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Su XQ, Sang HH, Kuai BX, Xue P, Guo YJ. Experiences of cancer survivors returning to work decision-making: a meta-synthesis of qualitative studies. J Cancer Surviv 2024:10.1007/s11764-023-01530-x. [PMID: 38198115 DOI: 10.1007/s11764-023-01530-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 12/28/2023] [Indexed: 01/11/2024]
Abstract
PURPOSE Return to work for cancer survivors (CSs) may be challenging, and there is a research gap in integrating the relevant experiences of the return-to-work decision-making process for CSs. Our aim was to synthesize existing qualitative research that integrates the dynamic experiences of CSs in the return-to-work decision-making process and highlights the factors influencing the return-to-work decisions of CSs. METHODS We retrieved qualitative studies on a relevant theme published in the PubMed, EBSCO, Scopus, Web of Science, Cochrane Library, and CINAHL databases since construction to December 2023. Literature screening, quality evaluation, and data analysis followed the PRISMA, Joanna Briggs Institute Critical Appraisal Tool (2016), and thematic analysis methods to ensure study reliability. The study was registered on PROSPERO (registration number: CRD42023429623). RESULTS Ten articles were included, and six key outcomes were identified based on Social Cognitive Career Theory (SCCT) integration: points of concern for individuals, sense of self-efficacy, outcome expectations, work perception and belonging, medical advice and guidance, and effects of the external reactions. CONCLUSION The decision-making process for CSs to return to work is affected by various personal and external factors. Effectively addressing personal appearance, financial, and emotional issues can enhance self-efficacy of CSs. Improving external perceptions of cancer patients and enhancing social support in the workplace and medical settings can help CSs make informed decisions regarding their return to work. IMPLICATIONS FOR CANCER SURVIVORS The decision of CSs to return to work is a result of integrating personal, job, and medical care considerations. These findings contribute to the development of future interventions for CSs' return-to-work decisions that target an array of potential factors.
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Affiliation(s)
- Xiao-Qin Su
- Medical School of Nantong University, Nantong, 226001, Jiangsu, China
| | - Hong-Hua Sang
- Medical School of Nantong University, Nantong, 226001, Jiangsu, China
| | - Ben-Xin Kuai
- Medical School of Nantong University, Nantong, 226001, Jiangsu, China
| | - Ping Xue
- Office of the Medical Community, Taizhou Second People's Hospital, Taizhou, 225300, Jiangsu, China.
| | - Yu-Jie Guo
- Medical School of Nantong University, Nantong, 226001, Jiangsu, China.
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Viseux M, Johnson S, Roquelaure Y, Bourdon M. Breast Cancer Survivors' Experiences of Managers' Actions During the Return to Work Process: A Scoping Review of Qualitative Studies. JOURNAL OF OCCUPATIONAL REHABILITATION 2023; 33:687-701. [PMID: 37010716 DOI: 10.1007/s10926-023-10101-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/03/2023] [Indexed: 06/19/2023]
Abstract
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.
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Affiliation(s)
- Marie Viseux
- UMR INSERM 1246 SPHERE "methodS in Patient-Centered Outcomes and HEalth ResEarch", Nantes University, University of Tours, 22 Boulevard Benoni Goullin, Nantes, France.
| | - Stacey Johnson
- Integrated Center for Oncology, Boulevard Jacques Monod, 44805, Nantes, Saint-Herblain, France
- Université Côte d'Azur, LAMHESS, 261 Boulevard du Mercantour, 06200, Nice, France
| | - Yves Roquelaure
- University of Angers, University of Rennes, Inserm, EHESP, IRSET (Institut de Recherche en Santé, Environnement Et Travail) - UMR_S 1085, SFR ICAT, F-49000, Angers, France
- UMR Inserm S 1085, EHESP, IRSET (Institut de Recherche en Santé, Environnement Et Travail) - University of Angers, CHU Angers, University of Rennes, SFR ICAT, F-49000, Angers, France
| | - Marianne Bourdon
- UMR INSERM 1246 SPHERE "methodS in Patient-Centered Outcomes and HEalth ResEarch", Nantes University, University of Tours, 22 Boulevard Benoni Goullin, Nantes, France
- Integrated Center for Oncology, Boulevard Jacques Monod, 44805, Nantes, Saint-Herblain, France
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Choi YJ, Lee WY. Unemployment risk of all employed working-age cancer survivors after cancer diagnosis in South Korea: a retrospective cohort analysis of population-based administrative data. Support Care Cancer 2023; 31:135. [PMID: 36701006 DOI: 10.1007/s00520-023-07603-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 01/20/2023] [Indexed: 01/27/2023]
Abstract
PURPOSE As the cancer survival rate increases, discussions on the employment status of cancer survivors should be actively carried out worldwide. This study examined patients' working status changes after cancer diagnosis to provide the basis for cancer survivors' return to work. METHODS We established a nationwide cohort to determine long-term work changes after cancer diagnosis. All patients aged 19 to 50 years who were newly diagnosed with cancer while working for the previous 3 years were considered as the case group in 2010. Using propensity score matching (PSM), the cases were matched by sex and age at a ratio of 1:3 with the control group. Kaplan-Meier curve and Cox hazard model analyses were performed to determine the occurrence of unemployment and return to work in the case and control groups on a yearly basis. RESULTS According to the 6-year follow-up after cancer diagnosis, 26.5% of cancer patients and 23.2% of controls had lost their jobs by the end of the follow-up (P < .0001). Meanwhile, 50.5% of cancer patients and 57.4% of controls had returned to work after unemployment (P < .0001). Subsequently, based on the Cox hazard model, the unemployment risk of cancer patients was 1.42 times higher than that of the general population, while the proportion of those who returned to work was 1.15 times lower. CONCLUSION Employment is very closely related to the quality of life of cancer survivors. These results highlight the need for a system that can support cancer survivors' work maintenance and return to work after unemployment during the treatment period and the fact that awareness of this must be improved.
