Cognitive challenges while at work and work output in breast cancer survivors employed in a rapidly evolving economy

The experiences and perceptions of employers on cancer survivors returning to work: a meta-synthesis of qualitative studies

PURPOSE

Employers play an important role in the return-to-work (RTW) of cancer survivors (CSs), and recently a substantial number of qualitative studies from the employers' perspective have emerged. This meta-synthesis aims to systematically review these qualitative studies regarding employers' experiences with CSs' RTW.

METHODS

Five electronic databases were searched from inception to January 2024 to identify the studies. Three researchers conducted quality assessment of included. Subsequent, we performed thematic integration of the included studies with the NVivo 11 software.

RESULTS

Thirteen qualitative studies were included, and 16 topics were finally extracted and summarized into seven categories to form three integrated themes: employers' perspective on facilitators and obstacles for CSs' RTW, employers' response including negative emotion and positive behavior, and employers' need resources from different aspects.

CONCLUSION

CSs' RTW is influenced by many factors; the support employers need is also extensive and complex. Employers need more support beyond healthcare.

Internet-based cognitive rehabilitation for working cancer survivors: results of a multicenter randomized controlled trial

BACKGROUND

Cognitive problems contribute to decline in work performance. We evaluated (1) the effectiveness of basic self-management and extensive therapist-guided online cognitive rehabilitation on attainment of individually predetermined work-related goals among occupationally active cancer survivors, and (2) whether effectiveness of the programs differed for survivors with and without formal cognitive impairment.

METHODS

In a 3-arm randomized controlled trial (NCT03900806), 279 non-central nervous system cancer survivors with cognitive complaints were assigned to the basic program (n = 93), the extensive program (n = 93), or a waiting-list control group (n = 93). Participants completed measurements pre-randomization (T0), 12 weeks post-randomization upon program completion (T1), and 26 weeks post-randomization (T2). Mixed-effects modeling was used to compare intervention groups with the control group on goal attainment, and on self-perceived cognitive problems, work ability, and health-related quality of life.

RESULTS

Participants in the extensive program achieved their predetermined goals better than those in the control group, at short- and long-term follow-up (effect size [ES] = .49; P < .001; ES = .34; P = .014). They also had fewer recovery needs after work (ES = -.21; P = .011), more vitality (ES = .20; P = .018), and better physical role functioning (ES = .0.43 P = .015) than controls. At long-term follow-up, this finding persisted for physical role functioning (ES = .42; P = .034). The basic program elicited a small positive nonsignificant short-term (not long-term) effect on goal attainment for those with adequate adherence (ES = .28, P = .053). Effectiveness of the programs did not differ for patients with or without cognitive impairment.

CONCLUSIONS

Internet-based therapist-guided extensive cognitive rehabilitation improves work-related goal attainment. Considering the prevalence of cognitive problems in survivors, it is desirable to implement this program.

Trajectories of cognitive symptoms and associated factors in cancer survivors after return to work: an 18-month longitudinal cohort study

PURPOSE

Cognitive symptoms affect cancer survivors' functioning at work. To date, cognitive symptoms trajectories in working cancer survivors and the factors associated with these trajectories have not been examined.

METHODS

Data from a heterogeneous group of working cancer survivors (n = 379) of the longitudinal "Work-Life-after-Cancer" study, linked with Netherlands Cancer Registry data, were used. The Cognitive Symptom Checklist-Work was administered at baseline (within the first 3 months after return to work), 6-, 12-, and 18-month follow-up to measure self-perceived memory and executive function symptoms. Data were analyzed using group-based trajectory modeling.

RESULTS

Four trajectories of memory and executive function symptoms were identified. All memory symptoms trajectories were stable and labeled as "stable-high" (15.3% of the sample), "stable-moderately high" (39.6%), "stable-moderately low" (32.0%), and "stable-low" (13.0%). Executive function symptoms trajectories changed over time and were labeled as "increasing-high" (10.1%), "stable-moderately high" (32.0%), "decreasing-moderately low" (35.5%), and "stable-low" (22.4%). Higher symptoms trajectories were associated with older age, longer time from diagnosis to return to work, more quantitative work demands, and higher levels of depressive symptoms at baseline.

