Sickness absence and return to work rates in women with breast cancer

Return to work and psychosocial trajectories after breast cancer: a longitudinal and sequential approach

PURPOSE

We aimed to describe the psychosocial adjustments according to return to work (RTW) trajectories in breast cancer survivors (BCS) using a sequential and temporal approach.

METHODS

We used BCS data included from February 2015 to April 2016 in the Longitudinal Study on Behavioural, Economic and Sociological Changes after Cancer (ELCCA) cohort. RTW trajectories were identified using the sequence analysis method followed by a clustering. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale and the EORTC quality of life questionnaire was used at inclusion and all follow-up visits to assess Health-Related Quality of Life (HRQoL).

RESULTS

Fifty-two BCS were included in the study among whom four clusters of RTW trajectories were identified and labeled: slow RTW (N = 10), quick RTW (N = 27), partial RTW (N = 8), and part-time work (N = 7). Quick and slow RTW clusters showed slightly lower baseline mean levels of anxiety and higher levels of HRQoL. In the 4 years following diagnosis, BCS in the quick RTW cluster tended to report higher HRQoL in terms of functioning and less symptoms of pain and fatigue while those in the partial RTW cluster showed a lower HRQoL on almost all dimensions. All clusters showed an increase in pain and fatigue symptoms until 6 months followed by a tendency to recover baseline levels.

CONCLUSIONS

The results of this study suggest that BCS who return to full-time work (slow and quick RTW patterns) recover better than patients who return to part-time work (partial and part-time RTW patterns).

Return to work after chronic disease: A theoretical framework for understanding the worker-employer dynamic

OBJECTIVES

Return to work after chronic disease is important for workers, employers and society. The process, however, is challenging. This article provides an analytical and theoretical framework for explaining this process informed by the person-environment fit theory.

METHODS

This article uses a narrative method to (1) review the key concepts, benefits and influencing factors in the literature on return to work after chronic diseases, (2) analyse and critique the most important theoretical models used for explaining return to work after chronic diseases, and (3) review the person-environment fit theory and how it has been used so far.

RESULTS

The existing models highlight different aspects, but they overlook the relationship between the worker and the employer. An analytical and theoretical framework is proposed to comprehensively explain the worker-employer dynamic. The framework also considers the role of broader factors (policy, labour market) and other stakeholders (health professionals, civil society actors) emphasising the idea that return to work is a phased and cyclical process.

DISCUSSION

The framework can be used to guide future qualitative and quantitative studies, or as a map for identifying problematic areas related to the worker or the work environment. The model should be empirically tested in future studies.

Predictive factors for prolonged sick leave in breast cancer patients treated with adjuvant therapies: a retrospective registry study

BACKGROUND

Being able to work during and after breast cancer treatments is important for patients to have a sense of normalcy, financial security, and improved quality of life, and for society due to the economic burden of sick leave. Factors influencing the length of sick leave can be sociodemographic factors, workplace adaptations, recurrences, symptoms, and type of treatment. The aim of this study is to analyse factors associated with prolonged sick leave after adjuvant breast cancer treatments.

METHODS

The population of this registry study consists of 1333 early breast cancer patients diagnosed and treated in Helsinki University Hospital between 2016 and 2018. Data on patient demographics, disease characteristics, treatment, and healthcare resource utilization were obtained from Helsinki University Hospital and data on income level and sick leave were obtained from Kela sickness benefits registry. Prolonged sick leave was determined as the patient accumulating 30 or more reimbursed sick leave days during a 60-day follow-up period after the end of active oncological treatment. Univariate analysis and multivariate analysis were conducted.

RESULTS

A total of 26% of the patients in this study were on sick leave for 30 or more days after the active treatments ended. Study findings show that chemotherapy, triple-negative breast cancer, reconstructive surgery, amount of outpatient visits, and income are associated with prolonged sick leave. Independent predictors of prolonged sick leave were treatment line, number of outpatient contacts, reconstruction, and triple-negative breast cancer.

CONCLUSIONS

Our study shows that prolonged sick leave affects a substantial number of working-age women with early breast cancer. Independent predictors for prolonged sick leave were all treatment-related. Targeted support for treatment-related side-effects already during the treatment period could lead to better recovery and earlier return to work.

Association of social service counseling in breast cancer patients with financial problems, role functioning and employment-results from the prospective multicenter BRENDA II study

BACKGROUND

This study examined the relationship between social service counseling (SSC) and financial and role functioning problems in primary breast cancer (BC) patients over a 5-year observation period.

METHODS

In the multicenter prospective study, patients were approached before surgery (t1), before initiation of adjuvant treatment (t2), after therapy completion (t3), and 5 years after surgery (t4). We examined the proportion of BC survivors who had financial and role functioning problems and the proportion who were employed at t4. We examined how frequently patients were informed about, offered, or used SSC, and we used multivariate logistic regression analyses to examine the relationship between this and financial and role functioning problem prevalence.

RESULTS

Of the 456 BC survivors, 33% had financial problems and 22% reported role functioning problems at t4. There was no evidence that women with increased financial problems were informed about SSC more often than those without (OR 1.1, p = 0.84) or that they used SSC more often (OR 1.3, p = 0.25). However, women with role functioning problems were informed about SSC significantly more often (OR 1.7, p = 0.02) and attended counseling significantly more often (OR 1.6, p = 0.03). Among participants aged < 65 years at t4 (n = 255), 70% were employed. Patients who had received SSC were more likely to be employed at t4 than patients who did not (OR 1.9, p = 0.04).

