages of the return to work process against the key stakeholders identified in the articles included. METHODS: A systematic search was done on four databases to identify relevant papers. Papers were selected based on pre-defined selection criteria. A qualitative evidence synthesis was performed on the articles included. RESULTS: A total of 57 articles were included in the analysis. Using the secondary thematic analysis, this study identified three categories of articles relative to the stakeholders included: articles focusing on patients’ experience (n = 41); articles dealing with multiple stakeholders, including patients (n = 12); and articles drawing on stakeholders other than patients (n = 4). The analysis also revealed five key stages of the return to work process which follow a sequential order and provide a comprehensive image of the process. CONCLUSIONS: More research is required on how employers view and are able to facilitate the return to work process after cancer. New forms of support must be planned and delivered by health professionals for patients who return on the labour market. The five stages model proposed in this study can help employers and policymakers to plan and deliver tailored legislation and guidance for RTW facilitation. All stakeholders must be further trained to embrace the idea that return to work is a complex process which continues long after the survivor returns to work.

The needs of gynecological cancer survivors at the end of primary treatment: A scoping review and proposed model to guide clinical discussions

OBJECTIVE

Gynecological cancer (GC) survivors have unmet needs when they complete primary cancer treatment. Despite this, no known research has summarized these needs and survivors' suggestions to address them. We conducted a scoping review to fill these gaps and develop a model useful to guide clinical discussions and/or interventions.

METHODS

English, full length, and accessible primary studies describing the needs of GC survivors were included. No restrictions on date nor country of publication were applied. Two reviewers screened and extracted data, which was verified by a third reviewer.

RESULTS

Seventy-one studies met the inclusion criteria for data extraction. Results were thematically grouped into seven dimensions: physical needs, sexuality-related concerns, altered self-image, psychological wellbeing, social support needs, supporting the return to work, and healthcare challenges and preferences. After consulting with a stakeholder group (a GC survivor, clinicians, and researchers), the dimensions were summarized into a proposed model to guide clinical assessments and/or interventions.

CONCLUSION

Results illuminate the diverse needs of GC survivors as they complete primary cancer treatment and their recommendations for care to meet these needs.

PRACTICE IMPLICATIONS

The resulting model can be used to guide assessments, discussions and/or interventions to optimally prepare GC survivors for transition out of primary cancer treatment.

Experiences of women with breast cancer while working or returning to work: a qualitative systematic review and meta-synthesis

PURPOSE

This systematic review aims to consolidate the available qualitative evidence regarding the experiences of women with breast cancer while working or returning to work.

METHODS

Six electronic databases were searched until December 2020 for qualitative English-language articles examining the experiences of adult females with reproductive cancers while working or returning to work. The Critical Appraisal Skills Program checklist was used to assess the quality of included studies while the Sandelowski and Barroso's two step approach was used to meta-summarize and meta-synthesize the extracted data.

RESULTS

Four themes were derived from the 28 included studies: (i) being lost to finding meaning after the cancer diagnosis; (ii) concerns and considerations before returning to work; (iii) reasons for returning to work; and (iv) life at work after cancer diagnosis and treatment.

CONCLUSIONS

Current findings allowed a deeper understanding into the way the women with breast cancer coped during their cancer journey. Challenges and motivating factors faced by these women while working or returning to work were discussed. Improvements to current support systems and working policies are needed to better support this group of women.

Changes in eating habits and food preferences in breast cancer patients undergoing adjuvant chemotherapy

