Auswirkungen der SARS-CoV-2-Pandemie auf die Inanspruchnahme der onkologischen Rehabilitation: eine Difference-in-Differences-Analyse

Ziel der Studie Der durch die SARS-CoV-2-Pandemie eingeschränkte Zugang zur rehabilitativen Versorgung kann die Teilhabe von Menschen mit Krebserkrankungen beeinträchtigen und birgt die Gefahr einer Progression der zugrundeliegenden Erkrankung. Ziel unserer Analysen war es zu beschreiben, in welchem Umfang die Inanspruchnahme onkologischer Rehabilitation pandemiebedingt zurückgegangen ist.

Methodik Wir nutzten monatliche Querschnittsdaten von der Deutschen Rentenversicherung zur Inanspruchnahme onkologischer Rehabilitation (Ca-Reha-Leistung nach § 15 für Versicherte im erwerbsfähigen Alter oder § 31 Abs. 1 Nr. 2 SGB VI für Rentner) in den Jahren 2019 und 2020. Mit einem Difference-in-Differences-Modell schätzten wir die auf die Pandemie zurückzuführende Reduktion der Inanspruchnahme onkologischer Rehabilitation. Als Difference-in-Differences-Schätzer wurde das Incidence Rate Ratio (IRR) berechnet.

Ergebnisse Wir berücksichtigten 146.924 onkologische Rehabilitationen im Jahr 2019 und 113.117 Leistungen im Jahr 2020. Die Inanspruchnahme onkologischer Rehabilitation reduzierte sich pandemiebedingt um 11,5% bei Leistungen nach § 15 SGB VI (IRR=0,885; 95% KI: 0,864 bis 0,906) und um 26,5% bei Leistungen nach § 31 (IRR=0,735; 95% KI: 0,717 bis 0,754). Bei Ca-Reha-Leistungen nach § 31 war der Rückgang in den alten Bundesländern höher als in den neuen Bundesländern und für allgemeine Antragsverfahren deutlich stärker als für Anschlussrehabilitationen.

Schlussfolgerung Die Analysen zeigen einen pandemiebedingten Rückgang onkologischer Rehabilitation vor allem bei onkologischen Rehabilitationsleistungen für Rentner nach § 31. Der Verzicht auf die durch medizinische Rehabilitation erreichbare körperliche und psychische Erholung und Linderung von Krankheits- und Behandlungsnebenwirkungen wird für viele an Krebs erkrankte Personen mit einer Verschärfung von Teilhabeeinschränkungen einhergehen. Ein wiederholtes Monitoring von Arbeitsfähigkeit und Gesundheit chronisch kranker Menschen könnte erforderliche Daten generieren, um zu klären, warum rehabilitationsbedürftige Menschen von der Inanspruchnahme onkologischer Rehabilitation Abstand genommen haben und wie sie unterstützt werden können.

Return to Work and Work Productivity During the First Year After Cancer Treatment

Objectives

Working-age cancer patients face barriers to resuming work after treatment completion. Those resuming work contend with reduced productivity arising from persisting residual symptoms. Existing studies of return to work (RTW) after cancer diagnosis were done predominantly in Western countries. Given that employment and RTW in cancer survivors likely vary regionally due to healthcare provision and social security differences, we documented rates and correlates of RTW, work productivity, and activity impairment among Chinese cancer survivors in Hong Kong at one-year post-treatment.

Methods

Of 1,106 cancer patients assessed at six-months post-cancer treatment (baseline), 593 previously worked; detailed work status, psychological distress (HADS), physical symptom distress (MSAS-SF), supportive care needs (SCNS-SF34-C), health-related quality of life (SF12), and illness perception (B-IPQ) were assessed. Six months later (follow-up), work productivity and activity impairment were assessed (WPAI; n = 402). Descriptive analyses examined RTW rate. Fully adjusted regressions determined RTW, work productivity, and activity impairment predictors.