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Affiliation(s)
- Yoon-Joo Choi
- Department of Preventive Medicine, College of Medicine, Chung-Ang University, 84, Heuk-Seok Dong, Dong-Jak Gu, Seoul, Republic of Korea.,Division of Cancer Prevention, National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Madu 1-dong, Ilsandong-gu, Goyang, Republic of Korea
| | - Weon-Young Lee
- Department of Preventive Medicine, College of Medicine, Chung-Ang University, 84, Heuk-Seok Dong, Dong-Jak Gu, Seoul, Republic of Korea.
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Popa AE. 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. Work 2022; 72:1299-1310. [DOI: 10.3233/wor-210554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
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.
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Affiliation(s)
- Adela Elena Popa
- Faculty of Social Sciences and Humanities, Lucian Blaga University of Sibiu, Sibiu, Romania E-mail:
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5
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Tan FSI, Shorey S. Experiences of women with breast cancer while working or returning to work: a qualitative systematic review and meta-synthesis. Support Care Cancer 2021; 30:2971-2982. [PMID: 34647131 DOI: 10.1007/s00520-021-06615-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 10/03/2021] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- Faustine Sze Ing Tan
- KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, Singapore, 117597, Singapore.
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Varga A, Gruß I, Ritzwoller DP, Bradley CJ, Sterrett AT, Banegas MP. Characterizing employment of colorectal cancer survivors using electronic health records. JAMIA Open 2021; 4:ooab061. [PMID: 34345806 PMCID: PMC8327368 DOI: 10.1093/jamiaopen/ooab061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/11/2021] [Accepted: 07/07/2021] [Indexed: 11/12/2022] Open
Abstract
Objective Although the value of collecting occupational data is well-established, these data are not systematically collected in clinical practice. We assessed the availability of electronic health record (EHR)-based occupation data within a large integrated health care system to determine the feasibility of its use in research. Materials and Methods We used a mixed-methods approach to extract EHR data and define employment status, employer, and employment industry of 1107 colorectal cancer survivors. This was a secondary analysis of a subset of the Patient Outcomes Research to Advance Learning (PORTAL) colorectal cancer cohort. Results We categorized the employment industry for 46% of the cohort. Employment status was available for 58% of the cohort. The employer was missing for over 95% of the cohort. Conclusion By combining data from structured and free-text EHR fields, we identified employment status and industry for approximately half of our sample. Findings demonstrate limitations of EHR data and underscore the need for systematic collection of occupation data in clinical practice.
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Affiliation(s)
- Alexandra Varga
- Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Inga Gruß
- Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Debra P Ritzwoller
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado, USA
| | - Cathy J Bradley
- University of Colorado Denver, Colorado School of Public Health, Aurora, Colorado, USA
| | - Andrew T Sterrett
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado, USA
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Iddrisu M, Aziato L, Ohene LA. Socioeconomic impact of breast cancer on young women in Ghana: A qualitative study. Nurs Open 2021; 8:29-38. [PMID: 33318809 PMCID: PMC7729654 DOI: 10.1002/nop2.590] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 07/05/2020] [Accepted: 07/13/2020] [Indexed: 12/13/2022] Open
Abstract
Aim This study was undertaken to discover the socioeconomic impact of breast cancer on young women in Ghana. Methods A qualitative exploratory and descriptive design was used to recruit 12 young women from the University of Ghana hospital, 37 Military hospital and Ridge hospital. Individual interviews were conducted face to face and data transcribed verbatim and analysed using content analysis. Results Three themes emerged: perceptions and beliefs; economic concerns; and secrecy. Participants perceived that breast cancer was a test of faith, a spiritual disease that is contagious and disgraceful. Mostly, participants stopped work to cater for themselves, and as a result, they encountered financial challenges. Their challenges were compounded with conscious efforts to keep diagnosis secret to avoid being stigmatized. Conclusion Young women living with breast cancer need support physically, economically and socially from healthcare providers, their families and the society at large.
