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Le GH, Hermansen Å, Dahl E. Return to work after cancer-the impact of working conditions: A Norwegian Register-based Study. J Cancer Surviv 2023:10.1007/s11764-023-01503-0. [PMID: 38114712 DOI: 10.1007/s11764-023-01503-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 11/15/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE The purpose of this study is to compare a cohort of cancer survivors with a cohort of cancer-free employees (1) with respect to employment prospects over a 15-year period and (2) with respect to the differential impact of working conditions on employment over this time period. METHODS The cancer cohort is retrieved from the Cancer Registry of Norway, while data on the non-cancer cohort are retrieved from register data managed by Statistics Norway. Job exposure matrices were used to remedy the lack of working-conditions information in the register data. We use nearest-neighbor matching to match the non-cancer cohort (the control group) to the cancer-survivor cohort (the treatment group). Cox regression analysis was applied to examine the relationships between working conditions, employment, and cancer. The results are reported separately for mechanical-job exposures and psychosocial exposures, as well as by gender. RESULTS Cancer survivors are more likely to experience reduced employment as compared to individuals without a history of cancer. Male cancer survivors in physically demanding occupations have an increased risk of reduced employment after being diagnosed with cancer. This does not apply to female cancer survivors. Regarding the impact of psychosocial exposures on employment, we find no differences over time between cancer survivors and the non-cancer population. CONCLUSIONS Male cancer survivors in physically demanding occupations have an increased risk of reduced employment after being diagnosed with cancer, whereas this is not the case for female cancer survivors. Psychosocial exposures do not impact the relative risk of reduced employment over time. IMPLICATIONS FOR CANCER SURVIVORS We suggest that return to work after cancer should be considered a process rather than only the re-entry step of resuming work. Thus, it is important to provide long-term support for cancer survivors. We recommend providing more attention to working conditions, particularly in occupations that involve a high level of mechanical-job exposures.
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Affiliation(s)
- Giang Huong Le
- Department of Social Work, Child Welfare and Social Policy, OsloMet - Oslo Metropolitan University, Faculty of Social Sciences, Oslo, Norway.
| | - Åsmund Hermansen
- Department of Social Work, Child Welfare and Social Policy, OsloMet - Oslo Metropolitan University, Faculty of Social Sciences, Oslo, Norway
| | - Espen Dahl
- Department of Social Work, Child Welfare and Social Policy, OsloMet - Oslo Metropolitan University, Faculty of Social Sciences, Oslo, Norway
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Hiltrop K, Heidkamp P, Halbach S, Brock-Midding E, Kowalski C, Holmberg C, Ernstmann N. Occupational rehabilitation of male breast cancer patients: Return patterns, motives, experiences, and implications-A qualitative study. Eur J Cancer Care (Engl) 2021; 30:e13402. [PMID: 33486818 DOI: 10.1111/ecc.13402] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 09/01/2020] [Accepted: 10/14/2020] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Knowledge regarding the occupational rehabilitation of male breast cancer patients (MBCPs) is currently scarce; however, there may exist unmet needs of men affected by this rare disease. Therefore, this exploratory study investigated the experiences of MBCPs in their return to work (RTW). METHODS Interview data from 14 men with a breast cancer diagnosis were used for qualitative content analysis. Data were collected within the mixed-methods N-MALE project (Male breast cancer: patients' needs in prevention, diagnosis, treatment, rehabilitation, and follow-up care), conducted in Germany from 2016 to 2018. RESULTS The eight identified motives for RTW were desire for normalcy, distraction, need for activity, social contacts, work as a source of pleasure, financial considerations, lack of self-perception of illness, and having a job requiring low physical effort. The participants reported positive experiences with their workplaces from diagnosis through RTW. However, stigmatisation occurred. The aftermath of the disease and treatment led to changes in the interviewees' productivity, for instance due to fatigue. CONCLUSION The findings of this study contribute to a better understanding of RTW processes, as new insights were gained about motives and experiences particular to MBCPs. Support needs after return were apparent and may help to reduce long-term effects that limit productivity.