CONCLUSIONS

In cancer survivors who returned to work, four cognitive symptoms trajectory subgroups were identified, representing different but relatively stable severity levels of cognitive symptoms.

IMPLICATIONS FOR CANCER SURVIVORS

To identify cancer survivors with higher symptoms trajectories, health care providers should assess cognitive symptoms at baseline after return to work. In case of cognitive symptoms, it is important to also screen for psychological factors to provide appropriate guidance.

The Contribution of Psychological Resilience and Job Meaningfulness to Well-being of Working Cancer Survivors

BACKGROUND

Although studies suggest that cancer survivors face workplace obstacles, to date there has been little empirical research regarding the personal and environmental factors that can help cancer survivors adjust to work. The purpose of this study was to examine how working survivors' resilience and job meaningfulness were related to their well-being outcomes, including lower cancer-related intrusive thoughts, fatigue, and presenteeism.

METHODS

We recruited 200 full-time employed cancer survivors from online participant panels using Qualtrics. Participants responded to an online survey that measured their resilience, job meaningfulness, job-related psychological distress, and well-being outcomes. We conducted descriptive statistical analysis, confirmatory factor analysis, and moderated mediated analysis to examine the psychological process in which resilience and job meaning are associated with cancer survivors' mental health and work outcomes. Findings: The relationship between cancer survivors' resilience and their well-being outcomes depended on job meaningfulness. For survivors whose jobs were not highly meaningful, their resilience was related to reduced job-related psychological distress, which, in turn, was related to lower intrusive thoughts, fatigue, and presenteeism. For survivors with highly meaningful jobs, they did not need to rely on resilience to protect them from workplace psychological distress and other negative outcomes. Conclusion/Application to Practice: It is important for working cancer survivors to develop resilience, especially when they do not perceive their work as highly meaningful. Successful resilience-building interventions can buffer the negative impact of low job meaningfulness and help working survivors achieve better outcomes. In addition, organizations can actively help enrich survivors' jobs to increase perceived meaningfulness.

A Systematic Review: The Effect of Cancer on the Divorce Rate

Introduction

Research on the impact of cancer on close relationships brings up conflicting results. This systematic review collects empirical evidence on the research questions whether a cancer diagnosis in general or the type of cancer affects the divorce rate.

Materials and Methods

This systematic review was conducted according to the guidelines of the Cochrane Collaboration and the PRISMA statement. The following electronic databases were searched: Web of Science, Ovid SP MEDLINE, PsycINFO, PsyINDEX, CINAHL, ERIC. Risk of bias assessment was performed with the preliminary risk of bias for exposures tool template (ROBINS-E tool). The grading of methodological quality was assessed with the Newcastle-Ottawa Scale.

Results

Of 13,929 identified records, 15 were included in the qualitative synthesis. In 263,616 cancer patients and 3.4 million healthy individuals, we found that cancer is associated with a slightly decreased divorce rate, except for cervical cancer, which seems to be associated with an increased divorce rate.

Discussion

According to this systematic review, cancer is associated with a tendency to a slightly decreased divorce rate. However, most of the included studies have methodologic weaknesses and an increased risk of bias. Further studies are needed.

Trajectories of Cognitive Symptoms in Sick-Listed Cancer Survivors

Simple Summary

The effects of cognitive symptoms on the ability to work are of major concern for cancer survivors. The aim of our study was to explore trajectories of cognitive functioning in sick-listed cancer survivors with work capacity. We found that cognitive functioning improved between two and four years after first day of sick leave, although cognitive symptoms remained of clinical concern in cancer survivors who are non-durable work-disabled (partly or fully). This underlines the importance to provide partly and fully, non-durable work disabled cancer survivors with evidence-based treatment options for their self-perceived cognitive symptoms.