Change in eating habits in early breast cancer (EBC) patients during chemotherapy has been poorly studied in the literature. The primary aim of this study was to prospectively evaluate food preferences and weight change in EBC patients before and after adjuvant chemotherapy. From April 2014 to June 2018, 205 EBC patients underwent a dietary assessment according to the following timeline: baseline evaluation (one week before starting chemotherapy, T0); first follow-up (approximately 2–3 months after starting chemotherapy, T1); final follow-up (one week after chemotherapy end, T2). A statistically significant reduction of the following foods was reported after the start of chemotherapy: pasta or rice, bread, breadsticks/crackers, red meat, fat and lean salami, fresh and aged cheese, milk, yogurt, added sugar, soft drinks, alcoholic beverages (wine, beer, and schnapps), and condiments (oil and butter). Conversely, fruit consumption consistently increased. As a result of these changes, a Healthy Eating Index (HEI) specifically developed for this study and suggestive of a balanced diet, significantly increased. Body weight did not increase, despite reduction in physical activity. This prospective study shows that EBC patients tend to adopt “healthier dietary patterns” during adjuvant chemotherapy, leading to a non-change in weight, despite reduction in physical activity.

Returning to Work After Cancer in Australia: What Facilitates a Positive Return to Work Experience?

Purpose This study examined the impact of task-based and relationship-based social support received in the workplace on cancer survivors' retrospective satisfaction with their return to work experience. Methods Cancer survivors (N = 159), completed an online questionnaire assessing their satisfaction with the return to work experience, overall job satisfaction, contact with employers and co-workers while absent, perceived task-based and relationship-based social support received at the time of returning to work, and the perceived emotional quality of workplace relationships. Results Survivors reported that contact with employers, but not co-workers, while absent from work was associated with a more positive return to work experience. Additionally, greater perceived task-based and relationship-based social support at the time of returning to work were significantly correlated with greater satisfaction with returning to work. Importantly, the impact of task-based and relationship-based social support was fully mediated by the perceived emotional quality of workplace relationships. Job satisfaction independently predicted variance in return to work satisfaction. Conclusions Supporting effective return to work after cancer involves consideration of the workplace social context. Greater resources are needed to help workplaces foster and maintain social connections with employees who are absent from work for cancer treatment.

Gynaecological cancer leads to long-term sick leave and permanently reduced working ability years after diagnosis

PURPOSE

The aim of the study was to investigate overall patterns in labour market affiliation, risk for permanently reduced work ability and prevalence of long-term sickness absence among women diagnosed with gynaecological cancer.

METHODS

We followed 8451 women diagnosed with ovarian, endometrial or cervical cancer, and 72,311 women with no history of cancer in nationwide registers for up to 19 years (mean 7.5 years). We computed hazards ratios for permanently reduced working ability and annual proportions of long-term sick leave.

RESULTS

Patterns of labour market affiliation varied by cancer diagnosis and stage. The hazard of permanently reduced working ability was increased for survivors of all three cancers but most pronounced for women diagnosed with advanced ovarian cancer. The highest hazard ratios were found 2-5 years after diagnosis, and they persisted for years in all groups and throughout the follow-up period of 19 years in women diagnosed with advanced cervical cancer. In the subgroups of women who continued to be potentially active on the labour market, long-term sick leave was more prevalent among cancer survivors than women with no history of cancer up to 10 years after diagnosis.

CONCLUSIONS

Women diagnosed with localised as well as advanced gynaecological cancer are at prolonged risk for permanently reduced working ability and long-term sick leave.

IMPLICATIONS FOR CANCER SURVIVORS

Gynaecological cancer can have long-term as well as permanent consequences for working ability, and survivors who remain active on the labour market might have to take more sick leave even years after cancer diagnosis than other women at their age.

Supporting the Return to Work After Cancer in Romania: Exploring Employers' Perspectives

Purpose Evidence shows that employers play a key role in facilitating the return to work of employees with cancer, yet little is known about the employers' experiences in settings where no policies or regulations are available to guide this process. Against this background, we aimed (1) to understand how employers experience and manage the process of having employees with cancer and (2) to explore their reflections regarding their role in returning to work. Methods Twenty employers from various types of organisations and sectors were interviewed. Inductive thematic analysis was performed using NVivo 11. Results Employers experienced having employees with cancer as a process with three distinct phases reflected in three emerging themes: disclosure of the diagnosis and absence from work; returning to work; post-returning to work. A fourth theme emphasizes the employers' reflections on how they conceive their own role. In the absence of a normative framework for dealing with employees with cancer, employers used commonsensical rules of thumb and immediate solutions based on ad-hoc decisions and were often compelled to innovate. They offered accommodations only if requested by the employee after returning to work. The return to work process was neither planned nor phased. Conclusion Employers need information and guidelines for effectively assisting employees with cancer. Better channels of communication and collaboration with health professionals are essential for more adequate support for the long-term consequences of cancer. A detailed return to work policy is required to tackle the inconsistencies in the support offered and this policy must also rethink how diagnosis disclosure takes place in Romanian organisations.