Results

At baseline, 39% (232/593) were working, 26% (153/593) on sick leave, and 35% (208/593) were unemployed. Compared to patients returning to work, unemployed participants were older, likely manual/service-oriented workers, and had lower family income, chemotherapy, fewer unmet health system and information needs, poorer physical functioning, and negative illness perceptions. Sick leave participants were likely service-oriented workers, who had head and neck cancer, chemotherapy, and poor physical functioning. At FU, baseline depressive symptoms, physical symptom distress, and negative illness perceptions predicted presenteeism and work productivity loss; gynecological cancer, fewer unmet health system and information needs, and greater unmet sexuality needs predicted absenteeism; physical symptom distress, negative illness perception, and poor physical functioning predicted activity impairment.

Conclusion

Cancer survivors who had more physically demanding jobs and poorer physical functioning delayed RTW. Unmanaged physical symptom and psychological distress hindered work productivity.

Work, daily activities and leisure after cancer

Objective

Determine if cancer survivors have lower participation in paid work, more limitations in daily activities or more limitations in leisure compared with those without cancer, stratified by age (working age ≤65 years; retirement age >65 years). Secondary objectives are identifying sociodemographic or clinical factors associated with work, daily activities or leisure and analysis of the relationship between work, daily activities and leisure.

Methods

Secondary analyses, using logistic regression, were performed on three cohorts (lymphoma, prostate and thyroid cancer) from the Dutch Patient Reported Outcomes Following Initial treatment and Long‐term Evaluation of Survivorship (PROFILES) registry and a nationally representative non‐cancer sample.

Results

Working‐age cancer survivors (n = 926) were significantly (p < 0.001) less likely to participate in paid work and more likely to report limitations in daily activities and leisure compared to the non‐cancer cohort (n = 1279). Among retirement aged cancer survivors (n = 1046), paid work was significantly more likely (p < 0.001), as were limitations in leisure (p < 0.05), compared with the non‐cancer controls (n = 334).

Conclusions

Cancer impacts daily activities and leisure, as well as paid work. These roles are important for cancer survivors' quality of life, suggesting support to return to these activities may be an important component of survivorship care.

The dynamic relationship between cancer and employment-related financial toxicity: an in-depth qualitative study of 21 Australian cancer survivor experiences and preferences for support

BACKGROUND

People with a cancer diagnosis experience physical and emotional impacts that may affect employment. Alongside cancer care costs, reduced ability to generate an income is a key contributor to financial toxicity which is associated with poor emotional wellbeing, quality of life, treatment adherence and survival. This study aimed to explore people's experiences of changes to employment and their suggestions for how cancer survivors can be better supported.

METHODS

Semi-structured telephone interviews were conducted with a purposive sample of 21 cancer survivors identified as part of a larger study of emotional distress. Purposive sampling was used to include a diverse group of people across age, gender, tumour type, self-reported financial difficulties and employment status. Interviews were inductively and iteratively coded by two independent coders and analysed using thematic analysis.

RESULTS

There is a dynamic relationship between a person's cancer treatment and their employment. For some, employment was disrupted due to physical or emotional impacts of cancer, or workplace stigma and discrimination. Others continued to work at the detriment of their health. Participants wished they had been made aware earlier how cancer might impact their capacity to work, their finances and their health. There was a lack of knowledge on the financial supports that may be available to them.

CONCLUSIONS

Healthcare professionals may have a role in minimising the financial impact of a cancer diagnosis through early assessment, communication of patients' potential work capacity and appropriate referrals to occupational therapy to aid return to work or financial planning. A robust government social support system specifically for households experiencing cancer is urgently required.

Association between cancer stigma and job loss among cancer survivors

OBJECTIVE

Previous qualitative studies found cancer stigma was associated with work discrimination and job loss among cancer patients. This study aims to quantify the association between cancer stigma and job loss among cancer survivors.