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Affiliation(s)
- Kati Hiltrop
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany.,Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Bonn, Germany
| | - Paula Heidkamp
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany.,Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Bonn, Germany
| | - Sarah Halbach
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany.,Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Bonn, Germany
| | - Evamarie Brock-Midding
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany.,Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Bonn, Germany
| | | | - Christine Holmberg
- Institute of Social Medicine and Epidemiology, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Nicole Ernstmann
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany.,Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Bonn, Germany
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Ullrich A, Rath HM, Otto U, Kerschgens C, Raida M, Hagen-Aukamp C, Bergelt C. Identifying Expectations of Delayed Return to Work in Patients with Prostate Cancer at the Beginning of a Cancer Rehabilitation Program. JOURNAL OF OCCUPATIONAL REHABILITATION 2020; 30:183-193. [PMID: 31734853 DOI: 10.1007/s10926-019-09860-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose To investigate factors associated with expectations of delayed return to work (RTW) in patients with prostate cancer recently admitted to a cancer rehabilitation program. Methods In this multicenter study, data about expected time until RTW and potential correlates (personal, medical, psychosocial and work-related factors) were obtained from 822 employed cancer rehabilitation participants at the beginning of the program. Participants expecting early RTW (≤ 3 months) and delayed RTW (> 3 months) were compared. Hierarchical multivariate logistic regression was applied to study which factors are associated with expecting delayed RTW. Results In total, 171 cancer rehabilitation participants (21%) expected delayed RTW. Group comparison showed education, type of occupation, income, number of comorbid conditions, tumor stage according to the staging system of the Union for International Cancer Control (UICC), anxiety and depression, quality-of-life functioning scales, urinary and treatment-related symptoms, duration of sick leave, subjective work ability, perceived ability to return to the former job, intention to apply for a disability pension, effort-reward-imbalance and occupational stress to be associated in bivariate analysis with participants' expectations. Multivariate analysis revealed UICC tumor stage III (compared to stages I/II, OR 2.36), lower subjective work ability (OR 0.82), perceived inability to return to the former job (OR 1.88) and intention to apply for a disability pension (OR 1.94) to increase the likelihood of expecting delayed RTW. Conclusions Negative or non-beneficial RTW expectations, which are related to self-perception and behavioral intention, seem to be key factors for expecting delayed RTW. Interventions to early identify and adjust such expectations might empower cancer rehabilitation participants to develop appropriate expectations for work recovery.
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Affiliation(s)
- Anneke Ullrich
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Hilke Maria Rath
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Ullrich Otto
- Rehabilitation Clinics Hartenstein GmbH, Clinic Quellental, Bad Wildungen, Germany
| | | | - Martin Raida
- HELIOS Rehabilitation Clinic Bergisch-Land, Wuppertal, Germany
| | | | - Corinna Bergelt
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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Ullrich A, Rath HM, Otto U, Kerschgens C, Raida M, Hagen-Aukamp C, Bergelt C. Return to work in prostate cancer survivors - findings from a prospective study on occupational reintegration following a cancer rehabilitation program. BMC Cancer 2018; 18:751. [PMID: 30029637 PMCID: PMC6053748 DOI: 10.1186/s12885-018-4614-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 06/20/2018] [Indexed: 01/21/2023] Open
Abstract
Background This prospective multicentre-study aimed to analyze return to work (RTW) among prostate cancer survivors 12 months after having attended a cancer rehabilitation program and to identify risk factors for no and late RTW. Methods Seven hundred eleven employed prostate cancer survivors treated with radical prostatectomy completed validated self-rating questionnaires at the beginning, the end, and 12 months post rehabilitation. Disease-related data was obtained from physicians and medical records. Work status and time until RTW were assessed at 12-months follow-up. Data were analyzed by univariate analyses (t-tests, chi-square-tests) and multivariate logistic regression models (OR with 95% CI). Results The RTW rate at 12-months follow-up was 87% and the median time until RTW was 56 days. Univariate analyses revealed significant