CONCLUSION

These findings underline the importance of SSC for BC patients with role functioning issues. They indicate that individuals who use SSC are more likely to be employed later on than individuals who do not.

Informing the development of multidisciplinary interventions to help breast cancer patients return to work: a qualitative study

PURPOSE

Return to work (RTW) after breast cancer (BC) can be a major challenge for patients. Multidisciplinary interventions seem to be effective but the role of digital solutions is under-developed and therefore not evaluated. We explored the preferences, needs, and barriers regarding RTW interventions, including opinions about the use of digital approaches to deliver such interventions.

METHODS

We conducted a qualitative study based on interviews with 30 patients with BC and 18 healthcare providers in four French regions. Emergent themes were identified using thematic content analysis.

RESULTS

Most providers declared that they did not proactively address RTW with patients, mainly due to having other priorities and a lack of knowledge. The following themes emerged: several development and deployment barriers regarding RTW interventions exist, multidisciplinary interventions are preferred, and there is a need to maintain contact between the patient and workplace during sick leave, including pathways and interlocutors that can facilitate RTW. Participants had mostly positive representations of using digital tools to facilitate RTW; however, fear of loss of human contact and the exacerbation of inequalities were identified as possible risks associated with the development of digital-only interventions.

CONCLUSIONS

Interventions blending the needs and preferences of patients with BC and the healthcare system are warranted. A personalized multimodal approach with mixed digital and in-person features has surfaced as a possible solution to address the weaknesses of existing interventions.

IMPLICATIONS FOR CANCER SURVIVORS

Since most women work at the time of diagnosis, it is of particular relevance to build interventions promoting RTW.

Financial difficulties in breast cancer survivors with and without migration background in Germany-results from the prospective multicentre cohort study BRENDA II

Purpose

We aimed to explore the trajectory of financial difficulties among breast cancer survivors in the German health system and its association with migration background.

Methods

In a multicentre prospective study, breast cancer survivors were approached four times (before surgery, before and after adjuvant therapy, five years after surgery) and asked about their migration history and financial difficulties.

Migrants were defined as born/resided outside Germany or having citizenship/nationality other than German. Financial difficulties were ascertained with the financial difficulties item of the European Organisation for Research and Treatment of Cancer Core Instrument (EORTC QLQ-C30) at each time-point (cut-off > 17). Financial difficulties were classified in trajectories: always (every time-point), never (no time-point), initial (first, not fourth), delayed (only fourth), and acquired (second and/or third, not first).

A logistic regression was conducted with the trajectories of financial difficulties as outcome and migration background as exposure. Age, trends in partnership status, and educational level were considered as confounders.

Results

Of the 363 participants included, 49% reported financial difficulties at at least one time-point.

Financial difficulties were reported always by 7% of the participants, initially by 5%, delayed by 10%, and acquired by 21%.

Migrants were almost four times more likely to report delayed (odds ratio [OR] = 3.7; 95% confidence interval [CI] 1.3, 10.5) or acquired (OR = 3.6; 95% CI 1.6, 8.4) financial difficulties compared to non-migrant participants.

Conclusion

Survivors with a migration background are more likely to suffer from financial difficulties, especially in later stages of the follow-up. A linguistically/culturally competent active enquiry about financial difficulties and information material regarding supporting services/insurances should be considered.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00520-022-07074-7.

Effectiveness of a Tailored Work-Related Support Intervention for Patients Diagnosed with Gastrointestinal Cancer: A Multicenter Randomized Controlled Trial

Purpose The aim of this research was to study the effectiveness on return to work (RTW) of an early tailored work-related support intervention in patients diagnosed with curative gastrointestinal cancer. Methods A multicenter randomized controlled trial was undertaken, in which patients were assigned randomly to the intervention or the control group (usual care). The intervention encompassed three psychosocial work-related support meetings, starting before treatment. Five self-reported questionnaires were sent over twelve months of follow-up. Primary outcome was days until RTW (fulltime or partial) and secondary outcomes included work status, quality of life, work ability, and work limitations. Descriptive analysis, Kaplan-Meier analysis, relative risk ratio and linear mixed models were applied. Results Participants (N = 88) had a mean age of 55 years; 67% were male and the most common cancer type was colon cancer (66%). Of the participants, 42 were randomized to the intervention group. The median time from sick leave until RTW was 233 days (range 187-279 days) for the control group, versus 190 days (range 139-240 days) for the intervention group (log-rank p = 0.37). The RTW rate at twelve months after baseline was 83.3% for the intervention group and 73.5% for the control group. Work limitations did statistically differ between the groups over time (p = 0.01), but quality of life and work ability did not. Conclusion Patients in the intervention group seem to take fewer days to RTW, albeit not to a statistically significant extent.Trial registration Trial NL4920 (NTR5022) (Dutch Trial Register https://www.trialregister.nl ).