Return to Work in Survivors of Human Papillomavirus-Associated Oropharyngeal Cancer: An Australian Experience

PURPOSE

Human papillomavirus (HPV)-associated oropharyngeal cancer (OPC) commonly affects people of working age, yet there is limited data regarding the return-to-work experience in this cohort. This study aimed to investigate the proportion of survivors currently working after completion of radiation therapy and to explore potential facilitators and barriers to working after treatment.

METHODS

A cross-sectional, single-institutional study was undertaken at the Peter MacCallum Cancer Centre, a comprehensive cancer center in Melbourne, Victoria, Australia. Eligible participants were 18 to 65 years old at diagnosis, were employed at or within the 3 months before diagnosis, and had completed curative treatment for HPV-associated OPC ≥4 months before enrollment. Participants completed a paper-based survey to assess baseline demographics, employment status, and quality of life (QOL; Functional Assessment of Cancer Therapy Head and Neck). Open-ended questions explored factors affecting return to work. Associations between current employment status and various disease, treatment, and demographic variables and with QOL were examined. Free-text items were analyzed by summarizing content analysis.

RESULTS

Of 93 participants approached, 68 responded (73.1%). Mean age was 54.1 years (range, 39-64 years), and 89.7% were male. Most participants (67.6%) had stage II disease and were treated with chemoradiation (85.3%). Mean time after treatment was 2.6 years (range, 0.3-9.1 years). Fifty-eight of 68 participants (85.3%) were working at enrollment; median time to return to work was 6.0 months (interquartile range, 4-10 months); 45 (77.6%) were in the same role and 35 (60.3%) worked the same number of hours. Ten participants were not working, 3 had retired, 5 reported persistent and significant treatment toxicity preventing employment. Survivors currently working reported higher physical, functional, and global QOL scores. Access to leave and support from treating doctors were facilitators for return to work, whereas fatigue was frequently reported as a barrier to returning to work.

CONCLUSION

With time, the majority of participants with HPV-associated OPC will return to work after radiation therapy. Attention to symptom management and support from the workplace may enable more successful return to work.

Cancer Survivors' Social Context in the Return to Work Process: Narrative Accounts of Social Support and Social Comparison Information

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.

Impact of sociodemographic characteristics on underemployment in a longitudinal, nationally representative study of cancer survivors: Evidence for the importance of gender and marital status

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.

Assessing factors associated with long-term work disability after cancer in Belgium: a population-based cohort study using competing risks analysis with a 7-year follow-up

OBJECTIVES

The number of workers with cancer has dramatically increasing worldwide. One of the main priorities is to preserve their quality of life and the sustainability of social security systems. We have carried out this study to assess factors associated with the ability to work after cancer. Such insight should help with the planning of rehabilitation needs and tailored programmes.

PARTICIPANTS

We conducted this register-based cohort study using individual data from the Belgian Disability Insurance. Data on 15 543 socially insured Belgian people who entered into the long-term work disability between 2007 and 2011 due to cancer were used.

PRIMARY AND SECONDARY OUTCOME MEASURES

We estimated the duration of work disability using Kaplan-Meier and the cause-specific cumulative incidence of ability to work stratified by age, gender, occupational class and year of entering the work disability system for 11 cancer sites using the Fine and Gray model allowing for competing risks.