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Affiliation(s)
- Merri Iddrisu
- Department of Adult HealthSchool of Nursing and MidwiferyUniversity of GhanaAccraGhana
| | - Lydia Aziato
- Department of Adult HealthSchool of Nursing and MidwiferyUniversity of GhanaAccraGhana
| | - Lillian A. Ohene
- Department of Community Health NursingSchool of Nursing and MidwiferyUniversity of GhanaAccraGhana
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Melnyk H, Djukic M, Merriman J, Vaughan Dickson V. An integrative review: Women's psychosocial vulnerability in relation to paid work after a breast cancer diagnosis. J Adv Nurs 2020; 77:2144-2154. [PMID: 33368563 DOI: 10.1111/jan.14730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 11/25/2020] [Accepted: 12/04/2020] [Indexed: 12/24/2022]
Abstract
AIM The aim of this integrative review was to explore psychosocial vulnerabilities in women after a breast cancer diagnosis that are related to their paid work. DESIGN The review methodology was guided by Whittemore and Knafl. The Mehnert Cancer Survivorship and Work Model provided a lens through which to view vulnerability in working women with a focus on facilitating interventions to improve both recovery and work outcomes. DATA SOURCES PUBMED, CINAHL, Web of Science, and PsycNET databases were searched for English language papers published between January 2014-June 2020. REVIEW METHODS Titles and abstracts were screened. Inclusion/exclusion criteria were then applied to full text screen of the remaining articles following PRISMA guidelines. Thirteen studies meeting the inclusion criteria were critically appraised using the Critical Appraisal Skills Programme (CASP) checklist. A constant comparison approach was used to systematically distil findings into categories and assess their fit within the Mehnert Model subdomains. RESULTS Vulnerabilities coalesced predominantly within the following subdomains: (a) changes in identity and role functioning; (b) social reintegration; (c) coping strategies; and (d) social supports. Patterns and themes within these subdomains were related both positively and negatively to form the contours of a survivor's satisfaction/dissatisfaction with quality of life related to work and breast cancer recovery. CONCLUSION Overall, findings highlight the importance of employment and work environments in bolstering women's psychosocial health after a breast cancer diagnosis. IMPACT Findings from this review support adapting psychosocial distress screening to include vulnerabilities relating to work life. Nurses are ideally positioned to facilitate this screening and engage clinicians in a dialogue surrounding patient's support needs due to nursing's central role on the interdisciplinary team. Nurses may also foster collective accountability for implementing ongoing multidisciplinary survivorship care plans that include a return to work component.
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Affiliation(s)
- Halia Melnyk
- College of Nursing, New York University Rory Meyers, New York, NY, USA
| | - Maja Djukic
- The University of Texas Health Science Center at Houston Cizik School of Nursing, Houston, TX, USA
| | - John Merriman
- College of Nursing, New York University Rory Meyers, New York, NY, USA
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Hunter EG, Rowles GD. Managing employment among pre-retirement aged cancer survivors. Br J Occup Ther 2020. [DOI: 10.1177/0308022620958377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Successfully maintaining (managing) paid employment can be a challenge as people negotiate the cancer care pathway and survivorship. Little research explores the influence of age on this situation. The purpose of this project was to explore the role of age in managing employment for survivors from age 45 to 64 years. Method A qualitative descriptive design was conducted to explore the intersection of age and managing employment for cancer survivors. In-depth semi-structured interviews were conducted with 19 United States cancer survivors (lung, breast, colorectal). Interviews were conducted in person or by phone. Verbatim transcripts were analyzed using thematic analysis. Codes were grouped by categories, incorporated into separate topical files, and then aggregated into broader emergent themes. Findings Survivors are not just “returning” to work after treatment. They are often managing work both during and after treatment. Age may have benefits but can also provide barriers to positive survivorship and employment experiences. Fulfilling the role of employee and maintaining a worker identity was a strong driver for many participants. Again, this was potentially both a support and a barrier. It was discovered that health care providers provided little support to facilitate employment. Conclusion Age is a factor that is poorly understood but influences both health and personal aspects of the experience of managing paid employment during and after cancer treatment. Occupational therapy practitioners should acknowledge this important role in addressing cancer survivorship.