Sickness absence and disability pension among women with breast cancer: a population-based cohort study from Sweden

BACKGROUND

Women's return to work after diagnosis of breast cancer (BC) is becoming more prevalent. However, register-based national investigation on sickness absence (SA) and disability pension (DP) in BC women is lacking. The aim of the study was to explore SA and DP before and after a first BC diagnosis and the possibility to predict new cancer-related SA by using disease-related and sociodemographic factors.

METHODS

A longitudinal register study of the 3536 women in Sweden aged 19-64 with a first BC diagnosis in 2010 was conducted by linkage of five nationwide registers. Particularly, detailed information on SA and DP was obtained from the National Social Insurance Agency. Descriptive statistics on SA and DP 2 years before through 3 years after the BC diagnosis were performed. The risk of having a new SA spell due to BC or BC-related diagnoses was modeled using logistic regression.

RESULTS

The proportion of women with SA increased during the year following the BC diagnosis date and declined over the next 2 years to proportions before diagnosis. At the time of BC diagnosis, half of the women began a new SA spell > 14 days with cancer, cancer-related, or mental diagnosis. Disease-related and sociodemographic factors including occupational sector, living area, age, cancer stage, educational level, and number of previous SA days showed statistical significance (p < 0.05) in predicting a new SA around BC diagnosis. By using these factors, it was possible to correctly predict 67% of the new SA spell.

CONCLUSIONS

SA among women with BC was elevated mainly in the first year after diagnosis. New SA following BC diagnosis can accurately be predicted.

Trajectories of sickness absence and disability pension in the 2 years before and 3 years after breast cancer diagnosis: A Swedish longitudinal population-based cohort study

BACKGROUND

After breast cancer (BC) diagnosis, work incapacity often occurs among working-age women. We investigated the trajectories of previous and subsequent sickness absence and/or disability pension (SA/DP) days, and risk factors for consistently high levels of future SA/DP among these women.

METHODS

This longitudinal cohort study included all 3536 women in Sweden aged 19-64 years who received a first BC diagnosis in 2010. Their annual SA/DP net days from 2 years before to 3 years after diagnosis were calculated. SA/DP patterns were depicted by a group-based trajectory model. Logistic regressions were used to calculate odds ratios (ORs) with 95% CIs of >90 or >180 SA/DP days/year.

RESULTS

Three trajectories of SA/DP days/year were identified: increasing only in year₊₁ (61% of all), increasing then decreasing in year₊₃ (30%), and constantly very high (9%). The risk factors associated with annual SA/DP days >90 (long) and >180 days (extreme long) were similar. Factors associated with having >90 SA/DP days for years 1-3 were: stage II (OR, 4.59; 95% CI, 2.98-7.07), stage III+IV (OR, 26.57; 95% CI, 13.52-52.22), prediagnosis SA 1-30 days (OR, 2.73; 95% CI, 1.30-5.70), prediagnosis SA >90 days (OR, 24.52; 95% CI, 12.25-49.08), and prediagnosis DP (OR, 659.97; 95% CI, 292.52->999.99). Conversely, adjusting for prediagnosis SA/DP and stage, sociodemographic factors were not associated with high levels of SA/DP.

CONCLUSION

After BC diagnosis, SA/DP increased significantly but then decreased. The absolute majority had no SA/DP during year 3. Advanced cancer stage and previous high SA/DP rendered the greatest risk for future high SA/DP. More knowledge is needed for applying the information in rehabilitation and return-to-work planning.

Changes in employment status up to 5 years after breast cancer diagnosis: A prospective cohort study

AIM

To assess how sociodemographic, clinical and treatment characteristics impact employment status five-years following a breast cancer diagnosis, and to compare the incidence rate of changes with the general population.

METHODS

A total of 462 women with incident breast cancer were evaluated before treatment and three- and five-years later. Adjusted odds ratios (ORs) with 95% confidence intervals (95%CIs) were computed through multinomial logistic regression. Data for comparisons were retrieved from the SHARE Project. Incidence rate ratios (IRRs) with 95%CIs were calculated using Poisson regression.

RESULTS

Among the 242 employed women prior to diagnosis, 162 remained employed, 26 became unemployed, 27 entered early retirement, 14 entered normal retirement and 13 were on sick leave at five-years. Unemployment increased with age (≥55 vs < 55 years: OR = 4.49, 95%CI:1.56-12.92; OR = 3.40, 95%CI:1.05-10.97 at three- and five-years, respectively) and decreased with education (>4 vs ≤ 4 years: OR = 0.36, 95%CI:0.13-0.97; OR = 0.27, 95%CI:0.10-0.71 at three- and five-years, respectively). Axillary surgery (unemployment at five-years: OR = 5.13, 95%CI:1.30-20.27), hormonal therapy (unemployment at three-years: OR = 0.28, 95%CI:0.10-0.83) and targeted therapy (sick leave at three-years: OR = 3.79, 95%CI:1.14-12.63) also influenced employment status. Five-years post diagnosis, women with breast cancer had a lower incidence of unemployment (IRR = 0.51, 95%CI:0.30-0.89) than the general population, while, among older women, there was a higher tendency to enter early retirement (IRR = 1.72, 95%CI:0.82-3.61).

CONCLUSIONS

Although not all women may want to pursue or continue a professional life following their breast cancer experience; those who do may benefit from social and employer support when returning to work.

Lasting effects of cancer and its treatment on employment and finances in adolescent and young adult cancer survivors

BACKGROUND

The impact of cancer and its treatment on employment and financial burden in adolescents/young adults (AYAs) is not fully known.