METHODS

For this study, we used the data from a face-to-face cross sectional survey conducted at two cancer hospitals in Seoul and Hwasun in South Korea from October 2017 to March 2018. Cancer stigma was assessed using a validated questionnaire which consists of 12 items in three domains: (a) impossibility of recovery; (b) stereotypes; and (c) discrimination. Multivariable logistic regression was performed to evaluate the association between cancer stigma and job loss adjusting age, sex, marital status, education, job type, residence area, cancer site, stage, comorbidity, time since diagnosis, and self-efficacy.

RESULTS

Among 433 cancer survivors, 24.0% lost their jobs after cancer, and 20.7% experienced discrimination at work. Of total, 21.7% of the survivors agreed that it was difficult to treat cancer regardless of highly developed medical science. Survivors with stigma on impossibility of recovery and stereotypes were 3.10 (95% confidence interval [CI]: [1.76, 5.44]) and 2.10 (95% CI: [1.20, 3.67]) times more likely to lose a job than survivors without cancer stigma. Survivors with discrimination experience at work had 1.98 (95% CI: [1.05, 3.74]) times higher risk of losing a job than survivors without it.

CONCLUSIONS

Survivors with cancer stigma were more likely to lose their jobs than survivors without cancer stigma. Considering its social and economic impact on job loss, comprehensive interventions for working cancer survivors as well as public campaigns against cancer stigma would be necessary.

Municipal return to work management in cancer survivors: a controlled intervention study

INTRODUCTION

Resuming work during or after cancer treatment has become an important target in cancer rehabilitation.

PURPOSE

The aim was in a controlled trial to study the return to work (RTW) effect of an early, individually tailored vocational rehabilitation intervention targeted to improve readiness for RTW in cancer survivors.

MATERIAL AND METHODS

Participants diagnosed with breast, cervix, ovary, testicular, colon-rectal, and head-and-neck cancers as well as being employed were allocated to a vocational rehabilitation intervention provided by municipal social workers (n = 83) or to usual municipal RTW management (n = 264). The intervention contained three elements: motivational communication inspired by Acceptance and Commitment Therapy by which RTW barriers were addressed, municipal cancer rehabilitation and finally employer and workplace contact. RTW effect was assessed as relative cumulative incidence proportions (RCIP) in the control and intervention group within 52 weeks of follow-up, estimated from the week where treatment ended at the hospital. RCIP was interpreted and reported as relative risk (RR) with 95% confidence intervals (CI) adjusted for gender, age cancer diagnosis, education, comorbidity, and sick leave weeks.

RESULTS

Across cancer diagnoses 69 (83.1%) and 215 (81.4%) returned to work in the intervention and control group, respectively. No statistical effect was seen (RR 1.08 (95% CI 0.98-1.19)). Repeating the analyses solely for participants with breast cancer (n = 290) showed a significant effect of the intervention (RR 1.12 (95% CI 1.01-1.23)).

CONCLUSION

More than 80% returned to work in both groups. However, no statistical difference in RTW effect was seen across cancer diagnoses within one year from being exposed to an early, individually tailored vocational rehabilitation intervention compared with usual municipal RTW management.

TRIAL REGISTRATION NUMBER

ISRCTN50753764.

Returning to Work After Cancer in Australia: What Facilitates a Positive Return to Work Experience?

Purpose This study examined the impact of task-based and relationship-based social support received in the workplace on cancer survivors' retrospective satisfaction with their return to work experience. Methods Cancer survivors (N = 159), completed an online questionnaire assessing their satisfaction with the return to work experience, overall job satisfaction, contact with employers and co-workers while absent, perceived task-based and relationship-based social support received at the time of returning to work, and the perceived emotional quality of workplace relationships. Results Survivors reported that contact with employers, but not co-workers, while absent from work was associated with a more positive return to work experience. Additionally, greater perceived task-based and relationship-based social support at the time of returning to work were significantly correlated with greater satisfaction with returning to work. Importantly, the impact of task-based and relationship-based social support was fully mediated by the perceived emotional quality of workplace relationships. Job satisfaction independently predicted variance in return to work satisfaction. Conclusions Supporting effective return to work after cancer involves consideration of the workplace social context. Greater resources are needed to help workplaces foster and maintain social connections with employees who are absent from work for cancer treatment.

