Return to work after breast cancer: Women’s experiences of encounters with different stakeholders

Interpersonal Processes in the Duration of Sick Leave of Workers with Chronic Diseases: A Dyadic Analysis

PURPOSE

Although there is increasing awareness that significant others' perceptions and behavior can affect health outcomes, the role of interpersonal processes between sick-listed workers and significant others in sick leave and return to work (RTW) has hardly been studied. This study aims to examine the associations between illness perceptions, RTW expectations, and behaviors of significant others (engagement, buffering and overprotection) with sick leave duration within dyads of sick-listed workers with chronic diseases and their significant others.

METHODS

We used survey data linked with sick leave registry data of 90 dyads. Pearson correlations were used to study the interdependence within dyads. Multiple linear regression analyses were conducted to examine associations between survey data of both dyad members and sick leave duration.

RESULTS

We found moderate to strong correlations between workers and significant others, indicating interdependence within dyads regarding illness perceptions, RTW expectations and perceived significant other behaviors. Dyad members' illness perceptions (R2 = .204, p = .001) and RTW expectations (R2 = .326, p =  < .001) were associated with sick leave duration, explaining respectively 12.3% and 24.5% of the variance. We found no associations between sick leave duration and active engagement, protective buffering and overprotection.

CONCLUSIONS

This study indicates that negative illness perceptions and RTW expectations of both workers and their significant others are associated with a longer sick leave duration. Considering the interdependence within dyads, involving significant others when intervening on maladaptive illness perceptions and RTW expectations may be more effective than solely focusing on the worker's perceptions and expectations.

Patients' Needs Regarding Work-Focused Healthcare: A Qualitative Evidence Synthesis

PURPOSE

To identify, appraise, and synthesize qualitative research evidence exploring patients' needs regarding work-focused healthcare.

METHODS

A systematic review was conducted in accordance with the PRISMA statement guidelines to identify studies reporting patients' needs regarding work-focused healthcare. Four databases (MEDLINE, Embase, PsychInfo and Web of Science) were systematically searched from January 2000 until May 2023 and screened in duplicate by pairs of two reviewers. Inclusion criteria were qualitative data collection method, and patients' perspectives regarding healthcare focusing on work when experiencing work-related problems due to chronic medical conditions. Data extraction and synthesis was executed by means of an inductive thematic analysis approach. The quality of the included studies was assessed using the CASP Qualitative Study checklist. Confidence in the review findings was assessed through the Confidence in the Evidence from Reviews of Qualitative research (CERQual) approach.

RESULTS

Out of 23,677 records, 97 qualitative studies were included. Needs regarding four main themes were identified: (1) Substantive guidance, which comprises the specific content of work-focused healthcare; (2) Clear and continuous process, which comprises clarification and optimization of the work-focused healthcare process; (3) Supportive attitude and behavior, which comprises a positive and supportive attitude and behavior from professionals towards the patients; and (4) Tailored approach, which comprises the delivery of tailored care to the individuals' needs. 17 subthemes were identified.

CONCLUSION

The broader insight in patients' needs in work-focused healthcare can help (occupational) healthcare professionals adopt a more patient-centred approach in practice.

Breast Cancer Survivors' Experiences of Managers' Actions During the Return to Work Process: A Scoping Review of Qualitative Studies

PURPOSE

Managers' actions can facilitate the return to work (RTW) process for breast cancer survivors (BCS). However, data on BCS' experiences of managers' actions regarding RTW are dispersed across multiple qualitative studies and do not offer useful insights for managers to support employees returning to work. This study aimed to summarize and map managers' actions experienced by BCS over three RTW phases (before, during, after) and categorize them as facilitating or hindering RTW.

METHODS

A scoping review of qualitative studies was conducted. Four databases (MEDLINE, PsycINFO, Cochrane Library, EMBASE) were systematically searched for articles published between 2000 and 2022. Studies and participant characteristics were extracted using an excel spreadsheet. A thematic analysis with a predominantly deductive and semantic approach was conducted.

RESULTS

Twenty-nine studies were included after screening 1042 records. Five themes were generated from the data. Two themes addressed the phase 'before RTW': 'managers' interpersonal skills' and 'preparing for RTW'; three in the 'during RTW' phase: 'managers' interpersonal skills', 'offering work flexibility', and 'offering work accommodations', and only one, 'paying attention to follow-up', was addressed in the 'after RTW' phase.

CONCLUSION

This review mapped managers' actions experienced by BCS in three phases of the RTW process. Results suggested that, according to BCS, managers need to mobilize specific skills to provide appropriate support during the RTW process. Further research is needed to better understand the skills underlying managers' actions facilitating the RTW process.

Return to work after COVID-19: Experiences and expectations from the first wave of COVID-19 in Stockholm

BACKGROUND

In Stockholm (Sweden) a substantial number of persons who were infected with SARS-CoV-2 during spring 2020, and received intensive care followed by rehabilitation due to COVID-19, were of working age. For this group, return to work (RTW) is an important part of the rehabilitation, however this is an area that thus far has received little scholarly attention. The Aim of this study was two-fold. First, to descriptively look at self-reported work ability over time using the Work Abilty Index among working age adults who recovered from severe COVID-19, and secondly, to explore experiences and expectations concerning RTW among working age adults who recovered from severe COVID-19.

METHODS

Focus group interviews and qualitative thematic analyses were utilized. In addition, the study populations' self-reported work ability index was recorded over one year.

FINDINGS

Qualitative analysis of data resulted in 5 themes: a) Initial experiences after discharge from in-patient rehabilitation, b) Disparate first contact with work, c) Uncertainties about own role in RTW process, d) Working situation for those who had started getting back to work, and e) A need to reprioritize expectations for work in the context of everyday life. There were no statistical differences in work ability index scores between 18 and 52 weeks after discharge from an in-patient rehabilitation unit.