Abstract

Many non-central nervous system (CNS) cancer survivors experience cognitive symptoms, which may affect their self-perceived work ability. Little is known about trajectories of self-perceived cognitive functioning in cancer survivors in the period after work disability assessment. Therefore, we evaluated: (1) trajectories of self-reported cognitive functioning, in cancer survivors with work capacity, (2) differences in trajectories of self-reported cognitive functioning between three work disability groups, and (3) explanatory factors of trajectories of self-reported cognitive functioning. Participants (n = 206) were assessed on self-reported cognitive functioning at three time points between two and four years after first day of sick leave. A statistically significant improvement in cognitive functioning was found in the total group (β = 4.62, SE = 0.91, p < 0.001). When comparing cancer survivors in different work disability groups, similar trajectories of cognitive functioning were observed. Fatigue was the only factor found to be associated with the reported trajectory (β = −0.23, SE = 0.086, p = 0.08). Self-perceived cognitive functioning scores remained considerably lower than the mean score of the general Dutch population, indicating that cognitive symptoms are a persistent problem in sick-listed cancer survivors and that evidence-based treatment options are warranted.

Cognitive changes after breast cancer: a scoping review to identify problems encountered by women when returning to work

PURPOSE

A scoping review of international literature was conducted to identify the various problems encountered by women with breast cancer associated with cognitive deficits, and the relationship to work roles and tasks.

METHOD

This scoping review was conducted using the structure recommended by Arksey & O'Malley in consideration of the PRISMA extension for Scoping Reviews checklist and reviewed for quality, inclusion criteria and key findings related to cognitive changes after breast and impact on work. Searches were conducted in five databases from January 2000 to December 2020.

RESULTS

A total of 34 studies met the inclusion criteria. There were 20 quantitative studies, 11 qualitative studies, one mixed method and two case study reports. Findings related to the type of cognitive changes that impact work performance and participation, how these are measured in a work context and the types of interventions directed towards improving cognitive function at work after breast cancer. An absence of ecologically valid assessments and interventions with a coherent approach to early identification and management of cognitive changes after breast cancer was apparent.

CONCLUSION

Breast cancer survivors can experience challenges in their employment due to cognitive deficits, which may lead to the loss of their employment. Health professionals need to explore breast cancer survivors work role and consider appropriate referrals to ensure women receive the necessary support and rehabilitation to address cognitive problems impacting work performance. Further research is needed to develop workplace-based cognitive assessments and interventions to improve the work performance and participation of women with breast cancer experiencing cognitive deficits.Implications for RehabilitationWork participation can be negatively impacted by unacknowledged cognitive changes that are not assessed and managed throughout the cancer survivorship journey.Health professionals in health care systems, particularly occupational therapists need to consider appropriate referrals to workplace rehabilitation providers to ensure necessary support and rehabilitation to address cognitive problems impacting on work performance.Occupational therapists performing workplace assessments for women with breast cancer, should assesses cognitive function in accordance with the cognitive demands of the job and work environment, and involve the employer and client in workplace based cognitive interventions.

Return to work and cancer: Perspectives of occupational therapists

INTRODUCTION

Progress in the early detection, diagnosis, and treatment of cancer has translated into more people in Australia living with and beyond cancer. Therefore, there is a larger number of people returning to work following cancer treatment while managing ongoing symptoms of cancer, and side effects of treatment. The purpose of this study was to explore the facilitators and barriers for return to work for someone with cancer, from the perspective of occupational therapists.

METHOD

This study used a qualitative descriptive design. Participants were recruited via key contacts within the industry and relevant interest groups, and included eight occupational therapists with experience supporting someone with cancer to return to work. Data were collected in semi-structured in-depth Interviews which were audio recorded, transcribed verbatim, and analysed thematically.

FINDINGS

Two main themes were developed; expectations of the cancer experience versus reality, and vulnerability during return to work. Occupational therapists perceived that the person with cancer, employers, family members, co-workers, and society underestimate the impact of ongoing cancer symptoms on return to work. Return to work was challenging as survivors face unexpected challenges due to ongoing fatigue, cognitive difficulties, or psychological factors. Fear of relapse, concerns regarding disclosure affecting how people with cancer are perceived at work, and worries of leaving the high levels of professional support during treatment, also affected return to work.

CONCLUSION

Findings from this study may contribute to occupational therapists and people with cancer setting realistic expectations for the return to work experience. Furthermore, it may provide support for occupational therapists to work more effectively with their clients to facilitate a smoother transition back to work as a cancer survivor.