RESULTS

The overall median time of work disability was 1.59 years (95% CI 1.52 to 1.66), ranging from 0.75 to 4.98 years. By the end of follow-up, more than one-third of the disabled cancer survivors were able to work (35%). While a large proportion of the women were able to work at the end of follow-up, the men who were able to work could do so sooner. Being women, white collar, young and having haematological, male genital or breast cancers were factors with the bestlikelihood to be able to return to work.

CONCLUSION

Good prognostic factors for the ability to work were youth, woman, white collar and having breast, male genital or haematological cancers. Reviewing our results together with the cancer incidence predictions up to 2025 offers a high value for social security and rehabilitation planning and for ascertaining patients' perspectives.

Holistic needs assessment and care plans for women with gynaecological cancer: do they improve cancer-specific health-related quality of life? A randomised controlled trial using mixed methods

Objectives

Holistic needs assessment (HNA) and care planning are proposed to address unmet needs of people treated for cancer. We tested whether HNA and care planning by an allied health professional improved cancer-specific quality of life for women following curative treatment for stage I–III gynaecological cancer.

Methods

Consecutive women were invited to participate in a randomised controlled study (HNA and care planning vs usual care) at a UK cancer centre. Data were collected by questionnaire at baseline, 3 and 6 months. The outcomes were 6-month change in European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-C30 (version 3), global score (primary) and, in EORTC subscales, generic quality of life and self-efficacy (secondary). The study was blinded for data management and analysis. Differences in outcomes were compared between groups. Health service utilisation and quality-adjusted life years (QALY) (from Short Form-6) were gathered for a cost-effectiveness analysis. Thematic analysis was used to interpret data from an exit interview.

Results

150 women consented (75 per group); 10 undertook interviews. For 124 participants (61 intervention, 63 controls) with complete data, no statistically significant differences were seen between groups in the primary endpoint. The majority of those interviewed reported important personal gains they attributed to the intervention, which reflected trends to improvement seen in EORTC functional and symptom scales. Economic analysis suggests a 62% probability of cost-effectiveness at a £30 000/QALY threshold.

Conclusion

Care plan development with an allied health professional is cost-effective, acceptable and useful for some women treated for stage I–III gynaecological cancer. We recommend its introduction early in the pathway to support person-centred care.

Work-related barriers, facilitators, and strategies of breast cancer survivors working during curative treatment

BACKGROUND

Research has identified barriers and facilitators affecting cancer survivors' return to work (RTW) following the end of active treatment (surgery, chemotherapy and/or radiation therapy). However, few studies have focused on barriers and facilitators that cancer survivors experience while working during active treatment. Strategies used by cancer survivors to solve work-related problems during active treatment are underexplored.

OBJECTIVE

The aim of this study was to describe factors that impact, either positively or negatively, breast cancer survivors' work activities during active treatment.

METHODS

Semi-structured, recorded interviews were conducted with 35 breast cancer survivors who worked during active treatment. Transcripts of interviews were analyzed using inductive content analysis to identify themes regarding work-related barriers, facilitators and strategies.

RESULTS

Barriers identified included symptoms, emotional distress, appearance change, time constraints, work characteristics, unsupportive supervisors and coworkers, family issues and other illness. Facilitators included positive aspects of work, support outside of work, and coworker and supervisor support. Strategies included activities to improve health-related issues and changes to working conditions and tasks.

CONCLUSIONS

Breast cancer survivors encounter various barriers during active treatment. Several facilitators and strategies can help survivors maintain productive work activities.

Return to work experience among military officers with cancer

PURPOSE

This study was done to describe the return to work experience of military officers with cancer.

METHODS

Individual in-depth interviews with 15 participants were conducted between September 2013 and April 2014. Participants were interviewed 1~4 times; interviews continued until the data became saturated. Data were analyzed using Strauss and Corbin's grounded theory.

RESULTS

The core category emerged as "living a new life after enduring difficulties". The return to work process consisted of four sequential phases: chaos, positive thought formation, behavior practices, and reformation. Action/interaction strategies used by military officers with cancer to resolve enduring difficulties were controlling emotions, accepting reality, prioritizing health, making efforts to improve relationships, and looking for future jobs.