CONCLUSION

RTW after COVID-19 can require systematic support for several months as well as be initiated earlier in the rehabilitation process. Further research in the area is needed.

An interpretative phenomenological analysis of the meaning of work to women living with breast cancer

OBJECTIVE

Work is an important aspect of everyday life. This remains true for those living with and beyond cancer. Less is known about how the meaning of work may change over the cancer journey, the needs of the individual in response to changes and how healthcare professionals and employing organisations can meet these needs. The aim of this study was to explore the lived experience of work after treatment for breast cancer in a group of professional working women within the UK.

METHODS

This article presents an Interpretative Phenomenological Analysis (IPA) of the experiences of 15 professional women diagnosed with breast cancer.

RESULTS

We discuss these women's journey from (1) rethinking the meaning of work to (2) making decisions about work ability and advice on work to (3) transitioning back in to the workplace and the value of continued engagement with employer.

DISCUSSION

The findings from this study demonstrate the complex interplay between living with cancer, treatment decisions and work. This study highlights two key areas for inclusion in practice: (1) support from Healthcare Professionals and judgements of functional ability and work ability and (2) the role of line managers in managing cancer and work.

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

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

Dilemma: Disclosure Experience Among Young Female Breast Cancer Survivors in China

Purpose: Culture influences whether cancer patients disclose their disease diagnosis to others. Understanding Chinese young female breast cancer survivors (BCSs)' experiences and perspectives on disclosure could play a vital role in clinical nursing. This study explores the experiences of Chinese young female BCSs with disease disclosure and describes the reasons for their choices. Methods: Using the tenets of phenomenological research and a purpose sampling method, semistructured interviews were conducted with 31 BCSs from February to April 2021. Colaizzi's analysis method was performed with NVivo software to develop common themes from the data. Results: From the analysis of the interviews of the 31 participants, three main themes were identified: (1) disclosure-to whom, including core family members, close friends, roommates, and employers; (2) disclosure to achieve positive outcomes, including: to gain social support, tell others to take precautions, obtain relevant information, and get permission to work flexibly, and (3) nondisclosure to avoid negative outcomes, including fear of discrimination and stigmatization, strengthen the role of the patient, bring excessive burden, and fear of excessive compassion. Conclusions: For young women diagnosed with breast cancer in China, it is a very complicated matter whether they choose to disclose their diagnosis to others. While disclosure can bring many benefits, it is important to look at the reasons why these women are concealing their diagnosis.

Barriers to and facilitators of labor market engagement for individuals with chronic physical illnesses in their experiences with work disability policy: a qualitative systematic review

OBJECTIVE

The objective of this review was to identify and synthesize the best available evidence to address two questions. From the perspectives of individuals with chronic physical illnesses: i) what are barriers in work disability policies with respect to labor market engagement? and ii) what are facilitators in work disability policies with respect to labor market engagement?

INTRODUCTION

Chronic physical illnesses have a high and increasing prevalence worldwide and are associated with significant disability in the working-age population. Individuals with chronic illnesses and disability have low employment and high unemployment rates, and low wages. Work disability policies have important role in reducing negative labor market impacts, but inadequate policies may also pose barriers to work engagement.

INCLUSION CRITERIA

This review included studies of individuals who were of working age, had one or more chronic physical illness, and had experience relevant to disability policy and work engagement. The phenomena of interest were perceived barriers and perceived facilitators in work disability policies with respect to labor market engagement. The context was any study setting globally. Studies considered for this review had qualitative data from a variety of methodologies.

METHODS

This review was conducted in accordance with the JBI methodology for systematic reviews of qualitative evidence. A literature search involved academic databases (ie, CINAHL Plus, MEDLINE, PsycINFO, AgeLine, SocINDEX, Social Work Abstracts, Sociological Abstracts, Social Services Abstracts) for published studies; gray literature sources (ie, ProQuest Dissertations and Theses, MedNar, Google Scholar, OpenGrey, OAIster, Google, and relevant websites) for unpublished studies; and reference lists of retrieved records. No language, date, or country limiters were applied to the searches. Retrieved records from the database and gray literature searches were screened, with potentially relevant records then examined in full against the inclusion criteria. Eligible studies were critically appraised for methodological quality and those included in this review were subjected to data extraction of descriptive details and the study findings that were relevant to the review questions. Study findings were synthesized and were assigned confidence scores.

RESULTS

Forty-four studies of various qualitative designs and varied methodological quality (from low to high) were included in this review. The study samples represented a number of different chronic physical illnesses. There were 301 credible and unequivocal study findings, which were aggregated into 20 categories and 5 synthesized findings. Persons with chronic physical illnesses perceived barriers and facilitators relevant to the adequacy of disability policies in meeting their needs for returning to work after leave due to illness and for sustaining ongoing work engagement. They also perceived barriers and facilitators relevant to stakeholders' communication, help, and support respecting workers' efforts toward work engagement.

CONCLUSION

Although confidence in the synthesized findings is low due to limitations in the methods and research findings across primary studies, the evidence suggests that both the adequacy and implementation of work disability policies need to be improved to meet the needs of workers with chronic physical illnesses, for their labor market engagement.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42016033476.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

The Challenge of Return to Work after Breast Cancer: The Role of Family Situation, CANTO Cohort

Return to work (RTW) after breast cancer is associated with improved quality of life. The link between household characteristics and RTW remains largely unknown. The aim of this study was to examine the effect of the family situation on women’s RTW two years after breast cancer. We used data of a French prospective cohort of women diagnosed with stage I-III, primary breast cancer (CANTO, NCT01993498). Among women employed at diagnosis and under 57 years old, we assessed the association between household characteristics (living with a partner, marital status, number and age of economically dependent children, support by the partner) and RTW. Logistic regression models were adjusted for age, household income, stage, comorbidities, treatments and their side effects. Analyzes stratified by age and household income were performed to assess the association between household characteristics and RTW in specific subgroups. Among the 3004 patients included, women living with a partner returned less to work (OR = 0.63 [0.47–0.86]) and decreased their working time after RTW. Among the 2305 women living with a partner, being married was associated with decreased RTW among women aged over 50 (OR = 0.57 [0.34–0.95]). Having three or more children (vs. none) was associated with lower RTW among women with low household income (OR = 0.28 [0.10–0.80]). Household characteristics should be considered in addition to clinical information to identify vulnerable women, reduce the social consequence of cancer and improve their quality of life.