Relationship of perceived everyday cognitive function and work engagement in breast cancer survivors

INTRODUCTION

Breast cancer survivors (BCS) who represent approximately 3.5 million survivors in the USA frequently report ongoing cognitive dysfunction that may impact work outcomes. However, little is known about how perceived everyday cognitive function may affect work engagement (a measure of work efficacy and work well-being) in BCS who have completed treatment.

OBJECTIVES

The purpose of this study was to examine the relationship between perceived everyday cognitive function and work engagement in BCS.

METHODS

A convenience sample of 68 employed BCS seen at a Midwest NCI-Cancer Center who were at least 1-year post-treatment, completed a cross-sectional questionnaire assessing demographic and medical characteristics, and perceived everyday cognitive function (Everyday Cognition Scale) and work engagement (Utrecht Work Engagement Scale). Descriptive statistics, Pearson's r, and separate regression models controlling for age and education were used to analyze the data.

RESULTS

BCS who were on average 52 (SD = 8.6) years old, 5 (SD = 3.8) years post-treatment, and primarily employed full-time (79%) participated. A subset of BCS (12%) identified poorer everyday cognitive function after BC diagnosis and treatment. Everyday cognition, including subscales vigor and dedication, were correlated with work engagement (p˂0.01), controlling for age and education.

CONCLUSIONS

Findings indicate the important role of perceived everyday cognitive function in work engagement well into survivorship. Reducing cognitive dysfunction may be an important area for future intervention research to support BCS who return to work.

IMPLICATIONS TO PRACTICE

Healthcare providers need to assess and address perceived cognitive dysfunction to promote work-related outcomes in BCS well into survivorship.

Associations between breast cancer survivorship and adverse mental health outcomes: A matched population-based cohort study in the United Kingdom

BACKGROUND

Breast cancer is the most common cancer diagnosed in women globally, and 5-year net survival probabilities in high-income countries are generally >80%. A cancer diagnosis and treatment are often traumatic events, and many women struggle to cope during this period. Less is known, however, about the long-term mental health impact of the disease, despite many women living several years beyond their breast cancer and mental health being a major source of disability in modern societies. The objective of this study was to quantify the risk of several adverse mental health-related outcomes in women with a history of breast cancer followed in primary care in the United Kingdom National Health Service, compared to similar women who never had cancer.

METHODS AND FINDINGS

We conducted a matched cohort study using data routinely collected in primary care across the UK to quantify associations between breast cancer history and depression, anxiety, and other mental health-related outcomes. All women with incident breast cancer in the Clinical Practice Research Datalink (CPRD) GOLD primary care database between 1988 and 2018 (N = 57,571, mean = 62 ± 14 years) were matched 1:4 to women with no prior cancer (N = 230,067) based on age, primary care practice, and eligibility of the data for linkage to hospital data sources. Cox models were used to estimate associations between breast cancer survivorship and each mental health-related outcome, further adjusting for diabetes, body mass index (BMI), and smoking and drinking status at baseline. Breast cancer survivorship was positively associated with anxiety (adjusted hazard ratio (HR) = 1.33; 95% confidence interval (CI): 1.29-1.36; p < 0.001), depression (1.35; 1.32-1.38; p < 0.001), sexual dysfunction (1.27; 1.17-1.38; p < 0.001), and sleep disorder (1.68; 1.63-1.73; p < 0.001), but not with cognitive dysfunction (1.00; 0.97-1.04; p = 0.88). Positive associations were also found for fatigue (HR = 1.28; 1.25-1.31; p < 0.001), pain (1.22; 1.20-1.24; p < 0.001), receipt of opioid analgesics (1.86; 1.83-1.90; p < 0.001), and fatal and nonfatal self-harm (1.15; 0.97-1.36; p = 0.11), but CI was wide, and the relationship was not statistically significant for the latter. HRs for anxiety and depression decreased over time (p-interaction <0.001), but increased risks persisted for 2 and 4 years, respectively, after cancer diagnosis. Increased levels of pain and sleep disorder persisted for 10 years. Younger age was associated with larger HRs for depression, cognitive dysfunction, pain, opioid analgesics use, and sleep disorders (p-interaction <0.001 in each case). Limitations of the study include the potential for residual confounding by lifestyle factors and detection bias due to cancer survivors having greater healthcare contact.