Predictors of resignation and sick leave after cancer diagnosis among Japanese breast cancer survivors: a cross-sectional study

BACKGROUND

In Japan, 55.5% of breast cancer survivors (BCSs) are of working age, so various perspectives regarding return to work (RTW) after cancer diagnosis need to be considered. Therefore, this study aimed to clarify the risk factors for resignation and taking sick leave (SL) among BCSs in continued employment at the time of diagnosis.

METHODS

A web-based retrospective cross-sectional survey was conducted on BCSs using data from a 2018 Japanese national research project (Endo-Han) commissioned by the Ministry of Health, Labour and Welfare of Japan. The subjects were women aged 18-69 years who had been diagnosed with breast cancer for the first time at least 1 year previously. The risk factors for resignation and taking SL after breast cancer diagnosis, including age at diagnosis, education level, cancer stage, surgery, chemotherapy, radiotherapy, employment status, and occupational type, were then analyzed using a logistic regression model.

RESULTS

In total, 40 (14.9%) of 269 BCSs quit their jobs at least 1 year after being diagnosed with breast cancer. The results of the multivariable analysis indicated that lower education level (odds ratio [OR]: 3.802; 95% confidence interval [CI]: 1.233-11.729), taking SL (OR: 2.514; 95%CI: 1.202-5.261), and younger age at diagnosis (OR: 0.470; 95%CI: 0.221-0.998) were predictors of resignation. Of 229 patients who continued working, SL was taken by 72 (31.4%). In addition, undergoing surgery was found to be a predictor of taking SL (OR: 8.311; 95%CI: 1.007-68.621).

CONCLUSIONS

In total, 40 (14.9%) of 269 BCSs quit their jobs at least 1 year after being diagnosed with breast cancer. The results of this study indicated that younger age, lower education level, and taking SL were predictors of resignation after breast cancer diagnosis.

Cancer survivors' efforts to facilitate return to work

This study assesses individual factors that influence return to work (RTW) and in particular on the cancer survivors' ability to prepare his/her job resumption. A self-administered questionnaire was completed by 105 cancer survivors after at least 4 weeks after the time of their RTW. Various methods of returning to work were compared between occupational and medical characteristics with multivariate statistical tests. Regular contact by a cancer survivor with the company during sick leave is associated with RTW within 1 year of diagnosis (ORaj = 5.78). Optional pre-reinstatement visit with the occupational physician is associated with the absence of employee activity's change (ORaj = 2.30). The cancer survivors who during treatment period ask for an adaption of treatment are more likely to have a change in working conditions (ORaj = 14.5). The adaptation to recovery conditions appears to be associated with survivors' effort to RTW. It should be confirmed with new studies.

Analysis of medico-social factors for return to work among patients presenting with haematological malignancy (adamantine): results of a 'pilot study'

Objective

The aim of this study was to describe return to work determinants in patients with haematological malignancy.

Results

This medico-social pilot study included patients with haematological malignancy in the département of Calvados, aged 18 to 55 years, diagnosed between 1st January and 31st December 2010 and alive at 1st January 2015. Patients were identified via consultation of the Lower Normandy haematological malignancy Registry. They completed a specially developed self-questionnaire, in addition to validated questionnaires for anxiety-depression, quality of life and fatigue. Of the patients contacted, 50% accepted to participate. The mean age at diagnosis was 49.8 years, and the majority of patients (79.2%) was professionally active at the time of diagnosis. Only 64.9% of subjects had stopped work due to illness. The psychological impact (demonstrated anxiety) was significantly greater in men (p = 0.01). The majority of subjects returned to work after treatment (80.7%) and among them, the mean duration of absence from work was 16.1 months. Only 52.6% of subjects had informed their occupational physician and 56.7% had benefited from a pre-return visit. The satisfactory response rate obtained is promising for the extension of the present project as a prospective multicentric study.