Employment status and information needs of patients with breast cancer: a multicentre cross-sectional study of first oncology consultations

OBJECTIVES

To investigate the early information needs of women with a recent diagnosis of breast cancer (BC) according to their employment status.

DESIGN

Cross-sectional.

SETTING

Secondary-care patients attending three outpatient oncology clinics in northern Italy.

PARTICIPANTS

377 women with a recent diagnosis of early-stage, non-metastatic BC aged 18-75 were recruited. Of them, 164 were employed, 103 non-employed and 110 retired.

OUTCOME MEASURES

The first consultation visit with an oncologist was audio-recorded and analysed for the number and type of questions asked. Linear regression models considering consultations' and patients' characteristics as confounding variables were applied.

RESULTS

Employed patients asked significantly more questions than non-employed and retired patients (17 vs 13 and 14; F=6.04; p<0.01). When age and education were included in the statistical model, the significance of employment status was rearranged among all the variables and was no more significant (b=1.2, p=0.44). Employed women asked more questions concerning disease prognosis (0.7 vs 0.4 and 0.6; F=3.5; p=0.03), prevention (1.4 vs 0.6 and 0.7; F=10.7; p<0.01), illness management (7.2 vs 6 and 5.4; F=3.8; p=0.02) and social functioning (37% vs 18% and 20%; χ²=14.3; p<0.01) compared with the other two groups. Finally, they attended more frequently the consultation alone (37% vs 18% and 25%; χ²=10.90, p<0.01), were younger (50 vs 58 and 67 years; F=63.8; p<0.01) and with a higher level of education (77% vs 27% and 45%; χ²=68.2; p<0.01).

CONCLUSIONS

Employment status is related to the type of questions asked during the first consultation. Also, it interrelates with other patients' characteristics like age and education in determining the number of questions asked. Patients' characteristics including employment status could be considered in tailoring work and social-related information provided during the first oncological consultation. Future studies could explore potential differences in information needs according to the different kinds of work.

Women's experiences of being in the sick leave process

BACKGROUND

Being on sick leave is a risky situation, with loss of meaningful activities, exclusion from the labour market and losing the worker role. Although the benefits of the person's active involvement in the sick leave process have been emphasized, an increase in sickness absence and longer sick leave periods is still seen, especially among women. Further studies are needed to more deeply understand the person's own view of the situation.

AIMS/OBJECTIVES

To explore the experiences of being on sick leave among a group of women.

METHODS

An explorative, qualitative design was used. The analysis was based on individual, semi-structured interviews with 13 women, using qualitative content analysis.

RESULTS

Three categories emerged that describe the women's experiences of the situation of being on sick leave: being regarded as an object, being supported and being engaged. The categories appeared as either barriers or enablers during the sick leave process.

CONCLUSIONS

The sick leave process could be better understood through multiple dimensions, working at the individual, organizational and societal levels. Using occupation based models underlining the importance of the interaction between person, occupation (work activity) and the environment may contribute to elucidating the complexity in supporting options for the return to work.

Predictors of post-cancer diagnosis resignation among Japanese cancer survivors

PURPOSE

In Japan, due to the increased incidence of cancer among the working population, it has become more important to support employees to achieve a balance between cancer treatment and work. This study aimed to clarify the predictors of resigning from employment after being diagnosed with cancer (post-cancer diagnosis [PCD] resignation) among Japanese employees.

METHODS

As part of a Japanese national research project (Endo-Han), the investigators conducted a web-based survey of cancer survivors (CSs) in 2017. The investigators analyzed the risk factors for PCD resignation using a logistic regression model, including age at diagnosis, sex, cancer type, cancer stage, year of diagnosis, whether the patient held a managerial role, type of employment, and company size.

RESULTS

Of 750 employed Japanese CSs, 93 (12.4%) resigned from their jobs. The non-managers resigned more often (14.6%) than the managers (7.6%) (p = 0.007). The temporary workers exhibited the highest PCD resignation rates (22.2%), while the PCD resignation rates of the self-employed workers and permanent workers were 15.2% and 7.6%, respectively (p < 0.001). As the result of multivariate analysis, being female (odds ratio [OR], 3.67; 95%CI, 1.71-7.87), having hematological cancer (OR, 4.23; 95%CI, 1.37-13.04), having advanced cancer (OR, 2.48; 95%CI, 1.52-4.03), and being a temporary worker (OR, 2.51; 95%CI, 1.40-4.50) were identified as predictors of PCD resignation.

CONCLUSIONS

In total, 12.4% of Japanese employees quit their jobs after being diagnosed with cancer. Being female or a temporary worker and having advanced cancer were identified as predictors of PCD resignation. Regarding cancer type, hematological cancer was most strongly associated with PCD resignation.

IMPLICATION OF CANCER SURVIVORS

CSs who are females and temporary workers and have advanced cancer should be followed-up more carefully after cancer diagnosis for their work sustainability, by medical professionals, companies, and society.