CONCLUSIONS

In this study, we observed that compared to women with no prior cancer, breast cancer survivors had higher risk of anxiety, depression, sleep problems, sexual dysfunction, fatigue, receipt of opioid analgesics, and pain. Relative risks estimates tended to decrease over time, but anxiety and depression were significantly increased for 2 and 4 years after breast cancer diagnosis, respectively, while associations for fatigue, pain, and sleep disorders were elevated for at least 5-10 years after diagnosis. Early diagnosis and increased awareness among patients, healthcare professionals, and policy makers are likely to be important to mitigate the impacts of these raised risks.

Employers' Experience on Involvement in Sickness Absence/Return to Work Support for Employees with Cancer in Small Enterprises

PURPOSE

Return to work (RTW) is important for employees who have survived cancer, yet it is challenging for employers. Small enterprises (< 100 employees) might have limited resources to facilitate RTW of cancer survivors. The purpose of this article is to examine how such employers engage in the support of RTW and to uncover their needs.

METHODS

Eleven owners and one HR manager representing 12 small enterprises (various sectors) were interviewed regarding their experience with RTW of employees surviving cancer. We conducted a thematic analysis with aspects of Grounded Theory.

RESULTS

The characteristics of being a small enterprise (i.e. informal practical arrangements, working as a family, working with limited resources and people) related to four concerns experienced by these employers (concerns about the employer's enterprise; the employee's cancer and recovery; RTW and work adjustments; and about communication). In line with these concerns, employers need information on rights and obligations, RTW arrangements and communication skills during RTW guidance.

CONCLUSIONS

In small enterprises, employers have generally close relationships with their employees, which means that support is gladly provided when employees are diagnosed with cancer. They do however have limited financial means to facilitate RTW and workplace adjustments. They therefore perceive long-term sickness and RTW as a major financial risk for the company.

Cancer-related Fatigue in Breast Cancer Survivors: A Review

Fatigue has been the most distressing and frequent symptom in breast cancer (BC) survivors after treatment. Although fatigue can occur in other cancer survivors, women with a history of BC might share some distinctive features. The present study aimed to recapitulate the knowledge about risk factors and correlates of cancer-related fatigue (CRF) in BC survivors after oncologic therapy. An electronic data search was conducted in PubMed using the terms "fatigue," "breast," "cancer," and "survivors." Records were included if they were original articles, available in English, had used a quantitative scale, had > 100 participants, and had excluded women with BC relapse. BC survivors were required to have finished their treatments ≥ 2 months before, except for hormonal therapy. The physiopathology and other interventions were considered beyond the scope of our review. The correlates were subsequently classified into 7 main categories: (1) sociodemographic data, (2) physical variables, (3) tumor- and treatment-related variables, (4) comorbidities, (5) other symptoms, (6) psychological issues, and (7) lifestyle factors. Fatigue was consistently greater in younger, obese, and diabetic women. Women reporting fatigue often communicated symptoms such as pain, depression, insomnia, and cognitive dysfunction. Coping strategies such as catastrophizing could play an important role in the persistence of fatigue. However, tumor characteristics, previous treatments received, and physical activity were not consistently reported. CRF was a strong predictor of the quality of life of BC survivors after treatment. In conclusion, we found CRF was a frequent and serious symptom that severely affects the quality of life of BC survivors after treatment. Health practitioners require more awareness and information about CRF.

Internet-based cognitive rehabilitation for WORking Cancer survivors (i-WORC): study protocol of a randomized controlled trial

Background

Cognitive problems are common in non-central nervous system cancer survivors. These problems are perceived as an important contributor to decline in work performance and work ability. Various interventions for cognitive problems have been proposed, but effectiveness regarding work-related outcomes has not yet been established. Effective treatment options to alleviate the adverse influence of cognitive problems on work performance are needed for working cancer survivors. In this paper, we will describe the design of a randomized, controlled, multicenter trial that evaluates the (cost-)effectiveness of an Internet-based cognitive rehabilitation program for occupationally active cancer survivors confronted with cognitive problems.