METHODS

Eligibility for this cross-sectional study of AYA cancer survivors included the diagnosis of a malignancy between ages 18 and 39 years and survey completion within 1 to 5 years from diagnosis and ≥1 year after therapy completion. Participants were selected randomly from the tumor registries of 7 participating sites and completed an online patient-reported outcomes survey to assess employment and financial concerns. Treatment data were abstracted from medical records. Data were analyzed across diagnoses and by tumor site using logistic regression and Wald-based 95% confidence intervals adjusting for age (categorized), sex, insurance status, education (categorized), and treatment exposures.

RESULTS

Participants included 872 survivors (breast cancer, n = 241; thyroid cancer, n = 126; leukemia/lymphoma, n = 163; other malignancies, n = 342). Exposure to chemotherapy in breast cancer survivors was associated with an increase in self-reported mental impairment in work tasks (odds ratio [OR], 2.66) and taking unpaid time off (OR, 2.62); survivors of "other" malignancies reported an increase in mental impairment of work tasks (OR, 3.67) and borrowing >$10,000 (OR, 3.43). Radiation exposure was associated with an increase of mental impairment in work tasks (OR, 2.05) in breast cancer survivors, taking extended paid time off work in thyroid cancer survivors (OR, 5.05), and physical impairment in work tasks in survivors of "other" malignancies (OR, 3.11). Finally, in survivors of "other" malignancies, having undergone surgery was associated with an increase in physical (OR, 3.11) and mental impairment (OR, 2.31) of work tasks.

CONCLUSIONS

Cancer treatment has a significant impact on AYA survivors' physical and mental work capacity and time off from 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.

Loss in working years after a breast cancer diagnosis

Background:

Breast cancer can negatively influence working life, but it is unclear how many working years women with breast cancer can expect to lose.

Methods:

Women diagnosed with breast cancer between 1997 and 2012 were identified in the Breast Cancer Data Base Sweden (N=19 661), together with breast cancer-free comparison women (N=81 303). Using flexible parametric survival modelling, the loss in working years was calculated as the difference in the remaining years in the work force between women with and without breast cancer.

Results:

Women aged 50 years at diagnosis with stage I disease lost on average 0.5 years (95% CI, 0.2–0.7) of their remaining working time; the corresponding estimates were 0.9 years (0.5–1.2) in stage II, 2.5 years (1.9–3.1) in stage III and 8.1 years (6.5–9.7) in stage IV. Women with in situ breast cancer did not lose any working years. The strongest treatment determinant was axillary lymph node dissection.

Conclusions:

We found a loss in working years not only in late but also in early-stage breast cancer. Although it is reassuring that some groups had no or only a modest work loss, the economic consequences for society are considerable given the large number of women annually diagnosed with breast cancer.

The long-term financial consequences of breast cancer: a Danish registry-based cohort study

BACKGROUND

A breast cancer diagnosis affects an individual's affiliation to labour market, but the long-term consequences of breast cancer on income in a Danish setting have not been examined. The present study investigated whether breast cancer affected future income among Danish women that participated in the work force. We also examined the roles of sociodemographic factors and prior psychiatric medical treatment.

METHODS

This registry-based cohort study was based on information retrieved from linked Danish nationwide registries. We compared the incomes of 13,101 women (aged 30-59 years) diagnosed with breast cancer (exposed) to those of 60,819 women without breast cancer (unexposed). Changes in income were examined during a 10-year follow-up; for each follow-up year, we calculated the mean annual income and the relative change compared to the income earned one year prior to diagnosis. Expected changes in Danish female income, according to calendar year and age, were estimated based on information from Statistics Denmark. For exposed and unexposed groups, the observed income changes were dichotomized to those above and those below the expected change in income in the Danish female population. We examined the impact of breast cancer on income each year of follow-up with logistic regression models. Analyses were stratified according to educational level, marital status, and prior psychiatric medical treatment.

RESULTS

Breast cancer had a temporary negative effect on income. The effect was largest during the first three years after diagnosis; thereafter, the gap narrowed between exposed and unexposed cohorts. The odds ratio for an increase in income in the cancer cohort compared to the cancer-free cohort was 0.81 (95% CI 0.77-0.84) after three years. After seven years, no significant difference was observed between cohorts. Stratified analyses demonstrated that the negative effect of breast cancer on income lasted longest among women with high educational levels. Being single or having received psychiatric medical treatment increased the chance to experience an increase in income among women with breast cancer.

CONCLUSION

A breast cancer diagnosis led to negative effects on income, which ameliorated over the following seven years. Sociodemographic factors and prior psychiatric medical treatment might influence long-term consequences of breast cancer on income.