O retorno ao trabalho de mulheres após a experiência do câncer de mama: uma metassíntese

Resumo Introdução: o câncer de mama (CM) é a neoplasia mais comum em mulheres no mundo e o número de casos vem aumentando na população economicamente ativa. Por isso, o retorno ao trabalho após CM tem despertado interesse da comunidade científica. Objetivo: sistematizar e sintetizar os estudos qualitativos que abordam a experiência do retorno ao trabalho após o CM. Métodos: metassíntese qualitativa com busca dos estudos primários nas bases ASSIA, BIREME, CINAHL, Embase, PsycInfo, SciELO, Scopus e Web of Science. Foram localizados 779 artigos, dos quais, nove atenderam aos critérios de seleção. Resultados: seis conceitos de segunda ordem foram gerados: os efeitos da doença na reabilitação; questões financeiras; medo de recidivas; apoio da família, amigos e profissionais de saúde; e mudanças do significado do trabalho após CM. Conclusão: o retorno ao trabalho não deve se limitar aos aspectos relacionados aos obstáculos e facilitadores da reabilitação Os “mundos da vida” evidenciados nos fatores contextuais mais abrangentes revelam que o enfrentamento do retorno ao trabalho implica no aprimoramento do suporte às trabalhadoras no ambiente de trabalho, na vida familiar, na relação com os sistemas de saúde e seguridade social e na esfera individual, a fim de prevenir aposentadorias precoces e incapacidade prolongada.

What Employer Actions Are Considered Most Important for the Return to Work of Employees with Cancer? A Delphi Study Among Employees and Employers

Purpose Employers are important stakeholders in the return to work (RTW) of employees with cancer. However, it is unclear what employer actions are most important to that process. The objective, therefore, was to reach consensus on what employer actions are considered most important for the RTW of employees with cancer, by employers and employees separately. Methods A two-round online Delphi study was conducted with two expert panels: one with 23 employers and one with 29 employees with cancer. The results from each panel were analysed separately. Out of 24 suggested employer actions, participants selected the 10 they considered most important for RTW in each of the following RTW phases: (1) disclosure, (2) treatment, (3) RTW plan, and (4) actual RTW. The consensus threshold was set at ≥ 80% during the second round. Results The employer and employee expert panels both reached consensus on the importance of 'emotional support', 'practical support', 'allow sufficient sick leave', 'plan return to work', 'adjust expectations', 'assess work ability', and 'show appreciation'. Employers also reached consensus on 'communicate' and 'treat normally', and employees on 'handle unpredictability'. All these employer actions were considered to be specific for one to three RTW phases. Conclusions Employers reached consensus on the importance of nine employer actions, employees on eight. Both stakeholder perspectives showed great similarities, but did vary regarding important employer actions during the employee's treatment. We recommend developing interventions targeting the employer, meeting both employer and employee needs in each RTW phase, to enhance RTW support for employees with cancer.

Return to Work of Cancer Survivors: Predicting Healthcare Professionals' Assumed Role Responsibility

Purpose Returning to work is highly beneficial for many cancer survivors. While research has documented the significance of healthcare professionals in the process of return to work (RTW), very little is known about those professionals' views regarding their responsibility for RTW. The purpose of the present study was to identify factors that predict the extent to which healthcare professionals view involvement in the RTW of cancer survivors as part of their role. Methods In a cross-sectional design, questionnaires measuring attitudes regarding personal role responsibility for RTW, team role responsibility for RTW and benefits of RTW were administered to 157 healthcare professionals who care for working-age cancer survivors: oncologists, occupational physicians, family physicians, oncology nurses, oncology social workers, and psychologists. Results Both belief in the benefits of RTW, and the view that RTW is the team responsibility of healthcare professionals working with cancer survivors, are positively related to viewing RTW as part of the responsibilities of one's personal professional role. Moderation analysis indicated that perception of team responsibility for RTW moderates the effect of the perceived benefits of RTW, such that the perception of benefits is significantly associated with personal role responsibility only when there is a low level of perceived team responsibility. Conclusions Issues related to RTW should be routinely included in basic and advanced training of healthcare professionals involved in the treatment of working-age cancer survivors, to increase awareness of this aspect of cancer survivors' well-being and position RTW as part of healthcare professionals' role responsibilities.

Colorectal cancer survivors' challenges to returning to work: A qualitative study

OBJECTIVE

To assess the challenges and needs of colorectal cancer (CRC) survivors in maintaining employment and returning to work (RTW) from the perspectives of both CRC survivors and employers in the United States.

METHODS

Semi-structured interviews with CRC survivors (n = 10) and employers (n = 4) were transcribed, coded and thematically analysed using NVivo 12 software.

RESULTS

Workplace challenges for survivors included the following: inadequate availability of paid and unpaid leave, limited availability of workplace accommodations, and employers' lack of knowledge about CRC and the recovery process. Survivors were concerned about the lack of adequate financial resources to take unpaid leave and the need to relearn control of bodily functions. Workplace challenges for employers of cancer survivors included the following: limited institutional flexibility to provide individualised accommodations, communication with frontline managers about leave availability for employees and communication with employees about legal protections and limitations. Employers perceived that employees were unwilling to take leave.

CONCLUSION

Colorectal cancer survivors in the US face difficult, sometimes insurmountable, challenges when trying to balance their physical and financial needs within the constraints of employment. Employers recognise challenges associated with this concern. Multi-level interventions-ranging from flexible work schedules to training for frontline managers-might facilitate the RTW process.

Women's experiences of encounters with healthcare professionals' regarding work after breast-cancer surgery and associations with sickness absence: a 2-year follow-up cohort study

INTRODUCTION

Breast cancer (BC) is the most common cancer among women, and half of those diagnosed are of working age. Positive encounters regarding work from healthcare professionals have been shown to promote return to work among sickness absentees in general. However, the knowledge about encounters possible associations with sickness absence (SA) in women with BC is scarce.

AIM

To explore if women had experienced encounters regarding work from healthcare professionals during the first year after BC surgery and if this was associated with SA during the second year after surgery, controlled for treatment and sociodemographic effects.

METHODS

A prospective cohort study of 690 Swedish women with primary BC, aged 24-63 years included after surgery. Descriptive statistics and adjusted logistic regression (age, birth country, education, self-rated health, treatment) with 95% confidence intervals (CI) were used.