CONCLUSION

These results will promote understanding of military officers' return to work experience following cancer survival, and will be helpful in developing more effective nursing interventions through enhanced perspectives and insights of practitioners.

A Guided Workbook Intervention (WorkPlan) to Support Work-Related Goals Among Cancer Survivors: Protocol of a Feasibility Randomized Controlled Trial

Background

Returning to and staying at work following illness is associated with better physical and psychological functioning. Not working has been shown to be associated with reduced self-esteem, lowered self-efficacy, and decreased belief in one's ability to return to the workplace. Although there is a growing body of research looking at what predicts return to work following cancer treatment, there are fewer studies examining interventions targeting return to work.

Objective

The primary objective is to assess the feasibility and acceptability of a theoretically led workbook intervention designed to support cancer patients in returning to work to inform a fully powered randomized controlled trial (RCT).

Methods

This is a multicenter feasibility RCT where the main analysis uses a qualitative approach. Sixty participants (aged 18-65 years) who have received a diagnosis of cancer and who intend to return to work will be randomized to either the WorkPlan intervention group or a usual care group (ratio 1:1). Participants in the intervention group will receive a guided workbook intervention (which contains activities aimed at eliciting thoughts and beliefs, identifying targets and actions, and concrete steps to achieve goals) and will receive telephone support over a 4-week period. The primary outcome measure is time taken to return to work (in days), and secondary outcome measures include mood, quality of life, illness perceptions, and job satisfaction. Data will be collected through postal questionnaires administered immediately postintervention and at 6- and 12-month follow-ups. In addition, interviews will be undertaken immediately postintervention (to explore acceptability of the intervention and materials) and at 12-month follow-up (to explore perceptions of participation in the trial and experiences of returning to work).

Results

Enrollment for the study will be completed in May 2016. Data analysis will commence in April 2017, and the first results are expected to be submitted for publication in late 2017.

Conclusions

Currently no standardized return-to-work intervention based on targeting cancer patient beliefs is in existence. If the intervention is shown to be feasible and acceptable, the results of this study will inform a future full RCT with the potential to provide a valuable and cost-efficient tool in supporting cancer survivors in the return-to-work process.

Trial Registration

International Standard Randomized Controlled Trial Number (ISRCTN): ISRCTN56342476; http://www.isrctn.com/ISRCTN56342476 (Archived by WebCite at http://www.webcitation.org/6gblhEPXd).

Am I ready to return to work? Assisting cancer survivors to determine work readiness

PURPOSE

A critical initial step in work re-entry involves the determination of work readiness. Cancer survivors have requested increased health care provider involvement in their work readiness decisions. However, there has been no exploration of current practices in determining work readiness, and thus no specific recommendations regarding how to assist survivors in answering the question: Am I ready to return to work?

METHODS

To explore return to work following cancer and the workplace supports survivors require, we completed an exploratory qualitative study. We conducted semi-structured interviews with (i) cancer survivors (n = 16) and (ii) health care/vocational service providers (n = 16). Data were analyzed using thematic analysis. Themes specific to work readiness are discussed.

RESULTS

Three key processes were deemed relevant to determining work readiness by health care providers and survivors: (1) assessing functional abilities in relation to job demands; (2) identifying survivor strengths and barriers to return to work; and (3) identifying supports available in the workplace. Challenges to work readiness determinations, were described by survivors and providers, related to: (i) the complexity of cancer, (ii) the accuracy of work readiness determinations, and (iii) the lack of established processes for addressing work goals.

CONCLUSIONS

Health care providers need to work collaboratively with survivors to determine if they are physically, cognitively, and emotionally ready to return to work, and with workplaces to determine if they are prepared to provide the necessary supports. Further stakeholder collaboration is also warranted.

IMPLICATIONS FOR CANCER SURVIVORS

Supports from health care providers in determining work readiness can ensure survivors do not return to work either "too early" or "too late."