Work functioning trajectories in cancer patients: Results from the longitudinal Work Life after Cancer (WOLICA) study

More than 60% of cancer patients are able to work after cancer diagnosis. However, little is known about their functioning at work. Therefore, the aims of this study were to (1) identify work functioning trajectories in the year following return to work (RTW) in cancer patients and (2) examine baseline sociodemographic, health-related and work-related variables associated with work functioning trajectories. This longitudinal cohort study included 384 cancer patients who have returned to work after cancer diagnosis. Work functioning was measured at baseline, 3, 6, 9 and 12 months follow-up. Latent class growth modeling (LCGM) was used to identify work functioning trajectories. Associations of baseline variables with work functioning trajectories were examined using univariate and multivariate analyses. LCGM analyses with cancer patients who completed on at least three time points the Work Role Functioning Questionnaire (n = 324) identified three work functioning trajectories: "persistently high" (16% of the sample), "moderate to high" (54%) and "persistently low" work functioning (32%). Cancer patients with persistently high work functioning had less time between diagnosis and RTW and had less often a changed meaning of work, while cancer patients with persistently low work functioning reported more baseline cognitive symptoms compared to cancer patients in the other trajectories. This knowledge has implications for cancer care and guidance of cancer patients at work.

Sickness Absence and Disability Pension After Breast Cancer Diagnosis: A 5-Year Nationwide Cohort Study

Purpose To explore future diagnosis-specific sickness absence and disability pension among women with breast cancer compared with women without breast cancer. Also, to examine associations with disease-related and sociodemographic factors among those with breast cancer. Methods Longitudinal register data on 3,547 women living in Sweden (age 20 to 65 years) who were first diagnosed with breast cancer in 2005, and a matched comparison cohort (n = 14,188), were analyzed for the annual prevalence of diagnosis-specific sickness absence and disability pension over 5 years. Logistic regressions were used to explore associations of disease-related and sociodemographic factors with future sickness absence and disability pension among women with breast cancer. Results Immediately after being diagnosed with breast cancer, the proportion of women with sickness absence was high but decreased continuously from the 1st through 5th year after diagnosis (71%, 40%, 30%, 22%, and 19%, respectively). In comparison, the range for women without breast cancer was 17% to 11%, respectively. The higher prevalence of sickness absence after breast cancer was mainly a result of breast cancer diagnosis, not a mental diagnosis, or other somatic diagnoses. Advanced cancer at diagnosis, > 90 days sickness absence before diagnosis, low education, and being born outside Sweden were associated with higher odds ratios for sickness absence and disability pension (odds ratio range, 1.40 to 6.45). Conclusion The level of sickness absence increased substantially in women with breast cancer during the first year after diagnosis and approached the level of breast cancer-free women in the following years; however, even in the first year, most women were not on sickness absence for a substantial time, and even in high-risk groups, many were not on sickness absence or disability pension in the following years. Information about relatively low future sickness absence and disability pension levels can be used by patients when planning their work, by health care professionals, and by social insurance officers. Employers and Occupational Health Services need this information to adequately handle workplace adjustments.

Factors Related to Return to Work in Women After Breast Cancer in Iran

Background:

Most women are diagnosed with breast cancer (BC) when they are still at the appropriate age for employment. The increasing survival rates of patients with BC call for more attention to their ability to return to work.

Objectives:

The aim of this study was to identify factors related to the return to work in Iranian women underwent BC treatment.

Patients and Methods:

A total of 175 women with BC, who met the inclusion criteria, were enrolled in this cross-sectional study. The subjects were recruited from four hospitals affiliated to Mashhad university of medical sciences. These hospitals are oncology referral centers in eastern Iran. All records of employed women with BC were studied in four hospitals of Mashhad city, Iran, during 2000 - 2010. The researchers designed a questionnaire, which consisted of questions regarding social/demographic, health/disease, and work characteristics. The questionnaires were completed through interviews. Data were analyzed using SPSS software, version 11.5.

Results:

The mean age of the patients at the time of interview was 44.3 ± 6.72 years. Mean age of “Return- to-work” group was 42.71 and “No return-to-work” group was 51.06. Most women (80%) were married. At the time of the interview, 80% had returned to work after a BC diagnosis. Older patients (OR = 0.796; 95% CI, 0.625 - 0.907, P = 0.002), and those with a great deal of work experience (OR = 0.861; 95% CI, 0.752 - 0.986, P = 0.030) were less likely to return to work. Also, women who had no pain or surgery scar (OR = 23.03; 95% CI, 4.53 - 117.02, P < 0.001) as well as those who had no lymphedema after the BC treatment were more likely to return to work (OR = 22.373; 95% CI, 4.04 - 23.892, P < 0.001).

Conclusions:

The results of this study show the factors related to the return-to-work after BC treatment in working women in Mashhad city, Iran. These predictors should be taken into account in order to improve the patient’s life quality.

Quality of working life of cancer survivors: development of a cancer-specific questionnaire

Purpose

The aim of this study was to generate, and select quality of working life issues for the development of an initial version of the Quality of Working Life Questionnaire for Cancer Survivors (QWLQ-CS).

Methods

Quality of working life issues were generated through focus groups with cancer survivors and oncological occupational physicians, and interviews with employers, supervisors, and organization officers. A selection of these quality of working life issues was made based on relevance and importance by conducting an online questionnaire among the cancer survivors and oncological occupational physicians. Researchers formulated the issues into items for the QWLQ-CS.

Results

A total of 24 cancer survivors, six oncological occupational physicians and 11 employers, supervisors, and organization officers participated. The 222 quality of working life issues identified through the focus groups, interviews, and literature were converted into an online questionnaire. Cancer survivors (N = 20) found 44 issues not relevant or important with respect to their quality of working life. The researchers reviewed the remaining 178 issues and formulated them into 102 items classified by five categories: work perception, job characteristics, the social structure and environment, organizational characteristics, and the effect of the disease and treatment.