RESULTS

Eighty percent of the women had experienced encounters regarding work. Women who got advice and support regarding work (adjusted odds ratio (OR) 0.5; 0.3-0.9) or were encouraged to work (adjusted OR 0.6; 0.3-0.9) had less SA. A larger proportion of those encouraged to work had less advanced cancer, surgery, hormone, or radiotherapy. Consistently, women encouraged to be on SA had more SA, but this was partly explained by disease or treatment factors (crude OR 1.6; 1.1-2.4, adjusted OR 1.2 (0.8-1.9) since a larger proportion of those with more advanced cancer, surgery, or chemotherapy had more SA.

CONCLUSION

Most women experienced encounters regarding work, and the nature of these encounters were associated with SA 2 years after BC surgery.

Experiences of positive encounters with healthcare professionals among women on long-term sickness absence due to breast cancer or due to other diagnoses: a nationwide survey

Background

Experiences of encounters with professionals have been shown to influence return to work (RTW) among sickness absentees in general. The aim was to gain knowledge on experiences of encounters with healthcare professionals and the ability to RTW among women on long-term sickness absence (SA) due to breast cancer (BC) compared to among women on long-term SA due to other diagnoses.

Methods

Analyses of questionnaire data about experiences of encounters with healthcare professionals among 6197 women aged 19–65 years and on a SA spell lasting 4–8 months. Of those, 187 were on SA due to BC. Descriptive statistics and adjusted (for age, birth country, educational level, depressive symptoms) logistic regression analyses with 95% confidence intervals (CI) were conducted.

Results

About 95% in both groups of women stated that they had experienced positive encounters with healthcare, and a minority, about 20%, had experienced negative encounters. Four specific types of positive encounters had been experienced to a lesser extent by women with BC: “allowed me to take own responsibility” (odds ratio (OR) 0.6; 95% CI 0.4–0.8), “encouraged me to carry through my own solutions” (OR 0.5; 95% CI 0.4–0.7), “made reasonably high demands” (OR 0.6; 95% CI 0.4–0.9), and “sided with me/stood on my side” (OR 0.6; 95% CI 0.4–0.8). Among the women with BC, 46% stated that positive encounters promoted their ability to RTW compared to 56% among the others. Conclusion: Most of the women had experienced positive encounters and about half stated that positive encounters promoted their ability to RTW, although a slightly smaller proportion of the women with BC stated that. This study emphasizes that not only medical treatment but also encounters may influence the ability to RTW, something that is of clinical importance.

Respectful encounters from healthcare professionals and return to work among 9032 long-term sick-listed due to cancer or due to other diagnoses: results from a Swedish population-based survey

Purpose

To examine whether experiences of positive respectful encounters and negative disrespectful encounters differ between sickness absentees with a cancer diagnosis and sickness absentees with other diagnoses, especially in relation to their ability to return to work (RTW).

Methods

A total of 9032 long-term sickness absentees in Sweden responded to a questionnaire (response rate 52%) about experiences of positive and negative encounters with healthcare professionals. The association between different types of such encounters and participants feeling respected or disrespected were calculated with population attributable risk with 95% confidence intervals (CI). The perceived impact on ability to RTW was also examined.

Results

Significantly, larger proportions among those who experienced a positive encounter and also felt respected stated that those encounters facilitated their ability to RTW, compared to those who experienced a positive encounter without feeling respected: among cancer absentees the difference in proportions were 21% (CI, 7–34) versus 50% (CI, 45–55); among absentees with other diagnoses 42% (CI, 37–47) versus 63% (CI, 61–64). Similar comparisons among sick-listed who experienced negative encounters indicated that also feeling disrespected impeded ability to RTW among a significantly larger proportion of those with other diagnoses [51% (CI, 48–54) versus 35% (CI, 31–39) of those not feeling disrespected]. Among cancer absentees, the corresponding proportions were 20% (CI, 9–30) versus 25% (CI, 9–41).

Conclusions

Compared to sickness absentees with other diagnoses, a larger proportion of cancer sickness absentees stated that they were facilitated by respectful encounters and not impeded by disrespectful encounters, regarding self-estimated ability to RTW. More research is needed to examine whether these differences can be associated with use of a patient-centered encountering approach.

Influence of significant others on work participation of individuals with chronic diseases: a systematic review

OBJECTIVE

It is widely recognised that significant others (SOs), such as a partner, family member or friend, can influence health outcomes of individuals with a chronic disease. However, not much is known about which specific cognitions (ie, illness perceptions and expectation of work ability) and behaviours (eg, emotional and practical support) of SOs influence work participation. Therefore, we aimed to identify cognitions and behaviours of SOs that are related to work participation of individuals with a chronic disease.

DESIGN

A systematic review and thematic synthesis.

DATA SOURCES

PubMed, Embase, PsycINFO, SocINDEX and Web of Science were searched until 28 March 2017.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

We included studies reporting on cognitions and behaviours of SOs related to work participation in populations with various chronic diseases.

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers extracted the data and performed a quality assessment using the Quality Assessment Tool for Quantitative Studies from the Effective Public Health Practice Project 2007 and a checklist for assessment of qualitative studies derived from the Cochrane Supplemental Handbook Guidance. Evidence was thematically synthesised.

RESULTS

Out of 5168 articles, 18 were included (15 qualitative and 3 quantitative) of moderate to high quality. Studies were on cancer, chronic pain, brain injuries and mental health disorders. After thematic synthesis 27 factors could be distinguished. Consistent evidence was found that SOs' positive and encouraging attitudes regarding work participation, encouragement and motivating behaviour and open communication with patients are facilitators for work participation. Consistently reported barriers were SOs' positive attitudes towards sickness absence and advise, encouragement or pressure to refrain from work.