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Affiliation(s)
- Elizabeth G Hunter
- Graduate Center for Gerontology, College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Graham D Rowles
- Graduate Center for Gerontology, College of Public Health, University of Kentucky, Lexington, KY, USA
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Hamzah SR, Musa SNS, Muda Z, Ismail M. Quality of working life and career engagement of cancer survivors: the mediating role of effect of disease and treatment. EUROPEAN JOURNAL OF TRAINING AND DEVELOPMENT 2020. [DOI: 10.1108/ejtd-02-2020-0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This study aims at investigating the relationship between the quality of working life and career engagement of cancer survivors and the mediating role of the effect of disease and treatment.
Design/methodology/approach
A cross-sectional study was conducted on 400 cancer survivors in Malaysia. The participants, aged between 18 and 40, were Malaysian citizens undergoing follow-up sessions at the Kuala Lumpur General Hospital and the National Cancer Institute of Malaysia. Data were analysed using descriptive statistics, Pearson’s correlation coefficient and regression analysis that implemented Baron and Kenny’s method for mediation were used for analyses.
Findings
The effect of treatment and disease was found to significantly mediate the relationship between quality of work-life and career engagement of cancer survivors.
Research limitations/implications
The instrument for this study was a self-reported questionnaire, with participants responding to specific items on a five-point Likert scale under the supervision of the researchers. As results from the survey were subjective in nature, the bias in the participants could not be eliminated completely. This study was also limited to the two main parameters, namely, quality of working life and career engagement and a mediator, namely, effects of the disease and treatment. Moreover, as the survey was conducted in only two hospitals in the Klang Valley area, the results cannot be generalized to other cancer survivors in other regions of Malaysia.
Practical implications
The results of this study indicated that the mediating role of the effects of disease and treatment on the relationship of the quality of working life subscales with career engagement. Practical implications, cancer survivor consciousness of the effects of disease and treatment is very important and should be addressed and could be notable to improve the quality of working life.
Originality/value
This study gives valuable insight to managers and practitioners by investigating the relationship between the quality of working life and career engagement and mediates by the effects of disease and treatment. The findings highlight the challenges cancer survivors face on their return to working life. The findings also highlight the need for management to take steps to help cancer survivors cope with career engagement for better work performance.
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Currin-McCulloch J, Stanton A, Boyd R, Neaves M, Jones B. Understanding breast cancer survivors' information-seeking behaviours and overall experiences: a comparison of themes derived from social media posts and focus groups. Psychol Health 2020; 36:810-827. [PMID: 32654515 DOI: 10.1080/08870446.2020.1792903] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Using two different analysis techniques, this study explored differences and similarities in information-seeking discourse and overall breast cancer experiences between posters to a Reddit board and breast cancer survivor focus groups. DESIGN This study incorporates two qualitative methods for determining themes in breast cancer survivors' information-seeking behaviours and overall cancer experiences. First, posts from a breast cancer-specific Reddit community were extracted and analysed using the meaning extraction method (MEM) to determine core themes. Then, investigators performed a thematic analysis of two focus groups of breast cancer survivors (N = 18). Finally, themes derived from each analysis method were compared. MAIN OUTCOME MEASURES Outcome measures include themes extracted from Reddit posts and themes generated from breast cancer survivor focus groups. RESULTS Findings between qualitative methodologies represent similar yet nuanced themes in survivors' discourse. The MEM resulted in seven themes: diagnosis, treatment process, social support, existentialism, risk, information-seeking and surgery. Focus groups revealed the same initial four MEM themes plus the following: disclosure, coping and fears. CONCLUSIONS The MEM is a cost-effective research mechanism for informing common themes of experiences of cancer patients and survivors and may offer initial data to guide psychosocial oncology research design and recruitment.
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Affiliation(s)
| | - Amelia Stanton
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Ryan Boyd
- Psychology Department, Lancaster University, Lancaster, UK
| | - Margaret Neaves
- Department of Social Work, Satellite Healthcare, San Jose, CA, USA
| | - Barbara Jones
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, USA
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Butow P, Laidsaar-Powell R, Konings S, Lim CYS, Koczwara B. Return to work after a cancer diagnosis: a meta-review of reviews and a meta-synthesis of recent qualitative studies. J Cancer Surviv 2020; 14:114-134. [PMID: 31858379 DOI: 10.1007/s11764-019-00828-z] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 10/23/2019] [Indexed: 12/29/2022]
Abstract
PURPOSE Returning to work (RTW) after cancer treatment can be challenging, but when desired, has many benefits. While there are many qualitative studies (reviews and recent studies) available on cancer survivors' experience of returning to work, synthesis of these qualitative studies is lacking. We aimed to summarise the existing qualitative reviews and recent studies following the last published review, to examine cancer survivors' motivations for and experiences of RTW, and to highlight factors within both the survivors and his or her environment that influence RTW. METHOD A set of systematic reviews focusing on RTW were identified. A systematic search for individual papers published on RTW since the last review was also completed. Data extraction and bias assessment were conducted, with 25% double-coded to ensure reliability. A meta-ethnographic approach was utilised to synthesise the findings of each. RESULTS Seven systematic reviews and 12 individual papers between 2017 and 2019 were identified. Quality was variable. Most reviews and studies focused on women with breast cancer. Three major themes were identified: person factors, employment factors and wider contextual factors including family, social and cultural variables. CONCLUSIONS We identified gaps in research on the RTW experiences of people with cancers other than breast, men, those with low incomes and more diverse populations. IMPLICATIONS FOR CANCER SURVIVORS Cancer survivors need to consider personal, employer and wider contextual factors when deciding whether and when to RTW. Future interventions to support survivors should be informed by these findings, addressing the diverse range of potential factors related to RTW in an individual survivor.