Methods/ design

A three-armed randomized controlled trial will be conducted, including two intervention groups (i.e., basic and extensive cognitive rehabilitation program) and one waitlist control group. In total, 261 cancer survivors (18–65 years) who have returned to work and who experience cognitive problems will be recruited. Patients with and without cognitive impairment as established in a neuropsychological assessment will be eligible; stratification will take place based on the presence of this cognitive impairment. The extensive intervention arm will contain a comprehensive training program (including psycho-education, fatigue management, and cognitive strategy training) with individual guidance (blended intervention). The basic intervention arm will contain a brief cognitive training program (including psycho-education and fatigue management) without individual guidance. The primary outcome will be accomplishment of an individually defined work-related treatment goal. Secondary outcomes include, among others, subjective cognitive functioning, work functioning, and quality of life. Primary and secondary outcomes will be measured at baseline (T0) and at 12 weeks (T1) and 26 weeks (T2) post-randomization.

Discussion

About 40–50% of the cancer patients worldwide are of working age at time of diagnosis. Many of the occupationally active cancer survivors experience cognitive problems. Both from an individual and a societal perspective, it is important to sustain cancer survivors’ employability. An effective treatment to alleviate the impact of cognitive decline and to improve work ability might help cancer survivors to sustain employability.

Trial registration

ClinicalTrials.gov NCT03900806. Registered on 03 April 2019 (current status: ongoing).

Changes in Attentional Function in Patients From Before Through 12 Months After Breast Cancer Surgery

CONTEXT

Although approximately 75% of patients with breast cancer report changes in attentional function, little is known about how demographic, clinical, symptom, and psychosocial adjustment (e.g., coping) characteristics influence changes in the trajectories of attentional function over time.

OBJECTIVES

This study evaluated interindividual variability in the trajectories of self-reported attentional function and determined which demographic, clinical, symptom, and psychosocial adjustment characteristics were associated with initial levels and with changes in attentional function from before through 12 months after breast cancer surgery.

METHODS

Before surgery, 396 women were enrolled. Attentional Function Index (AFI) was completed before and nine times within the first 12 months after surgery. Hierarchical linear modeling was used to determine which characteristics were associated with initial levels and trajectories of attentional function.

RESULTS

Given an estimated preoperative AFI score of 6.53, for each additional month, the estimated linear rate of change in AFI score was an increase of 0.054 (P < 0.001). Higher levels of comorbidity, receipt of adjuvant chemotherapy, higher levels of trait anxiety, fatigue, and sleep disturbance, and lower levels of energy and less sense of control were associated with lower levels of attentional function before surgery. Patients who had less improvements in attentional function over time were nonwhite, did not have a lymph node biopsy, had received hormonal therapy, and had less difficulty coping with their disease.

CONCLUSION

Findings can be used to identify patients with breast cancer at higher risk for impaired self-reported cognitive function and to guide the prescription of more personalized interventions.

Cancer-related cognitive problems at work: experiences of survivors and professionals

PURPOSE

Cancer-related cognitive problems (cancer-related cognitive problems) in working cancer survivors are found to affect work outcomes. We aimed to generate in-depth information regarding cancer-related cognitive problems in working cancer survivors, strategies used to cope with cancer-related cognitive problems at work, and needs of cancer survivors and professionals regarding cancer-related cognitive problems at work.

METHODS

Five focus groups were formed, amongst which three focus groups with cancer survivors (n = 8, n = 7, and n = 8) and two focus groups with professionals (n = 7, n = 8). Thematic analysis of the transcripts was performed to create concepts.

RESULTS

Both cancer survivors and professionals confirmed that cancer-related cognitive problems, which occurred in several domains of neurocognitive functioning, affect work functioning. Cancer survivors used several strategies (e.g., applying practical adjustments, re-organization of work, and accepting limitations) to cope with cancer-related cognitive problems at work, as did professionals in their attempt at supporting cancer survivors facing these problems. Various needs of cancer survivors (e.g., supportive care options, acknowledgment by others) and professionals (e.g., improvement of expertise, clarity about referral pathways) regarding cancer-related cognitive problems at work were mentioned.