CONCLUSIONS

Our findings show that several cognitions and behaviours of SOs can facilitate or hinder work participation of individuals with a chronic disease. Intervening on these factors by involving SOs in disability prevention and return to work intervention strategies may be beneficial. More prognostic studies are needed, as the current evidence is mostly based on qualitative studies.

Cancer-related cognitive impairment and patients' ability to work: a current perspective

PURPOSE OF REVIEW

About half of all cancer survivors are 65 years of age or younger and potentially part of the labor force. Increasing numbers of these survivors are able to return to work (RTW) or even continue working during treatment. Many factors are known to inhibit occupational reintegration of cancer survivors, and further affect job performance after RTW. However, the impact of cancer-related cognitive impairment on work-related outcomes in cancer survivors is not well understood.

RECENT FINDINGS

Previous studies exploring cancer, cognition and the ability to work reported mixed results, because of inconsistency in the definitions of work-related outcomes, the use of self-reported rather than performance-based measurements and the interaction between cognitive limitations and other symptom burden, such as fatigue or job stress. In addition, a lack of interventions to specifically target cognitive problems at work was identified.

SUMMARY

Cognitive problems because of cancer diagnosis and treatment demand action in terms of developing a better understanding of their impact on the ability to work, as well as identifying effective therapeutic interventions to diminish this impact, including innovative accommodations, changes in work tasks or organization and ergonomic adjustments. Both employers and survivors should welcome such changes, to rise to the challenge of successfully adapting from the precancer status quo.

Life satisfaction of women of working age shortly after breast cancer surgery

Purpose

To explore, among women of working age, satisfaction with life as a whole and with different life domains, and its associations with social and health variables, shortly after breast cancer surgery.

Methods

This cross-sectional study included 605 women, aged 20–63 years, who had had breast cancer surgery with no distant metastasis, pre-surgical chemotherapy, or previous breast cancer. Associations between LiSat-11 and demographic and social factors as well as health- and treatment-related variables were analysed by multivariable logistic regression.

Results

Compared with Swedish reference levels, the women were, after breast cancer surgery, less satisfied with life, particularly sexual life. Women working shortly after breast cancer surgery were more often satisfied with life in provision domains compared with the reference population. Although most included variables showed associations with satisfaction, after adjustment for all significantly associated variables, only six variables—having children, being in work, having emotional and informational social support, and having good physical and emotional functioning—were positively associated with satisfaction with life as a whole. The odds ratios for satisfaction were higher in most life domains if the woman had social support and good emotional and cognitive functioning.

Conclusions

One month after breast cancer surgery, satisfaction with different life domains was associated primarily with social support and health-related functioning. However, this soon after surgery, treatment-related variables showed no significant associations with life satisfaction. These results are useful for planning interventions to enhance e.g. social support and emotional as well as cognitive functioning.

Does the quality of encounters affect return to work? Lay people describe their experiences of meeting various professionals during their rehabilitation process

BACKGROUND

Among the many aspects of the rehabilitation process that may be relevant for its outcome, the impact of encounters with various professionals has received little attention.

OBJECTIVE

The objective was to gain a deeper understanding of how individuals with experiences of being on sick leave perceive their encounters with professionals, and how such encounters affected their ability to return to work, as well as their attitudes towards the sickness insurance system.

METHODS

An inductive qualitative approach was used to analyze data from 20 interviews with men and women, aged 33-59, in Sweden who had experience of being on sick leave for at least 28 days.

RESULTS

The study shows how interviewees encounters with professionals affected their self-confidence and perception of their ability to return to work. Professionals' treatment of people on sick leave seems to be affected by the structural prerequisites for offering support, where sickness insurance regulations are suggested to have a large impact.

CONCLUSIONS

An encouraging and supportive attitude on the part of the professionals is essential for empowering people to handle obstacles during the rehabilitation process; whereas feeling rejected and belittled in the return to work process may lead to disempowerment, and/or delays in measures and longer periods on sick leave.

Bridging Health Care and the Workplace: Formulation of a Return-to-Work Intervention for Breast Cancer Patients Using an Intervention Mapping Approach

Purpose An increasing number of breast cancer (BC) survivors of working age require return to work (RTW) support. Objective of this paper is to describe the development of a RTW intervention to be embedded in the care process bridging the gap between hospital and workplace. Method The Intervention Mapping (IM) approach was used and combined formative research results regarding RTW in BC patients with published insights on occupational therapy (OT) and RTW. Four development steps were taken, starting from needs assessment to the development of intervention components and materials. Results A five-phased RTW intervention guided by a hospital-based occupational therapist is proposed: (1) assessing the worker, the usual work and contextual factors which impacts on (re-)employment; (2) exploration of match/differences between the worker and the usual work; (3) establishing long term goals, broken down into short term goals; (4) setting up tailored actions by carefully implementing results of preceding phases; (5) step by step, the program as described in phase 4 will be executed. The occupational therapist monitors, measures and reviews goals and program-steps in the intervention to secure the tailor-made approach of each program-step of the intervention. Conclusion The use of IM resulted in a RTW oriented OT intervention. This unique intervention succeeds in matching individual BC patient needs, the input of stakeholders at the hospital and the workplace.

A study to examine the influence of health professionals' advice and support on work capacity and sick leave after breast cancer surgery

PURPOSE

The aim of this study was to investigate how women, shortly after breast cancer surgery, experienced encounters with, and information from, healthcare professionals regarding work and sick leave and if these experiences were associated with self-reported work capacity and sick leave.

METHODS

This is a cross-sectional study based on questionnaire data from 605 women who had had breast cancer surgery, aged 20-63 years. Exclusion criteria were known distant metastases, pre surgical therapy, and/or previous breast cancer. Data on age, type of surgery, global health, and work environment were included as covariates in multivariable logistic regression analysis.