Reintegrating Employees Undergoing Cancer Treatment into the Workplace: A Qualitative Study of Employer and Co-worker Perspectives

Purpose The purpose of this study was to explore how employers and co-workers experience the return to work (RTW) process of employees undergoing cancer treatment. Methods Sixteen semi-structured individual interviews and participant observations at seven workplaces took place, involving seven employers and nine co-workers with different professions. A phenomenological-hermeneutic analytic approach was applied involving coding, identification of themes, and interpretation. Results We identified three employer themes: call for knowledge, Making decisions, and Feeling helpless. Also, three co-worker themes were identified: understanding and sympathy, extra work and burden, and Insecurity about future work tasks. Early initiated RTW, e.g. less work hours and work accommodations, did neither constitute challenges for employers nor co-workers in the beginning of the RTW process. However, when the RTW process was prolonged employers encountered difficulties in finding suitable work tasks, whereas co-workers were burdened by extra work. Conclusions Overall, cancer survivors' RTW process was welcomed and encouraged at the workplace level. However, employer and co-worker experiences suggested that RTW initiation parallel with cancer treatment raised challenges at the workplace level, when the RTW process was extended beyond the initial RTW plan; increased workload and difficulties in balancing the needs of the cancer survivor and co-workers. Mechanisms that support cancer survivors' RTW without introducing strain on co-workers should be investigated in future research. Furthermore, support for employers in their RTW management responsibilities needs to be addressed in general and in particular in future RTW interventions.

Patient-reported outcomes from a workplace intervention program for cancer survivors highlight ongoing needs to support continuation of work

Purpose

The aim of this study was to investigate the perceptions of cancer survivors who continue to work and provide information to evaluate and develop a supportive workplace program (Ensemble) based on the principles of navigation.

Methods

A mixed-methods design using surveys and open-ended questions was used to study the perceptions of two groups of cancer survivors in the same workplace: those who chose to use a workplace navigational program (Ensemble program users) and those who declined (non-users). Key outcomes were communication and attitudinal self-efficacy, measured by the Communication and Attitudinal Self-Efficacy scale for cancer (CASE-cancer); emotional and informational social support, measured by the Patient-Reported Outcomes Measurement Information System Social Support domain (PROMIS-Social Support); and satisfaction with the navigator relationship, measured using the Patient Satisfaction with Interpersonal Relationship with Navigator (PSN-I).

Results

The study included 7 program users and 17 non-users. There were no significant differences in attitudinal self-efficacy, emotional support, or informational support between the groups. The relationship with the Nurse Navigator was rated highly by program users. The most frequent themes to the open-ended responses included work demands, privacy, integration of life and work, and program improvement.

Conclusions

Successful reintegration into/continuation of work remains a key need for cancer survivors. The navigation program design for cancer survivors should be further improved and applied across work settings.

Electronic supplementary material

The online version of this article (10.1007/s00520-019-04964-1) contains supplementary material, which is available to authorized users.