Conclusions

The initial version of the QWLQ-CS exists out of 102 items which cover the experiences and perceptions of cancer survivors in the work environment. All items were indicated by working cancer survivors as relevant and important.

Implications for cancer survivors

This initial version of the QWLQ-CS may increase awareness of the potential problems or emotional difficulties working cancer survivors face during the work continuation process.

The global impact of non-communicable diseases on macro-economic productivity: a systematic review

Non-communicable diseases (NCDs) have large economic impact at multiple levels. To systematically review the literature investigating the economic impact of NCDs [including coronary heart disease (CHD), stroke, type 2 diabetes mellitus (DM), cancer (lung, colon, cervical and breast), chronic obstructive pulmonary disease (COPD) and chronic kidney disease (CKD)] on macro-economic productivity. Systematic search, up to November 6th 2014, of medical databases (Medline, Embase and Google Scholar) without language restrictions. To identify additional publications, we searched the reference lists of retrieved studies and contacted authors in the field. Randomized controlled trials, cohort, case-control, cross-sectional, ecological studies and modelling studies carried out in adults (>18 years old) were included. Two independent reviewers performed all abstract and full text selection. Disagreements were resolved through consensus or consulting a third reviewer. Two independent reviewers extracted data using a predesigned data collection form. Main outcome measure was the impact of the selected NCDs on productivity, measured in DALYs, productivity costs, and labor market participation, including unemployment, return to work and sick leave. From 4542 references, 126 studies met the inclusion criteria, many of which focused on the impact of more than one NCD on productivity. Breast cancer was the most common (n = 45), followed by stroke (n = 31), COPD (n = 24), colon cancer (n = 24), DM (n = 22), lung cancer (n = 16), CVD (n = 15), cervical cancer (n = 7) and CKD (n = 2). Four studies were from the WHO African Region, 52 from the European Region, 53 from the Region of the Americas and 16 from the Western Pacific Region, one from the Eastern Mediterranean Region and none from South East Asia. We found large regional differences in DALYs attributable to NCDs but especially for cervical and lung cancer. Productivity losses in the USA ranged from 88 million US dollars (USD) for COPD to 20.9 billion USD for colon cancer. CHD costs the Australian economy 13.2 billion USD per year. People with DM, COPD and survivors of breast and especially lung cancer are at a higher risk of reduced labor market participation. Overall NCDs generate a large impact on macro-economic productivity in most WHO regions irrespective of continent and income. The absolute global impact in terms of dollars and DALYs remains an elusive challenge due to the wide heterogeneity in the included studies as well as limited information from low- and middle-income countries.

Predictors of return to work in cancer survivors in the Royal Air Force

PURPOSE

Return to work (RTW) is beneficial for cancer survivors, employers and society. However, little is known about predictors of RTW in the military environment.

METHODS

A cohort of 194 Royal Air Force (RAF) personnel aged 18-58 who survived primary cancer treatment between 2001 and 2011 were followed up for 18 months. Information was obtained from occupational health and primary care records. Personal, occupational and clinical predictors of RTW were identified by Cox proportional hazards regression.

RESULTS

The median sickness absence before RTW was 107 days. Six months after diagnosis 54 % of participants had RTW, and reached 80 % by 12 months. Time taken to RTW was predicted by age at diagnosis, rank, trade group, pre-diagnosis sickness absence, site of cancer, treatment modality, and prognosis. RTW at 18 months were predicted by higher rank (HR = 2.31; 95 % CI 1.46-3.65), and having melanoma (9.75; 4.97-19.13). Those receiving chemotherapy were significantly less likely to have RTW compared to other treatment modalities (0.18; 0.10-0.32).

CONCLUSIONS

Rank, cancer diagnostic group, and treatment modality are the most important predictors of RTW in cancer survivors in the RAF. These predictors can be used to inform rehabilitation programmes and decisions on RTW.

Sickness absence and disability pension following breast cancer - A population-based matched cohort study

PURPOSE

To compare sickness absence and disability pension in a population-based cohort of women with breast cancer (n = 463) from 1 year pre-diagnosis until 3 years post-diagnosis with a matched control group (n = 2310), and to investigate predictors of sickness absence during the 2nd and 3rd year post-diagnosis.

RESULTS

Following breast cancer, the proportion of disease-free women with sickness absence decreased post-diagnosis (1st-3rd year; 78%-31%-19%), but did not reach the pre-diagnostic level (14%; P < 0.05). Post-diagnosis, patients were more likely than controls to be sickness absent (1st-3rd year; P < 0.001). No between-group differences were observed for disability pension post-diagnosis (P > 0.05). Among patients, chemotherapy, baseline fatigue and pre-diagnosis sick days predicted sickness absence during the 2nd, 3rd, and 2nd and 3rd year post-diagnosis, respectively (P < 0.05).

CONCLUSIONS

Breast cancer is associated with increased sickness absence 3 years post-diagnosis. In a clinical setting, prevention and treatment of side effects are important in reducing long-term consequences.

Return to work following breast cancer treatment: the employers' side

PURPOSE

Research on employers' experiences with return to work (RTW) of employees with breast cancer is lacking. Employers seem to be the key people to create good working conditions. Our aim is to explore how Belgian employers experience their role and responsibility in RTW of employees with breast cancer.