An Exploration of the Factors Considered When Forming Expectations for Returning to Work following Sickness Absence Due to a Musculoskeletal Condition

Introduction

Workers’ own expectations for returning to work following a period of sickness absence have been found to be one of the best predictors of future work status; however, there is a limited understanding of why people expect what they do. The current study was undertaken with the aim of determining what people take into consideration when forming their expectations for returning to work.

Methods

Thirty-four people (8 women, 26 men), who were off work due to a musculoskeletal condition, participated in one of 14 focus groups. Participants were aged 25 to 65 (M = 45, SD = 12.6), and all had been out of work for 3 months or less.

Results

All participants reported expecting to return to work, with the most common timeframe being approximately 30 days (Range = 1 day-12 months). When explaining what they thought about when forming their expectations, participants referenced numerous considerations. Much of what was spoken about could be compartmentalized to reflect features of themselves, their condition, or their broader environmental contexts. Participant’s subjective experience of these features influenced his or her expectations. Prominent themes included concerns about employability, a desire to get back to normal, no job to go back to, mixed emotions, re-injury concerns, the judgments of workplace stakeholders, being needed by their employer, waiting for input, until the money runs out, and working out what was in their best interest.

Conclusions

Indications are that many of the reported considerations are amenable to intervention, suggesting opportunities to assist workers in the process of returning to work.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Cured of primary bone cancer, but at what cost: a qualitative study of functional impairment and lost opportunities

Purpose. Our study aims to explore how former cancer patients experience physical and psychosocial late effects 3–7 years after they underwent treatment for primary bone sarcoma in the hip/pelvic region. A qualitative, phenomenological, and hermeneutic design was applied. Methods. Sarcoma survivors (n = 10) previously treated at Oslo University Hospital, Norwegian Radium Hospital were selected to participate. In-depth and semistructured interviews were conducted. The interviews were analysed using inductive thematic analysis. Results. The participants reported that the late effects had three core spheres of impact: “their current daily life,” “their future opportunities,” and “their identity.” They expressed negative changes in activity, increased dependence on others, and exclusion from participation in different areas. Their daily life, work, sports activities, and social life were all affected. Several of their experiences are similar to those described by people with functional impairment or disability. Conclusion. Patients cured of bone cancer in the hip/pelvic region pay a significant price in terms of functional impairment, practical challenges, exclusion from important aspects of life, and loss of previous identity. It is important to appreciate this in order to help bone cancer survivors who struggle to reorient their life and build a secure new identity.

Patterns and predictors of disclosure of a diagnosis of cancer

BACKGROUND

The value of talking (i.e. disclosing ones innermost thoughts and feelings) has been recognised as playing an important role in helping people work through their difficulties. Although disclosing a diagnosis of cancer has been identified to be one of the hardest aspects of having the disease, relatively little is known about the extent to which people talk about their diagnosis of cancer. This study aimed to identify disclosure patterns among patients with cancer and to determine the factors associated with disclosure.

METHODS

Patients (n = 120) who had received a diagnosis of either lung, colorectal or skin cancer completed a questionnaire assessing potential psychosocial predictors of disclosure.

RESULTS

Results indicated that the majority of patients (95%) found it helpful to disclose information and did so to a variety of social targets, with the highest levels of disclosure being reported to medical personnel (38% talked 'very much'), followed by family members (24%) and then friends (12%). There were no differences in disclosure across cancer types, with the exception of patients with colorectal cancer who disclosed information more to nurses and other cancer patients. Men disclosed information more than women to some social targets. Dispositional openness (B = .233, p < 0.05) and treatment type (B = -.240, p < 0.01) were found to predict 13% of the variance in degree of disclosure.

CONCLUSIONS

The results suggest that individual differences and social and clinical factors impact on disclosure and that medical professionals play an important role in the disclosure process.