CONCLUSIONS

Due to the growing number of working cancer survivors dealing with cancer-related cognitive problems, it is essential to sustain their employability. Therefore, cognitive rehabilitation interventions should be developed, taking functioning at work into account. Knowledge amongst professionals regarding cancer-related cognitive problems, as well as coordination of care for cancer-related cognitive problems, should be improved. Ensuring professional education regarding cancer-related cognitive problems, within both the healthcare and occupational setting, is of utmost importance.

IMPLICATIONS FOR CANCER SURVIVORS

Support for working cancer survivors who experience cancer-related cognitive problems might increase their employability in the longer term.

Type of cancer treatment and cognitive symptoms in working cancer survivors: an 18-month follow-up study

PURPOSE

Cognitive symptoms are reported to affect cancer survivors' functioning at work. However, little is known about the type of cancer treatment and cognitive symptoms in working cancer survivors. We examined the longitudinal association between type of cancer treatment and cognitive symptoms in cancer survivors post return to work, and whether the course of cognitive symptoms over 18 months differed per type of cancer treatment.

METHODS

Data from the Dutch longitudinal "Work-Life after Cancer" study were used. The study population consisted of 330 working cancer survivors who completed questionnaires at baseline, and 6, 12, and 18 months follow-up. Cognitive symptoms were assessed with the cognitive symptom checklist-work and linked with cancer treatment data from the Netherlands Cancer Registry. Data were analyzed using generalized estimating equations.

RESULTS

Cancer survivors who received chemotherapy reported comparable memory symptom levels (b: - 2.3; 95% CI = - 7.1, 2.5) to those receiving locoregional treatment. Executive function symptom levels (b: - 4.1; 95% CI = - 7.8, - 0.4) were significantly lower for cancer survivors who received chemotherapy, compared with those receiving locoregional treatment. In cancer survivors who received other systemic therapy, memory (b: 0.4; 95% CI = 0.1, 0.7) and executive function symptom levels (b: 0.4; 95% CI = 0.0, 0.7) increased over time. In cancer survivors who received chemotherapy and locoregional treatment, memory and executive function symptom scores were persistent during the first 18 months after return to work.

CONCLUSIONS

The contradictory finding that cancer patients receiving chemotherapy report fewer cognitive symptoms warrants further research.

IMPLICATIONS FOR CANCER SURVIVORS

Working cancer survivors may have cognitive symptom management needs irrespective of the type of cancer treatment they received.

Experiences with cancer survey in China

BACKGROUND

China accounts for approximately 27% of global cancer deaths. However, to the authors' knowledge, the lasting effects of cancer and cancer treatments on patients have not been investigated in China. The authors developed a questionnaire, the China Survey of Experiences with Cancer, for Chinese cancer survivors. This article introduces the study design and domains covered in the questionnaire.

METHODS

The Cancer Survivorship Supplement of the Medical Expenditure Panel Survey (MEPS) was used as a reference to develop the questionnaire. The final in-person surveys were conducted in 2015 and 2016. Samples were chosen through multistage sampling. The authors described the characteristics of the study participants and their cancer experiences.

RESULTS

At the time of last follow-up, a total of 1166 patients had completed at least 1 component of the survey. Approximately 59% of the cancer survivors were aged ≥60 years. Greater than one-half of the participants had an elementary education level or less (51%) and a yearly family income of <$3174. Chinese cancer survivors were more likely to retire earlier than planned compared with American cancer survivors (37% vs 9%). The majority of Chinese cancer survivors (84%) reported that their work abilities were hindered by their cancer or cancer treatments. Approximately one-half of patients in China had to incur debt because of cancer, whereas <10% of patients in the United States reported having incurred debt.

CONCLUSIONS

The survey provides information regarding the burden of cancer in China that to the authors' knowledge currently is unavailable from other sources, including medical care use, financial impacts, employment patterns, and life experience after a cancer diagnosis for survivors and their families.