[Role of Clinical, Sociomedical and Psychological Factors on Return to Work of Patients with Breast Cancer 6 Months after Rehabilitation]

[Return to Work after Cancer - a Systematic Review of Predictors in Germany]

INTRODUCTION

More than one third of cancer survivors are of working age. Return to work (RTW) with and after cancer treatment is therefore an important issue for this group - but this is often accompanied with many challenges. The aim of this systematic review was to identify predictors of RTW after cancer from the literature specifically for Germany and to place these factors chronologically in the oncological course of treatment.

METHODS

A systematic search was performed using PubMed in June 2022. Included were all papers original published in German or English between 2000 and 2022 and referring to a German sample, regardless of study design.

RESULTS

From a total of 8,381 hits in the meta-database, 30 publications were finally considered in the synthesis of results. Higher age, lower education, lower socioeconomic status, higher disease stage, more progressive disease course, more severe side effects of treatment, (more severe) fatigue, higher psychological distress, worse health status, occupational status as a blue collar worker and manual labor, unemployment prior to diagnosis, more negative perceptions of the work(place) environment, and lower intention to work and lower work ability/ subjective prognosis of employability were associated with lower likelihood of RTW after cancer in the literature. Treatment type and use of rehabilitation were also found to be associated with RTW.

DISCUSSION

Sociodemographic, disease-related, psychosocial, and work-related predictors of RTW after cancer in Germany were identified. The results may help to develop targeted support measures that can be applied in specific phases of treatment. The comparability of the literature on predictors for RTW is limited due to a high heterogeneity in the operationalization of RTW and methodological approaches. There is need for further standardization in this area.

[Work Participation after Multimodal Rehabilitation due to Cancer: Representative Analyses using Routine Data of the German Pension Insurance]

PURPOSE

Cancer diseases are associated with multiple physical, psychosocial, and occupational burdens that jeopardize work participation and must be specifically addressed with rehabilitative interventions. This study addressed the following questions regarding cancer patients whose rehabilitation was covered by German Pension Insurance (GPI): (a) What socio-medical risks existed prior to rehabilitation, (b) how well persons were able to return to work after rehabilitation, and (c) what conditions determined work participation?

METHODS

We used the rehabilitation statistics database of the German Pension Insurance and included patients with completed medical rehabilitation due to cancer in 2017. Analyses were carried out for the entire group as well as for those differentiated according to their tumor sites (breast, prostate, colon and lung). Work participation was operationalized both via a monthly state up to 24 months after rehabilitation discharge and as a rate of all persons who were employed 12 or 24 months and the 3 preceding months (stable work participation). For the analysis of the influencing factors on stable work participation, multiple logistic regression models with stepwise inclusion were calculated separately for the rates after 12 and 24 months.

RESULTS

A total of 63,587 data sets were included in the analysis (breast cancer: n=20,545, 32%; prostate: n=6,434, 10%; colon: n=4,727, 7%; lung: n=2,866, 5%). Of the rehabilitation participants 55% (lung), 49% (colon), 46% (breast), and 13% (prostate) had sickness absences of six or more months in the year before rehabilitation. Two years after rehabilitation, return-to-work rates were 66% (breast), 54% (prostate), 50% (colon), and 24% (lung). The strongest factors influencing stable work participation were time of sick leave, wage before rehabilitation and age.

CONCLUSION

Two years after cancer rehabilitation, 5 to 6 out of 10 persons returned to stable work participation. Relevant influencing factors were the length of sick leave and wages prior to cancer rehabilitation. The results suggest inclusion of more work-related aspects in cancer rehabilitation and greater suppor, especially in the first year post-rehabilitation.

[Importance of Gradual Reintegration for Return to Work in Oncology Patients]

AIM OF THE STUDY

Gradual reintegration has been an established tool for return to work for many years. However, the effect is unclear in patients with oncological diseases. The objective of this study was to determine the significance of gradual reintegration after inpatient medical rehabilitation.

METHODS

Within the framework of a cohort study, data of 787 patients who underwent medical rehabilitation at Clinic Reinhardshöhe from 06/2012 to 06/2019 were retrospectively analyzed. Patients were routinely contacted 6 months after the end of medical rehabilitation and asked about their occupational situation. The subjective employment prognosis stated by the patient was recorded using the Würzburg Screening Questionnaire.

RESULTS

485/787 patients (62%) had undergone gradual reintegration, 302/787 patients (38%) had not. At the time of the follow-up survey, 456/485 patients with gradual reintegration had returned to work, while only 155/302 patients in the group without gradual reintegration had done so (94 vs. 51%; p<0.001). As a positive predictor of return to work, gradual reintegration was found to be by far the strongest factor (OR 20.21; 95% CI 8.605-47.065).

CONCLUSION

Although this is a retrospective analysis of routine data, gradual reintegration turns out to be a very strong predictor of return to work. Nonuse of stWE is likely influenced by other medical or personal factors not controlled for in our study. This may have led to overestimation of the effect.