RESULTS

Five percent of the women had not received any advice concerning work or sick leave. Women reporting receiving useful advice or support related to paid work had lower risk of reporting reduced physical or psychological/social work capacity due to the cancer or treatment (OR 0.46 (95 % CI 0.26-0.81) respective OR 0.45 (95 % CI 0.26-0.77)). There were no associations between having received useful advice or support concerning work and being on sick leave. Women encouraged to take sick leave had an OR of 2.17 (95 % CI 1.39-3.37) of being sickness absent. They also to a higher extent had reduced physical and psychological/social work capacity. Women who reported to have been encouraged to work were sickness absent to a lower extent (OR 0.64; 95 % CI 0.41-0.98) and reported higher physical work capacity.

CONCLUSIONS

Work and sick leave is being discussed during consultations with women with breast cancer and the advice given seems to be in line with the women's subjective work capacity.

Advice about Work-Related Issues to Peers and Employers from Head and Neck Cancer Survivors

PURPOSE

The purpose of this exploratory and descriptive study is to contribute to the sparse return-to-work literature on head and neck cancer (HNC) survivors. Interview participants were asked to reflect upon their work-related experience with cancer by answering two specific questions: (1) What advice would you give someone who has been newly diagnosed with head and neck cancer? (2) What advice would you give to employers of these people?

METHODS

Data were gathered through 10 individual semi-structured in-depth interviews with HNC clinic patients at a regional cancer center's head and neck clinic in Ontario, Canada. A constant comparative method of theme development was used. Codes identified in and derived from the data were discussed by research team members until consensus was reached. Codes with similar characteristics were grouped together and used to develop overarching themes.

RESULTS

Work-related advice for peers focused on personal self-care and interactions within workplaces. Work-related advice to employers focused on demonstrating basic human values as well as the importance of communication.

DISCUSSION

The study results suggest HNC clinic patients should be proactive with employers and help to set reasonable expectations and provide a realistic plan for work to be successfully completed. HNC clinic patients should develop communication skills to effectively disclose their cancer and treatment to employers.

CONCLUSIONS

In this exploratory study, HNC clinic patients' advice was solution-focused underscoring the importance of self-care and pro-active communication and planning with employers. Employers were advised to demonstrate core human values throughout all phases of the work disability episode beginning at diagnosis.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

IMPLICATIONS FOR CANCER SURVIVORS

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

Returning to work after sick leave due to cancer: a 365-day cohort study of Japanese cancer survivors

Purpose

More employees are experiencing a cancer diagnosis during their working-age years, yet there have been no large-scale Japanese studies investigating sick leave due to cancer. We clarified differences in the cumulative partial and full return to work (RTW) rates between different cancer types among Japanese cancer survivors.

Methods

Data on Japanese employees who experienced an episode of sick leave due to clinically certified cancer diagnosed between 1 January 2000 and 31 December 2011 were obtained from an occupational health register. Subject outcomes within the 365-day period following their initial day of sick leave were utilized for this study. We investigated the cumulative partial/full and full RTW rates by using survival analysis with competing risks and predictors of time to RTW by a Fine-Gray proportional hazard regression model.

Results

One thousand two hundred seventy-eight subjects (1033 males and 245 females) experienced their first episode of sick leave due to cancer during the 12-year follow-up period. Of the subjects, 47.1 % returned to work full time within 6 months of their initial day of sick leave absence, and 62.3 % by 12 months. The cumulative RTW rate varied significantly by cancer type. There were considerable differences in the range of cumulative full RTW rates between the two categories (“lower full RTW rate” groups (“lung,” “hepatic, pancreatic,” “esophageal,” and “blood” cancer groups) vs. “higher full RTW rate” groups (“gastric,” “intestinal,” “breast,” “female genital,” “male genital,” “urinary”): 6.3 to 14.3 % vs. 11.4 to 28.3 % at 60 days, 10.6 to 22.4 % vs. 27.0 to 50.0 % at 120 days, 21.3 to 34.7 % vs. 38.5 to 65.4 % at 180 days, 34.3 to 42.9 % vs. 66.0 to 79.5 % at 365 days). Additionally, older age may be associated with a longer time to full RTW.

Conclusions

More than half of the subjects returned to work full-time within the 365-day period following their initial day of sick leave, with cumulative RTW rates varying by cancer type. Older employees may require a longer time to full RTW.

Implications of Cancer Survivors

It is very important for companies (especially small- and medium-sized companies) to establish and improve their RTW support system for cancer survivors, with knowledge that the median time to RTW is expected to be at least a few months.

Factors associated with return to work of breast cancer survivors: a systematic review

BACKGROUND

The breast cancer survival rate is the highest among all types of cancers, and survivors returning to work after completing treatment is extremely important in regards to economy and rehabilitation. The aim of this systematic review study is to identify the prevalence of breast cancer survivors who return to work (RTW) and the factors associated to RTW.

METHODS

A computer based literature search was carried out. "PubMed, Cochrane Library, Embase, Web of Science, and Science Direct" databases were searched systematically. Our search strategy identified a total of 12,116 papers of which 26 studies met the inclusion criteria and quality assessment. These were original papers published between January 2003 and January 2013.

RESULTS

The trends in RTW differ among countries for the breast cancer survivors. The time to RTW after successful cancer treatment also varies among the countries and by ethnicity. The prevalence of the RTW varies from 43% to 93% within one year of diagnosis. The prevalence of the RTW for the Netherland is the lowest in the world (43%). The United States survivors showed the highest RTW (93%) within 12 months of the diagnosis. Numerous barriers and facilitators were identified as factors that affect RTW. For instance, socio-demographic factors such as education and ethnicity; treatment oriented factors such as chemotherapy; work related factors such as heavy physical work; disease related factors such as poor health condition and fatigue; and psychological factors such as depression and emotional distress, act as barriers of RTW. In contrast, social, family, employer support, and financial independency emerge as key facilitators in enabling breast cancer survivors to return and continue work.

CONCLUSION

Minimising these identified barriers and strengthening these facilitators could further improve the work condition and increase the percentage of RTW among the breast cancer survivors.