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Affiliation(s)
- Phyllis Butow
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology, The University of Sydney, Sydney, NSW, Australia.
| | - Rebekah Laidsaar-Powell
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Stephanie Konings
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Chloe Yi Shing Lim
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Bogda Koczwara
- Flinders Medical Centre, (5B:118.5) GPO Box 2100, Adelaide, SA, 5001, Australia
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Swanberg JE, Vanderpool RC, Tracy JK. Cancer-work management during active treatment: towards a conceptual framework. Cancer Causes Control 2020; 31:463-472. [PMID: 32125547 DOI: 10.1007/s10552-020-01285-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 02/19/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE Forward progress in cancer treatment has resulted in fewer adverse consequences of cancer during and after treatment, offering employed cancer patients the possibility of continuing to work during treatment, returning to work after treatment, or implementing a combination of strategies to manage the cancer-work interface. Yet, much of the research on cancer and employment examines return to work as the primary outcome, neglecting to consider the circumstances of survivors who maintain employment while engaged in active treatment. We introduce the Cancer-Work Management Framework (CWMF), a conceptual framework for understanding the cancer and job demands survivors who continue to work during active treatment experience and how cancer and job resources and strategies could promote cancer-work fit and ultimately optimize employment and health outcomes. METHODS We provide an overview of the research describing the cancer-work management experiences of survivors who maintain employment during active treatment and summarize the theories that informed the CWMF including ecological systems, boundary-spanning, and job demands and resources theories. RESULTS The paper presents a description of the components of the CWMF which include cancer demands, cancer care resources and strategies, work demands, and workplace resources. We also describe a process-cancer-work fit-that reflects the interplay between demands and resources influence employment and health outcomes. CONCLUSIONS Future research directions for developing knowledge about the cancer-work management process are proposed with suggestions for study of how cancer and job demands influence cancer treatment and employment decisions.
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Affiliation(s)
- Jennifer E Swanberg
- Department of Health Policy and Management, School of Professional Studies, Providence College, 1 Cunningham Square, Providence, RI, 02918, USA.
- University of Maryland School of Social Work, Baltimore, MD, USA.
| | - Robin C Vanderpool
- Department of Health, Behavior & Society, College of Public Health, University of Kentucky, Lexington, KY, USA
| | - J Kathleen Tracy
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
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Semin JN, Palm D, Smith LM, Ruttle S. Understanding breast cancer survivors' financial burden and distress after financial assistance. Support Care Cancer 2020; 28:4241-4248. [PMID: 31900619 DOI: 10.1007/s00520-019-05271-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 12/23/2019] [Indexed: 12/26/2022]
Abstract
PURPOSE Little is known about how breast cancer may impact survivors' financial well-being. This study aims to investigate the financial status, burden, and opinions of breast cancer survivors who received short-term financial assistance, emotional support, and resource navigation from a community organization during treatment. METHODS Clients previously served by the community organization were mailed a 16-question survey (n = 751) to elicit their perspective on financial status and burden before, during, and after diagnosis and treatment along with general demographic and opinion items. RESULTS 136 surveys (18.1%) were returned yielding 118 (15.7%) suitable for analyses. Clients' average age was 54.3 years. Most were female (99.2%), Caucasian (66.1%), and diagnosed with Stage 1 or 2 breast cancer (58.5%). Clients reported significantly worse (p < 0.001) financial status after being diagnosed compared to before diagnosis. Financial distress was highest during cancer treatment (mean = 3.92, SD = 0.85), lowest prior to treatment (mean = 2.48, SD = 1.05), and remained high after treatment (mean = 3.59, SD = 1.05). Those with higher distress after treatment were significantly (p = 0.01) more likely to report lower social support during treatment. CONCLUSIONS Breast cancer survivors reported worsening financial status and distress after being diagnosed and during treatment despite receiving short-term financial assistance, emotional support, and resource navigation. Survivors' financial distress after treatment remained higher than before treatment. However, most felt receiving financial assistance improved their quality of life and made them feel more in control of financial decision-making. Breast cancer survivors who feel they have low social support during treatment may feel higher financial distress posttreatment.