What work means to people with work disability: a scoping review

PURPOSE

As paid work is the occupation that people spend the most amount of their time doing, it is an important provider of personal meaning in their lives. This meaning has been shown to vary from person to person and to be important to health and well being. When a person is unable to work due to a disabling condition, it is unclear whether this meaning remains or is replaced by other meanings. The purpose of this scoping review was to explore what was known in the existing literature on what work means to those with work disability.

METHODS

The review involved identifying and selecting relevant studies, charting the data and collating and summarizing the results.

RESULTS

Fifty-two studies explored the meaning of work for those with cancer, mental illness, musculoskeletal disorders, brain injuries, paraplegia, and AIDS. The studies revealed that, for most, work continued to be meaningful and important. Common themes across all types of disability included work being a source of identity, feelings of normality, financial support, and socialization. These meanings were found to be both motivating for return to work and health promoting. Conversely, a small number of studies found that the meanings and values ascribed to work changed following disability. New meanings, found either at home or in modified work, replaced the old and contributed to new identities.

CONCLUSIONS

The exploration of the meaning of work has been shown to provide important understanding of the experience of work and disability. This understanding can guide rehabilitation professionals in their interventions with the work disabled.

New approaches to understand cognitive changes associated with chemotherapy for non-central nervous system tumors

CONTEXT

Researchers have described a constellation of cognitive deficits (e.g., impairments in executive functions, working memory, attention, and information-processing speed) associated with cancer treatment, and specifically chemotherapy, for non-central nervous system tumors. However, findings have been inconsistent, largely because of measurement and study design issues.

OBJECTIVES

To propose ways for researchers to more clearly delineate and characterize the mild cognitive deficits and related outcomes that appear to affect a subset of cancer patients and suggest methods to make more effective use of the existing data to understand risk factors for impaired neuropsychological functioning.

METHODS

We examined the literature on the relationship between chemotherapy and cognitive impairment, as well as related literature on neuropsychological measurement, structural and functional neuroimaging, alternative measures of health outcomes, and integrative data analysis.

RESULTS

A more comprehensive picture of cognitive functioning might be obtained by incorporating nontraditional ecological measures, self-reports, computational modeling, new neuroimaging methods, and markers of occupational functioning. Case-control and integrative data analytic techniques potentially could leverage existing data to identify risk factors for cognitive dysfunction and test hypotheses about the etiology of these effects.

CONCLUSION

There is a need to apply new research approaches to understand the real-world functional implications of the cognitive side effects of chemotherapy to develop and implement strategies to minimize and remediate these effects before, during, and after cancer treatment.

Occupational stress and its association with early retirement and subjective need for occupational rehabilitation in cancer patients

OBJECTIVE

Returning to work often plays an important role for cancer survivors. Occupational stress may hamper a successful return to work, so cancer survivors should be given the opportunity to address occupational stress issues before returning to work. We investigated the amount of occupational stress among cancer patients and whether it is associated with their well-being, their subjective need for occupational rehabilitation and elevations in their risk of early retirement.

METHODS

At the beginning of rehabilitation, we asked cancer patients to respond to occupation-related and health-related questionnaires. We used t-tests, chi-square tests, and logistic regression analyses to address our research questions.

RESULTS

A total of 477 patients participated in the study. Of these, 19% were occupationally stressed, and 26% reported subjective need for occupational rehabilitation. Patients who reported work-related stress had a diminished quality of life, were more likely to report subjective need for occupational rehabilitation (OR = 2.16), and had a higher risk of early retirement (OR = 5.44). Furthermore, cancer patients reported deficits in both active coping abilities and mental stability at work.

CONCLUSIONS

Because occupational stress is associated with a higher risk of early retirement, both patients and physicians should take work-related problems seriously. Screening patients for occupational stress may help physicians identify patients who are at risk of experiencing problematic work re-entries. Furthermore, the results of the study suggest that cancer patients might have problems maintaining confidence in their abilities to solve work-related problems. Therefore, facilitating the development of a perception of self-efficacy might be an important treatment goal.