group differences in baseline personal characteristics and health status, psychosocial well-being and work-related factors between survivors who had vs. had not returned to work. Patients’ perceptions of not being able to work (OR 3.671) and feeling incapable to return to the former job (OR 3.162) were the strongest predictors for not having returned to work at 12-months follow-up. Being diagnosed with UICC tumor stage III (OR 2.946) and patients’ perceptions of not being able to work (OR 4.502) were the strongest predictors for late RTW (≥ 8 weeks). Conclusions A high proportion of prostate cancer survivors return to work after a cancer rehabilitation program. However, results indicate the necessity to early identify survivors with low RTW motivation and unfavorable work-related perceptions who may benefit from intensified occupational support during cancer rehabilitation. Electronic supplementary material The online version of this article (10.1186/s12885-018-4614-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anneke Ullrich
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Center for Psychosocial Medicine, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Hilke Maria Rath
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Center for Psychosocial Medicine, Martinistrasse 52, 20246, Hamburg, Germany
| | - Ullrich Otto
- Rehabilitation Clinics Hartenstein GmbH, Clinic Quellental, Bad Wildungen, Germany
| | | | - Martin Raida
- HELIOS Rehabilitation Clinic Bergisch-Land, Wuppertal, Germany
| | | | - Corinna Bergelt
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Center for Psychosocial Medicine, Martinistrasse 52, 20246, Hamburg, Germany
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Outcomes across the return-to-work process in PC survivors attending a rehabilitation measure—results from a prospective study. Support Care Cancer 2017; 25:3007-3015. [DOI: 10.1007/s00520-017-3790-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 06/07/2017] [Indexed: 10/19/2022]
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Rath HM, Steimann M, Ullrich A, Rotsch M, Zurborn KH, Koch U, Kriston L, Bergelt C. Psychometric properties of the Occupational Stress and Coping Inventory (AVEM) in a cancer population. Acta Oncol 2015; 54:232-42. [PMID: 24988540 DOI: 10.3109/0284186x.2014.933873] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Although the Occupational Stress and Coping Inventory (AVEM) questionnaire is used to assess work behaviour during occupation-related oncological rehabilitation, little is known about its psychometric characteristics in cancer patients. Therefore, we analysed the psychometric properties of the AVEM in this group. MATERIAL AND METHODS The AVEM was administered to 477 cancer patients at the beginning of rehabilitation. The AVEM consists of 11 subscales that categorise patients into one of four types of work behaviour. We obtained data from several subgroups and analysed reliability using Cronbach's α. We performed a confirmatory factor analysis (CFA) of the dimensional structure proposed by the authors of the AVEM. In addition, we analysed the AVEM's predictive validity by examining work-related outcomes one year after the end of rehabilitation (N = 336). RESULTS Similar to a population-based reference sample, half of the patients exhibited work behaviours that might be problematic in stressful working situations. The AVEM proved to be a reliable instrument, and the CFA supported the factor structure of the AVEM. The analyses of predictive validity suggest that work behaviour and mental health characteristics, that involve the tendency to feel overwhelmed and less motivated at work, might lead to an increased level of occupational stress one year post-rehabilitation. DISCUSSION The AVEM can be used during rehabilitation to assess the extent to which patients report work behaviours associated with occupational stress and dissatisfaction. Patients who exhibit the tendency to feel overwhelmed and helpless in stressful work situations should be identified early so they can be offered support.
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Affiliation(s)
- Hilke M Rath
- Hamburg-Eppendorf University Medical Centre, Centre of Psychosocial Medicine, Department of Medical Psychology , Hamburg , Germany
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Böttcher HM, Steimann M, Rotsch M, Zurborn KH, Koch U, Bergelt C. Occupational stress and its association with early retirement and subjective need for occupational rehabilitation in cancer patients. Psychooncology 2012; 22:1807-14. [PMID: 23175474 DOI: 10.1002/pon.3224] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 10/12/2012] [Accepted: 10/13/2012] [Indexed: 01/22/2023]
Abstract
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.
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Affiliation(s)
- Hilke M Böttcher
- Center of Psychosocial Medicine, Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Germany.
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