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Affiliation(s)
- Jessica N Semin
- College of Public Health, University of Nebraska Medical Center, 984355 Medical Center, Omaha, NE, 68198-4355, USA.
| | - David Palm
- College of Public Health, University of Nebraska Medical Center, 984355 Medical Center, Omaha, NE, 68198-4355, USA
| | - Lynette M Smith
- College of Public Health, University of Nebraska Medical Center, 984355 Medical Center, Omaha, NE, 68198-4355, USA
| | - Sarah Ruttle
- Visiting Nurse Association, 12565 West Center Road, Suite 100, Omaha, NE, USA
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15
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Nichols HM, Swanberg JE, Vanderpool RC. Patient-Provider Communication: Experiences of Low-Wage-Earning Breast Cancer Survivors in Managing Cancer and Work. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2019; 34:542-549. [PMID: 29480506 DOI: 10.1007/s13187-018-1338-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In 2017, there will be more than 250,000 new diagnoses of invasive breast cancer; most cases will occur in working-age women. The goal of this qualitative study was to explore low-wage-earning breast cancer survivors' experiences communicating with their oncology team about cancer and employment issues. Twenty-four low-wage-earning breast cancer survivors in the USA were interviewed in 2012 using a structured interview protocol. Sociodemographic data, cancer history, and patient-provider communication experiences regarding the management of cancer and work were collected. Interviews were analyzed using grounded theory strategy of constant comparative analysis. Low-wage-earning breast cancer survivors' experiences communicating with their oncology team about employment and cancer focused on three dimensions of patient-provider communication: extent, quality, and content. Over 70% of respondents reported no communication or only routine communication with their providers regarding work; three quarters of women reported poor or standard communication quality, and content of work-related communication covered scheduling issues, work absences, continuing to work during treatment, and financial concerns. Communication between oncology care teams and low-wage-earning cancer patients is critical to the successful management of treatment and work responsibilities given the vulnerable employment situation of these women. There is a need for education of oncology team members about how cancer and its treatment can impact employment for all workers, but especially for low-wage workers, thereby allowing the care team to address these issues proactively and help patients successfully manage both cancer treatment and work responsibilities.
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Affiliation(s)
- Helen M Nichols
- School of Social Work, University of Maryland, Baltimore, MD, USA
| | - Jennifer E Swanberg
- School of Social Work and Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, MD, USA
| | - Robin C Vanderpool
- Department of Health, Behavior & Society, University of Kentucky College of Public Health, 2365 Harrodsburg Road, Suite A230, Lexington, KY, 40504, USA.
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16
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Gruß I, Hanson G, Bradley C, McMullen C, Ritzwoller D, Hodge S, Varga A, Banegas MP. Colorectal cancer survivors' challenges to returning to work: A qualitative study. Eur J Cancer Care (Engl) 2019; 28:e13044. [PMID: 31006931 DOI: 10.1111/ecc.13044] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 02/22/2019] [Accepted: 03/25/2019] [Indexed: 01/20/2023]
Abstract
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.
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Affiliation(s)
- Inga Gruß
- Kaiser Permanente Center for Health Research, Portland, Oregon
| | - Ginger Hanson
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Cathy Bradley
- Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado
| | - Carmit McMullen
- Kaiser Permanente Center for Health Research, Portland, Oregon
| | - Debra Ritzwoller
- Kaiser Permanente Colorado Institute for Health Research, Aurora, Colorado
| | - Stephanie Hodge
- Kaiser Permanente Center for Health Research, Portland, Oregon
| | - Alexandra Varga
- Kaiser Permanente Center for Health Research, Portland, Oregon
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17
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Paxton RJ, Garner W, Dean LT, Logan G, Allen-Watts K. Health Behaviors and Lifestyle Interventions in African American Breast Cancer Survivors: A Review. Front Oncol 2019; 9:3. [PMID: 30723698 PMCID: PMC6349825 DOI: 10.3389/fonc.2019.00003] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 01/02/2019] [Indexed: 11/13/2022] Open
Abstract
Background: African American breast cancer survivors have a higher incidence of estrogen receptor negative and basal-like (e.g., triple negative) tumors, placing them at greater risk for poorer survival when compared to women of other racial and ethnic groups. While access to equitable care, late disease stage at diagnosis, tumor biology, and sociodemographic characteristics contribute to health disparities, poor lifestyle characteristics (i.e., inactivity, obesity, and poor diet) contribute equally to these disparities. Lifestyle interventions hold promise in shielding African American survivors from second cancers, comorbidities, and premature mortality, but they are often underrepresented in studies promoting positive behaviors. This review examined the available literature to document health behaviors and lifestyle intervention (i.e., obesity, physical activity, and sedentary behavior) studies in African American breast cancer survivors. Methods: We used PubMed, Academic Search Premier, and Scopus to identify cross-sectional and intervention studies examining the lifestyle behaviors of African American breast cancer survivors. Identified intervention studies were assessed for risk of bias. Other articles were identified and described to provide context for the review. Results: Our systematic review identified 226 relevant articles. The cross-sectional articles indicated poor adherence to physical activity and dietary intake and high rates of overweight and obesity. The 16 identified intervention studies indicated reasonable to modest study adherence rates (>70%), significant reductions in weight (range -1.9 to -3.6%), sedentary behavior (-18%), and dietary fat intake (range -13 to -33%) and improvements in fruit and vegetable intake (range +25 to +55%) and physical activity (range +13 to +544%). The risk of bias for most studies were rated as high (44%) or moderate (44%). Conclusions: The available literature suggests that African American breast cancer survivors adhere to interventions of various modalities and are capable of making modest to significant changes. Future studies should consider examining (a) mediators and moderators of lifestyle behaviors and interventions, (b) biological outcomes, and (c) determinants of enhanced survival in this population.