Recommendations for Research and Practice to Improve Work Outcomes Among Cancer Survivors

Major knowledge gaps limit the development and implementation of interventions to improve employment outcomes among people with cancer. To identify research priorities to improve employment outcomes after cancer, the National Cancer Institute sponsored the meeting "Evidence-Based Approaches for Optimizing Employment Outcomes among Cancer Survivors." This article describes research recommendations stemming from the meeting. At the patient level, longitudinal studies are needed to better understand how patient sociodemographic and clinical characteristics and their experiences at work shape employment outcomes. Interventions that mitigate the impact of cancer and its treatment on employment are critical. At the provider-level, future research is needed to characterize the extent to which physicians and other healthcare providers talk to their patients about employment concerns and how that information is used to inform care. Additionally, there is a need to test models of care delivery that support routine screening of employment concerns, the capture of employment outcomes in electronic health records, and the effective use of this information to improve care. At the employer level, evidence-based training programs are needed to prepare supervisors, managers, human resources staff, and occupational health professionals to address health issues in the workplace; and future interventions are needed to improve patient -employer communication and facilitate workplace accommodations. Importantly, research is needed that reflects the perspectives and priorities of patients and their families, providers and healthcare systems, and employers. Transdisciplinary partnerships and stakeholder engagement are essential to ensure that employment-focused interventions and policies are developed, implemented, and sustained in real-world healthcare delivery and workplace settings.

Work-Related Medical Rehabilitation in Cancer: A Cluster-Randomized Multicenter Study

BACKGROUND

Current guidelines recommend rehabilitative measures to alleviate dis- turbances resulting from cancer and its treatment. To give cancer survivors further assistance in getting back to work, work-related medical rehabilitation is currently being tested in Germany. In this cluster-randomized, multicenter trial, we studied the efficacy of work-related medical rehabilitation compared with conventional medical rehabilitation (trial no. DRKS00007770 in the German Clinical Trials Registry).

METHODS

A total of 484 cancer survivors of working age who were candidates for rehabilitation were recruited and assigned at random to either the intervention group (IG; work-related medical rehabilitation) or the control group (CG). The primary end- point was self-assessed function in a role one year after the end of rehabilitation, as evaluated with the health-related quality of life questionnaire of the European Organisation for Research and Treatment of Cancer (EORTC QLQ-C30). Further endpoints included symptom and function scales, subjective ability to work, coping with illness, and return to work. Neither the medical personnel nor the subjects were blinded.

RESULTS

One year after the end of rehabilitation, data from 379 subjects who par- ticipated in the last follow-up survey were evaluated. The intervention and control groups did not differ significantly either in the primary endpoint of role function (IG = 60.8 vs. CG = 57.6 out of a maximum of 100 points; p = 0.204) or in any of the secondary endpoints. A last observation carried forward analysis yielded com- parable results. At 12 months, 28.5% of the subjects in the IG and 25.3% of those in the CG were still unable to work.

CONCLUSION

This study did not reveal any significant clinically relevant advantage of work-related medical rehabilitation at one year. Future studies should determine whether a second period of rehabilitation might be helpful and whether selected subjects might benefit from the assistance of case managers beyond the period of rehabilitation.

Work-related medical rehabilitation in patients with cancer-Postrehabilitation results from a cluster-randomized multicenter trial

BACKGROUND

Effective multidisciplinary rehabilitation programs supporting the return to work have become increasingly relevant for cancer survivors. In Germany, inpatient work-related medical rehabilitation programs consider treatment modules of work-related diagnostics, work-related functional capacity training, psychosocial groups, and intensified social counseling. The authors tested the effectiveness of a work-related medical rehabilitation program compared with conventional medical rehabilitation using a cluster-randomized multicenter trial (German Clinical Trial Register: DRKS00007770).

METHODS

In total, 484 patients with cancer were recruited at 4 rehabilitation centers. Patients at a center who started their rehabilitation in the same week represented a cluster. These clusters were randomly assigned using computer-generated randomization schedules either to an intervention group (IG) or to a control group (CG). The primary outcome was role functioning. Secondary outcomes were other quality-of-life domains and the return to work.

RESULTS

In total, 425 patients (210 in the IG) were included in the analysis at the 3-month follow-up. There was no significant difference between the IG and CG in role functioning (b = 3.55; 95% CI, -1.18 to 8.29; P = .142). Participants in the IG reported better physical functioning (b = 5.99; 95% CI, 3.33-8.65; P < .001), less physical fatigue (b = -5.09; 95% CI, -9.62 to -0.56; P = .028), and less pain (b = -6.24; 95% CI, -11.24 to -1.23; P = .015).