Adjustment and social support at work early after breast cancer surgery and its associations with sickness absence

INTRODUCTION

As half of the women with breast cancer are of working ages and usually survive, knowledge is needed on how to support them early regarding work-related problems caused by treatments. Most previous studies have focused on individual and disease-related factors, whereas few have focused on work-related factors such as work adjustment and social support. The aim of this study was to investigate received and perceived social support from supervisor and colleagues as well as work adjustments, and their associations with sickness absence, among women who recently had had breast cancer surgery.

METHOD

Inclusion criteria were as follows: women aged 20-63 years, living in Stockholm County, treated surgically for a first diagnosis of breast cancer, literate in Swedish, without pre-surgical chemotherapy or known distant metastases. Included in the study were 605 women who worked at diagnosis and that had answered a questionnaire within eight weeks of inclusion. Descriptive statistics, univariate, and multivariable logistic regression analyses were applied to estimate odds ratios (OR) with 95% confidence intervals (CI) for the likelihood of being sickness absent.

RESULTS

Most women perceived and received social support and work adjustment after breast cancer surgery. Low adjustment (OR = 2.14; 95% CI, 1.45-3.18) and less social support (OR = 1.80; 95% CI, 1.16-2.78) were significantly associated with being sickness absent. Adjusting for sociodemographics, strenuous work posture, and treatment did not attenuate these associations.

CONCLUSION

Adjustment at work and social support from employer are associated with sickness absence and needs to be explored in discussions on return to work after breast cancer surgery.

Does feeling respected influence return to work? Cross-sectional study on sick-listed patients' experiences of encounters with social insurance office staff

Background

Previous research shows that how patients perceive encounters with healthcare staff may affect their health and self-estimated ability to return to work. The aim of the present study was to explore long-term sick-listed patients’ encounters with social insurance office staff and the impact of these encounters on self-estimated ability to return to work.

Methods

A random sample of long-term sick-listed patients (n = 10,042) received a questionnaire containing questions about their experiences of positive and negative encounters and item lists specifying such experiences. Respondents were also asked whether the encounters made them feel respected or wronged and how they estimated the effect of these encounters on their ability to return to work. Statistical analysis was conducted using 95% confidence intervals (CI) for proportions, and attributable risk (AR) with 95% CI.

Results

The response rate was 58%. Encounter items strongly associated with feeling respected were, among others: listened to me, believed me, and answered my questions. Encounter items strongly associated with feeling wronged were, among others: did not believe me, doubted my condition, and questioned my motivation to work. Positive encounters facilitated patients’ self-estimated ability to return to work [26.9% (CI: 22.1-31.7)]. This effect was significantly increased if the patients also felt respected [49.3% (CI: 47.5-51.1)]. Negative encounters impeded self-estimated ability to return to work [29.1% (CI: 24.6-33.6)]; when also feeling wronged return to work was significantly further impeded [51.3% (CI: 47.1-55.5)].

Conclusions

Long-term sick-listed patients find that their self-reported ability to return to work is affected by positive and negative encounters with social insurance office staff. This effect is further enhanced by feeling respected or wronged, respectively.

Women's reflections and actions regarding working after breast cancer surgery - a focus group study

BACKGROUND

To better understand processes affecting return to work (RTW) after breast cancer, more knowledge from the perspective of sickness absentees is warranted. Still, research based on women's own reasoning and actions in RTW is very scarce. This study aims to elucidate how women with breast cancer reflect and act on work-related issues.

MATERIAL AND METHODS

Thematic analyses of data from four focus group interviews with 23 women who had had breast cancer surgery in the previous 3-13 months were carried out.

RESULTS

The five following themes of reflections regarding RTW were identified: 'health and functioning', 'self-esteem/integrity', 'value of work', 'relationships at work', and 'social circumstances'. These reflections were associated with the three identified themes of actions taken by the women: 'to work or to be sickness absent', 'to adjust work according to own needs or not', and 'to disclose or to hide one's cancer'. There was a distinct difference between women who experienced work as a source of well-being and those who needed a respite from work.

CONCLUSION

This study adds knowledge to the process of RTW after breast cancer and focuses on factors that lead the women to an active role in this process. We point to the interplay between women's own preferences, perceived competence, outer opportunities, and the actions each woman take with regard to RTW, which need to be recognized by all stakeholders involved. Furthermore, it continues to be essential to address the specific issue of disclosure in the workplace because this may be distressing for women.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Patient perspectives on breast cancer treatment side effects and the prospective surveillance model for physical rehabilitation for women with breast cancer

Women's experience of breast cancer is complex, affecting all aspects of life during and after treatment. Patients' perspectives about common impairments and functional limitations secondary to breast cancer treatment, including upper extremity motion restriction, lymphedema, fatigue, weight gain, pain, and chemotherapy-induced peripheral neuropathy, are addressed. Women often report being uninformed regarding these side effects and surprised that they do not always disappear after treatment, but remain part of their lives. Breast cancer patients express strong, unmet needs for education, information, and intervention for these side effects. Evidence suggests that rehabilitation and exercise are effective in preventing and managing many physical side effects of breast cancer treatment. Nevertheless, few women are referred to rehabilitation during or after treatment, and fewer receive baseline assessments of impairment and function to facilitate early detection of impairment and functional limitations. The prospective surveillance model of rehabilitation will serve the needs of women with breast cancer by providing education and information about treatment side effects, reducing the incidence and burden of side effects through early identification and treatment, and enhancing access to timely rehabilitation. Integration of exercise as a component of the model benefits patients at every phase of survivorship, by addressing individual concerns about exercise during and after treatment and highlighting the important contribution of exercise to overall health and survival. The prospective surveillance model of rehabilitation can meet the evident and often expressed needs of survivors for information, guidance, and intervention--thus addressing, and potentially improving, overall quality of life for individuals diagnosed with and treated for breast cancer.