METHODS

Using a qualitative design (Grounded Theory) 17 employers from the public (7), private (5) and non-profit (5) sector, directly involved in the RTW process, were interviewed. The analysis was based on the Qualitative Analysis Guide of Leuven (QUAGOL) with constant data comparison and interactive team dialogue as important guiding characteristics.

RESULTS

RTW of employees with breast cancer is experienced by employers as an intangible process that is difficult to manage. This was expressed in (1) concern, referring to the employer's personal and emotional involvement, (2) uncertainty about the course of illness and the guidance needed by the employee and (3) specific dilemmas in the RTW process (when does one infringe on employee privacy; employee vs. organization interest; employers' personal vs. professional role). The degree to which this was experienced related to variety in organizational, employer, and employee factors.

CONCLUSIONS

The findings of this study confirm the importance of the employer's involvement in RTW of employees with breast cancer and contribute to a better understanding of its complexity. The employers did their best to grasp the intangibility of the RTW process. Further research is needed to refine these findings and to discover the specific needs of employers regarding supporting RTW of breast cancer patients.

Returning to Work After Breast Cancer: A Critical Review

Breast cancer and return to work (RTW) is a global issue affected by many factors. The World Health Organization's International Classification of Functioning, Disability and Health (ICF) can be used to address disease/treatment, person and work related factors that can impact the RTW process for breast cancer survivors. The work environment, treatment and sociodemographic factors can affect the timeliness of RTW. While conventional treatment methods are critical for survival, there are other strategies that may provide comfort and relief that can improve functioning in the workplace. Although the number of studies addressing this is increasing, certain issues such as differences in RTW rates, RTW needs and accountability need further investigation. A thorough understanding of the independent and combined effects of disease/treatment, work and person related factors can assist in the appropriate implementation of RTW strategies for breast cancer survivors. For many breast cancer survivors, returning to work is used as a gauge of healing and control over breast cancer, providing encouragement for the future.

Survived but feeling vulnerable and insecure: a qualitative study of the mental preparation for RTW after breast cancer treatment

Background

Improvements in treatment have resulted in an increasing number of cancer survivors potentially being able to return to work after medical treatment. In this paper we focus on the considerations regarding return to work (RTW) of breast cancer absentees in the Belgian context and how these considerations are related to reactions from their social environment.

Methods

A qualitative study was performed to understand the RTW considerations of Belgian breast cancer absentees who had undergone breast cancer surgery in 2006. Twenty-two participants (mean age 46) were included and interviewed between May 2008 and August 2009 in their personal environment. An in-depth analysis (Grounded Theory) took place using the Qualitative Analysis Guide of Leuven (Quagol).

Results

Before the actual RTW, breast cancer employees try to build an image of the future resumption of work based on medical grounds and their knowledge of the workplace. Four matters are considered prior to RTW: (i) women want to leave the sick role and wish to keep their job; (ii) they consider whether working is worth the effort; (iii) they reflect on their capability; and (iv) they have doubts about being accepted in the workplace after returning. These inner thoughts are both product and input for the interaction with the social environment. The whole process is coloured by uncertainty and vulnerability.

Conclusion

Our study demonstrated that mental preparation for RTW is not a linear process of improvement. It shows a detailed picture of four types of considerations made by breast cancer survivors before they actually resume work. Vulnerability appears to be an overarching theme during mental preparation. As the social environment plays an important role, people from that environment must become more aware of their influence on decreasing or increasing a woman’s vulnerability while preparing for RTW.

Change in working time in a population-based cohort of patients with breast cancer

PURPOSE

We examined changes in working time 16 months after a breast cancer diagnosis and identified factors associated with job discontinuation and/or decreased working time.

PATIENTS AND METHODS

This was a population-based cohort study with 735 patients identified in the Regional Breast Cancer Quality Register of Central Sweden. The study sample consisted of 505 women (age < 63 years at diagnosis) who completed questionnaires at baseline and at follow-up (on average 4 and 16 months after diagnosis, respectively). Clinical register data and questionnaire data on sociodemographic factors were obtained at baseline. Self-reported work-related data were obtained at follow-up. Odds ratios were estimated by using logistic regression models.

RESULTS

Compared with prediagnosis working time, 72% reported no change in working time, 2% reported an increase, 15% reported a decrease, and 11% did not work at follow-up. Chemotherapy increased the likelihood (odds ratio [OR], 2.45; 95% CI, 1.38 to 4.34) of job discontinuation/decreased working time. Among chemotherapy recipients, associated factors included full-time work prediagnosis (OR, 3.25; 95% CI, 1.51 to 7.01), cancer-related work limitations (OR, 5.26; 95% CI, 2.30 to 12.03), and less value attached to work (OR, 3.69; 95% CI, 1.80 to 7.54). In the nonchemotherapy group, older age (OR, 1.09; 95% CI, 1.02 to 1.17) and less value attached to work (OR, 5.00; 95% CI, 2.01 to 12.45) were associated with the outcome.

CONCLUSION

The majority of women treated for breast cancer returned to their prediagnosis working time. Chemotherapy and cancer-related work limitations are important factors to take into account in identifying women in need of support. Moreover, it is important to consider the woman's own valuation of labor market participation.