Qualitative research into the symptom experiences of adult cancer patients after treatments: a systematic review and meta-synthesis

PURPOSE

This review paper aimed to draw together the findings of qualitative research into the symptom experience of adult cancer patients in order to develop a better understanding of symptom experiences following cancer treatment.

METHODS

Systematic review and meta-synthesis techniques were used to identify, appraise and synthesise the relevant literature.

RESULTS

A thematic account of shared symptom experiences reported across papers is presented. Four main themes are discussed: interaction with health services, changing relationships, changing self and coping. In addition the range of symptoms reported across qualitative cancer research is highlighted.

CONCLUSIONS

Unexpected symptoms can have negative effects on patients who need to be better prepared for long-term symptom experiences. In addition, it is important to acknowledge that patients' symptom experiences do not happen in isolation and should be addressed holistically within the context of patients' lives.

Supporting 'work-related goals' rather than 'return to work' after cancer? A systematic review and meta-synthesis of 25 qualitative studies

BACKGROUND

This study aimed to systematically review and synthesise qualitative studies of employment and cancer.

METHODS

A rigorous systematic review and meta-synthesis process was followed. A total of 13,233 papers were retrieved from eight databases; 69 were deemed relevant following title and abstract appraisal. Four further publications were identified via contact with key authors. Screening of full texts resulted in the retention of 25 publications from six countries, which were included in the synthesis.

RESULTS

Studies consistently indicate that for people with cancer, 'work' forms a central basis for self-identity and self-esteem, provides financial security, forms and maintains social relationships, and represents an individual's abilities, talents and health. Work is therefore more than paid employment. Its importance to individuals rests on the relative value survivors place on these constituent functions. The desirability, importance and subsequent interpretation of individuals' experience of 'return to work' appears to be influenced by the ways in which cancer affects these functions or goals of 'work'. Our synthesis draws these complex elements into a heuristic model to help illustrate and communicate these inter-relationships.

CONCLUSION

The concept of 'return to work' may be overly simplistic, and as a result, misleading. The proposed benefits previously ascribed to 'return to work' may only be achieved through consideration of the specific meaning and role of work to the individual. Interventions to address work-related issues need to be person-centred, acknowledging the work-related outcomes that are important to the individual. A conceptual and operational shift towards supporting survivors to identify and achieve their 'work-related goals' may be more appropriate.

Distinct work-related, clinical and psychological factors predict return to work following treatment in four different cancer types

OBJECTIVE

Many factors influence return to work (RTW) following cancer treatment. However specific factors affecting RTW across different cancer types are unclear. This study examined the role of clinical, sociodemographic, work and psychological factors in RTW following treatment for breast, gynaecological, head and neck, and urological cancer.

METHODS

A 12-month prospective questionnaire study was conducted with 290 patients. Cox regression analyses were conducted to calculate hazard ratios (HR) for time to RTW.

RESULTS

Between 89-94% of cancer survivors returned to work. Breast cancer survivors took the longest to return (median 30 weeks), and urology cancer survivors returned the soonest (median 5 weeks). Earlier return among breast cancer survivors was predicted by a greater sense of control over their cancer at work (HR 1.2; 95% CI: 1.09-1.37) and by full-time work (HR 2.1; CI: 1.24-3.4). Predictive of a longer return among gynaecological cancer survivors was a belief that cancer treatment may impair ability to work (HR 0.75; CI: 0.62-0.91). Among urological cancer survivors constipation was predictive of longer RTW (HR 0.99; CI: 0.97-1.00), whereas undertaking flexible working was predictive of returning sooner (HR 1.70; CI: 1.07-2.7). Head and neck cancer survivors who perceived greater negative consequences of their cancer took longer to return (HR 0.27; CI: 0.11-0.68). Those reporting better physical functioning returned sooner (HR1.04; CI: 1.01-1.08).

CONCLUSION

A different profile of predictive factors emerged for the four cancer types. In addition to optimal symptom management and workplace adaptations, the findings suggest that eliciting and challenging specific cancer and treatment-related perceptions may facilitate RTW.