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Affiliation(s)
- Raheem J Paxton
- Department of Community Medicine and Population Health, The University of Alabama, Tuscaloosa, AL, United States
| | - William Garner
- Department of Life and Health Sciences, University of North Texas at Dallas, Dallas, TX, United States
| | - Lorraine T Dean
- Department of Epidemiology, John Hopkins School of Public Health, Baltimore, MD, United States
| | - Georgiana Logan
- Department of Community Medicine and Population Health, The University of Alabama, Tuscaloosa, AL, United States
| | - Kristen Allen-Watts
- Department of Community Medicine and Population Health, The University of Alabama, Tuscaloosa, AL, United States
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18
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Tracy JK, Falk D, Thompson RJ, Scheindlin L, Adetunji F, Swanberg JE. Managing the cancer-work interface: the effect of cancer survivorship on unemployment. Cancer Manag Res 2018; 10:6479-6487. [PMID: 30568507 PMCID: PMC6276819 DOI: 10.2147/cmar.s180649] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective This study assessed differences in employment outcomes among cancer survivors using data from a nationally representative sample. Methods The 2011 Medical Expenditure Panel Survey (MEPS) data and the 2011 MEPS Experiences with Cancer Survivorship Supplement representing 3,360,465 people in the US population were analyzed to evaluate factors associated with unemployment among cancer survivors during the 5 years following diagnosis and treatment. The sample included adults 1) diagnosed with cancer within 5 years prior to survey completion and 2) engaged in paid employment since diagnosis. Individuals diagnosed with nonmelanoma skin cancer (n=33) were excluded from analyses. Results Data of 221 cancer survivors were used to identify factors associated with employment status at the time respondents were employed (n=155) vs unemployed (n=66). Results of bivariate analyses indicated that unemployed survivors were older, more likely to be women, more likely to be uninsured at the time of cancer diagnosis, and to report lower incomes than cancer survivors who continue to be employed. Unemployed survivors were more likely than employed survivors to have had anxiety about being forced to retire or quit early when they were employed because of cancer and to report cancer-related interference with physical and mental aspects of their job tasks; unemployed survivors also took less paid time off and were less likely to change to a flexible job schedule when they were employed. In multiple logistic regression analyses, worry about being forced to retire (protective), worry that cancer recurrence will interfere with home or work responsibilities (risk), and change to a flexible work schedule (risk) following cancer diagnosis were associated with unemployment after controlling for demographic differences between employed and unemployed cancer survivors. Conclusion Findings of this study highlight the extent to which the challenges of managing the cancer-work interface create challenges to employment among cancer survivors and may lead to long-term unemployment among cancer survivors. Future studies should evaluate the strategies that the survivors could use to manage the cancer-work interface during cancer treatment to attain medical, psychological, social, and employment outcomes.