Sick leave patterns among 5-year cancer survivors: a registry-based retrospective cohort study

PURPOSE

The aims of this study were to observe the sick leave rates of cancer survivors for five consecutive years following a first lifetime diagnosis of invasive cancer and to identify socio-demographic and clinical predictors of sick leave taken in the fifth year after diagnosis.

METHODS

This registry study comprised 2,008 Norwegian individuals (18-61 years old) with their first lifetime diagnosis of invasive cancer in 1999 and alive in 2004 and a cancer-free control group (n = 3,240) matched by sex, age, educational level, and employment status in 1998. Sick leave was defined as at least one sick leave period >16 days within the year in question.

RESULTS

A total of 75 % of the long-term cancer survivors (LTCSs) took sick leave within the first 12 months after their diagnosis. The sick leave rate stabilized at a slightly higher level in the following 4 years compared to the year before diagnosis, with approximately 23 % of the male and 31 % of the female LTCSs taking sick leave. Being single with children, having low education, working in health and social work sector, or having taken sick leave the year before diagnosis (1998) predicted the sick leave taken 5 years after diagnosis (2004) among LTCSs. Compared to the controls, LTCSs with rectal, lymphogenic, breast, or "other" types of cancer had significantly higher sick leave rates 5 years after diagnosis. Socio-demographic factors explained more of the variance in sick leave than did clinical factors.

CONCLUSION

Employed LTCSs struggle with their ability to work 5 years after diagnosis. More research is needed to identify factors that would promote LTCSs' health and ability.

IMPLICATIONS FOR CANCER SURVIVORS

A socioeconomic and work environmental perspective seems necessary for achieving effective occupational rehabilitation and preventing sick leave among LTCSs.

A comparative study of cancer patients with short and long sick-leave after primary treatment

BACKGROUND

Sick-leave after primary cancer treatment has hardly been studied. This study compares Norwegian cancer patients (CPs) with shorter (≤8 months) and longer (≥9 months) sick-leave after primary cancer treatment. Our aim was to characterize factors associated with these two types of sick-leave in order to identify possible factors for interventions by which long-term sick-leaves may be avoided.

METHODS

A mailed questionnaire was completed by a sample of Norwegian CPs 15 to 39 months after primary treatment of the ten most common invasive types of cancer. The groups with shorter (n=359) and longer (n=481) sick-leaves (SSL vs LSL) were compared with each other by self-reported information as to socio-demographic and cancer-related variables, health, quality of life, work ability, work situation and supportive interventions.

RESULTS

The LSL consisted of 78% females, and 76% of them had breast or gynaecological cancer. A higher proportion of patients with low level of education, economical problems, treated with chemotherapy, hormones and multimodal treatment belonged to LSL compared to SSL. Significantly more LSL had recurrences of cancer, co-morbidity, regular use of medication, and poorer self-rated health, quality of life and work ability. Compared to SSL, more LSL reported needs for and offers of supportive care such as physiotherapy, physical activities and psychosocial support. A multivariate regression analysis showed that reduced work ability, changes in employment due to cancer, lack of support from supervisors at work, and having had combined treatment were significantly associated with being LSL.

CONCLUSIONS

Longer sick-leave after primary cancer treatment is associated with combined cancer treatment, lack of support from supervisors and reduced overall work ability. Interventions and counselling related to the work place and reduced work ability could be of value for prevention of long-term sick-leaves.

Breast cancer, sickness absence, income and marital status. A study on life situation 1 year prior diagnosis compared to 3 and 5 years after diagnosis

BACKGROUND

Improved cancer survival poses important questions about future life conditions of the survivor. We examined the possible influence of a breast cancer diagnosis on subsequent working and marital status, sickness absence and income.

MATERIALS

We conducted a matched cohort study including 4,761 women 40-59 years of age and registered with primary breast cancer in a Swedish population-based clinical register during 1993-2003, and 2,3805 women without breast cancer. Information on socioeconomic standing was obtained from a social database 1 year prior and 3 and 5 years following the diagnosis. In Conditional Poisson Regression models, risk ratios (RRs) and 95% confidence intervals (CIs) were estimated to assess the impact of a breast cancer diagnosis.

FINDINGS

Three years after diagnosis, women who had had breast cancer more often had received sickness benefits (RR = 1.49, 95% CI 1.40-1.58) or disability pension (RR = 1.47, 95% CI 1.37-1.58) than had women without breast cancer. We found no effect on income (RR = 0.99), welfare payments (RR = 0.98), or marital status (RR = 1.02). A higher use of sickness benefits and disability pension was evident in all stages of the disease, although the difference in use of sickness benefits decreased after 5 years, whereas the difference in disability pension increased. For woman with early stage breast cancer, the sickness absence was higher following diagnosis among those with low education, who had undergone mastectomy, and had received chemo- or hormonal therapy. Neither tumour size nor presence of lymph nodes metastasis was associated with sickness absence after adjustment for treatment.

INTERPRETATION

Even in early stage breast cancer, a diagnosis negatively influences working capacity both 3 and 5 years after diagnosis, and it seems that the type of treatment received had the largest impact. A greater focus needs to be put on rehabilitation of breast cancer patients, work-place adaptations and research on long-term sequelae of treatment.

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.