CONCLUSIONS

Work-related medical rehabilitation had no effect on the primary outcome compared with conventional medical rehabilitation but may enhance physical functioning and reduce physical fatigue and pain.

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

AIM

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Employment trends in young women following a breast cancer diagnosis

PURPOSE

Little is known about how a breast cancer diagnosis and treatment affects job-related outcomes in young women with breast cancer, who are an integral part of the workforce. We sought to describe employment trends among young breast cancer survivors.

METHODS

911 women with non-metastatic breast cancer were surveyed about employment-related outcomes 1 year post-diagnosis. Participants were enrolled in the Young Women's Breast Cancer Study an ongoing, multi-center cohort of women diagnosed with breast cancer at age ≤ 40.

RESULTS

Among 911 women, median age at diagnosis was 36 years (range 17-40). Most women (80%, n = 729) were employed 1 year post-diagnosis. Among the 7% (n = 62) employed before diagnosis but who reported unemployment at 1 year, approximately half reported they were unemployed for health reasons. Among employed women, 7% said treatment affected their ability to perform their job. Women with stage-three disease (vs. stage 1 disease, odds ratio (OR): 3.73, 95% CI 1.39-9.97) and those who reported having money to pay bills after cutting back or difficulty paying bills at baseline (vs. having enough money for special things, OR 2.70, 95% CI 1.32-5.52) at baseline were more likely to have transitioned out of the workforce.

CONCLUSIONS

Our results suggest an impact of disease burden and socioeconomic status on employment in young breast cancer survivors. There is a need to ensure young survivors who leave the workforce following diagnosis are sufficiently supported given the potential adverse psychosocial and financial impacts of unemployment on survivors, their families, communities, and society.

The EMPCAN study: protocol of a population-based cohort study on the evolution of the socio-economic position of workers with cancer

BACKGROUND

The improvements in cancer control led to an increase in the number of cancer survivors, notably, in the working age population (16-64 years). There is a strong need to assess and understand their reintegration on the labour market, which underlines and ensures their social integration and quality of life. The objectives of the EMPCAN study is therefore to measure the scale of return-to-work after cancer and to identify the determining factors, allowing for the implementation of an adequate socio-professional support.

METHODS

We requested data from the Belgian Cancer Registry and the Crossroad Bank for Social Security. We included all socially insured Belgian workers diagnosed between 2004 and 2011 with colorectal, breast, head & neck, prostate, testis, lung and corpus uteri cancer. The end of (administrative) follow-up was 31st December 2012. We include demographic, health-related and work-related factors in the analysis and observed how these factors interplay to determine the working status. After having solved legal, ethical and technical issues for the coupling, we will perform survival analysis with competing risks using the Fine and Gray model; we will also perform a multistate model using transitions probabilities; and finally, a group-based modeling for longitudinal data using the 'proc traj' package in SAS.

DISCUSSION

The results of the EMPCAN study will allow the provision of an evidence-based support to professional reintegration policies. It will also bring some key features for the prediction of the cancer-related social security needs. Besides the raise of awareness among health professionals and policy makers, this study could lead to a better planning and organization of vocational rehabilitation programs.

Concerns and Returns to Work in Patients with Breast Cancer Receiving Outpatient Chemotherapy: a Pilot Study

Objective

Breast cancer survivors are increasing in number among survivors of all types of cancer, and survivors returning to work are extremely important. The development of outpatient chemotherapy has increased the working population of patients undergoing cancer therapy. Consequently, a significant number of breast cancer survivors experience physical, psychological, and social problems. This study aimed to clarify differences in concerns among patients with breast cancer receiving outpatient chemotherapy according to their employment status.