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Affiliation(s)
- J Kathleen Tracy
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA, .,University of Maryland Greenebaum Comprehensive Cancer Center, University of Maryland Medical Center, Baltimore, MD, USA,
| | - Derek Falk
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA, .,University of Maryland School of Social Work, Baltimore, MD, USA
| | | | - Lily Scheindlin
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA,
| | - Fiyinfolu Adetunji
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA,
| | - Jennifer E Swanberg
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA, .,University of Maryland Greenebaum Comprehensive Cancer Center, University of Maryland Medical Center, Baltimore, MD, USA, .,University of Maryland School of Social Work, Baltimore, MD, USA.,Department of Health Policy and Management, School of Professional Studies, Providence College, Providence, RI, USA
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19
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Swanberg JE, Nichols HM, Vanderpool RC, Rosenblatt P, Tracy JK. Working poor and working nonpoor cancer survivors: Work-related and employment disparities. Cancer Rep (Hoboken) 2018; 1:e1134. [PMID: 32729229 DOI: 10.1002/cnr2.1134] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 08/06/2018] [Accepted: 08/10/2018] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Many cancer survivors face challenges remaining at work during treatment or returning to work posttreatment. Workplace supports can ease the strain associated with managing the cancer-work interface. Limited research has examined the employment experiences of low-wage earning survivors, who are less likely to have access to workplace supports, overlooking a factor that may influence survivors' employment outcomes. AIMS This study assessed differences in employment experiences between working poor (WP) and working nonpoor (WNP) cancer survivors in the United States. METHODS AND RESULTS Data from the 2011 Medical Expenditure Panel Survey (MEPS) and the 2011 MEPS Experiences with Cancer Survivorship Supplement were analyzed to evaluate differences in workplace supports, cancer-related psychological job distress, productivity, and employment outcomes between WP and WNP cancer survivors. The sample included adults diagnosed with cancer within 5 years prior to survey completion and engaged in paid employment since diagnosis. Working poor respondents had income below 200% of the poverty level. Chi-square tests assessed differences between WP (n = 57) and WNP (n = 164) cancer survivors' demographic, cancer, and employment characteristics; cancer-related psychological job distress; employee productivity; and employment outcome measures. Multiple logistic regression analyses determined the independent association between WP status and these same variables controlling for sociodemographic confounders. Working poor survivors were more likely to take unpaid time off, change from full-time to part-time, to report cancer-related psychological job distress, negative influences on job productivity and employment outcomes, and less likely to have health insurance. In logistic regression analyses, those who took unpaid time off were more likely to be WP; being WP was also associated with poorer employment outcomes, after controlling for sociodemographics differences between WP and WNP. CONCLUSION Working poor survivors had fewer workplace supports and poorer employment outcomes than WNP survivors, highlighting important occupational disparities for cancer survivors. Areas for future research are discussed.
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Affiliation(s)
- Jennifer E Swanberg
- Department of Health Policy and Management, School of Professional Studies, Providence College, Providence, Rhode Island.,University of Maryland School of Social Work, Baltimore, Maryland.,Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland.,University of Maryland Greenebaum Comprehensive Cancer Center
| | - Helen M Nichols
- University of Maryland School of Social Work, Baltimore, Maryland
| | - Robin C Vanderpool
- Department of Health, Behavior & Society, College of Public Health, University of Kentucky, Lexington, Kentucky
| | - Paula Rosenblatt
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland.,University of Maryland Greenebaum Comprehensive Cancer Center
| | - J Kathleen Tracy
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland.,Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland.,University of Maryland Greenebaum Comprehensive Cancer Center
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20
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Thomson MD, Siminoff LA. Managing work and cancer treatment: Experiences among survivors of hematological cancer. Cancer 2018; 124:2824-2831. [PMID: 29660822 DOI: 10.1002/cncr.31375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 03/04/2018] [Accepted: 03/09/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND The current study was performed to characterize the employment status of survivors of hematological cancer who have an informal caregiver from the time of diagnosis through the first 6 months of treatment. METHODS Using a mixed methods approach, semistructured interviews with survivors of hematological cancer were conducted within 6 months of the initiation of cancer treatment. Interviews assessed cancer treatment status, barriers and facilitators to employment, financial and insurance status, and relationship with the primary caregiver. These results are part of a longitudinal study of cancer survivors and informal caregivers. RESULTS A total of 171 patients were enrolled. Within 6 months of beginning cancer treatments, approximately 35% were no longer employed. Reasons to remain employed included financial need, employee benefits, and a sense of purpose and normalcy. Employer accommodations and supportive colleagues facilitated continued employment. Logistic regression analysis demonstrated that having a higher household income, a desire to work, nonphysical job tasks, and congruent survivor-caregiver communication were associated with greater odds of remaining employed. CONCLUSIONS Within 6 months of initiating cancer treatment, the majority of survivors of hematological cancer had maintained employment. Because of the limitations imposed by the physical stress of cancer treatments, as well as the need to maintain employment to continue receiving employee benefits to cover such treatments, survivors of hematological cancer likely would benefit from employment accommodations that are sensitive to their unique needs. Cancer 2018;124:2824-2831. © 2018 American Cancer Society.
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Affiliation(s)
- Maria D Thomson
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, Virginia
| | - Laura A Siminoff
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, Pennsylvania
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