Methods

Twenty-eight patients with breast cancer undergoing outpatient chemotherapy were recruited. A questionnaire was used to survey the attributes, employment status, and levels of concern in these patients based on the Cancer-chemotherapy Concerns Rating Scale (CCRS). Data from three groups (employed full time, employed part-time, and unemployed) were analyzed using multiple comparison tests.

Results

The patients' mean age was (55.1 ± 9.9) years. According to the CCRS findings, the following three parameters differed between the three groups: scores for the items "I always think about my disease" (employed vs. unemployed, P = 0.005) and "I can't work (housework/schoolwork)" (employed full time vs. part time, P = 0.045), and scores for the "self-existence" subscale (employed vs. unemployed, P = 0.024).

Conclusions

This study revealed the characteristics of concerns in patients with breast cancer according to their employment status. Being able to continue working is considered to enhance the social health of these patients. Predicting concerns in employed patients will help gain perspective in early nursing interventions.

Financial toxicity is more than costs of care: the relationship between employment and financial toxicity in long-term cancer survivors

PURPOSE

The aim of this study was to examine the relationship between employment and financial toxicity by examining the prevalence of, and factors associated with, financial toxicity among cancer survivors.

METHODS

We conducted a secondary analysis of a sub-sample from the Dutch Patient Reported Outcomes Following Initial Treatment and Long-term Evaluation of Survivorship (PROFILES) registry. Descriptive statistics, bivariate analysis and logistic regression were used.

RESULTS

A total of 2931 participants with diverse cancer types were included in the analysis with a mean age of 55 years (range 18 to 65). Nearly half (49%) of participants were employed at the time of the survey, and 22% reported financial toxicity. Those who were not employed were at greater risk of financial toxicity (27% vs 16%, p < 0.001), and this did not vary according to time since diagnosis. The odds of reporting financial toxicity were greater for participants who were male, younger, unmarried, with low education, low socioeconomic status, or without paid employment. Those with basal cell carcinoma had lower risk of financial toxicity, while those with haematological or colorectal cancer had highest risk of financial toxicity.

CONCLUSIONS

This research confirms that unemployment is significantly associated with financial toxicity and that those with limited financial resources are most at risk.

IMPLICATIONS FOR CANCER SURVIVORS

Increased awareness of financial toxicity and its associated factors among clinicians may result in improved screening and appropriate referrals for support services. The implementation of effective multidisciplinary return to work interventions, as part of standard cancer survivorship care, may reduce financial toxicity among cancer survivors.

Cancer Survivors' Social Context in the Return to Work Process: Narrative Accounts of Social Support and Social Comparison Information

Purpose Returning to work is a process that is intertwined with the social aspects of one's life, which can influence the way in which that person manages their return to work and also determines the support available to them. This study aimed to explore cancer patients' perceptions of the role of their social context in relation to returning to work following treatment. Methods Twenty-three patients who had received a diagnosis of either urological, breast, gynaecological, or bowel cancer participated in semi-structured interviews examining general perceptions of cancer, work values and perceptions of the potential impact of their cancer diagnosis and treatment on work. Interviews were analysed using the iterative process of Framework Analysis. Results Two superordinate themes emerged as influential in the return to work process: Social support as a facilitator of return to work (e.g. co-workers' support and support outside of the workplace) and Social comparison as an appraisal of readiness to return to work (e.g. comparisons with other cancer patients, colleagues, and employees in other organisations or professions). Conclusions Two functions of the social context of returning to work after cancer were apparent in the participants' narrative: the importance of social support as a facilitator of returning to work and the utilisation of social comparison information in order to appraise one's readiness to return to work. The role of social context in returning to work has largely been absent from the research literature to date. The findings of this study suggest that social support and social comparison mechanisms may have a significant impact on an individual's successful return to the workplace.

Prognostic factors for return to work and work disability among colorectal cancer survivors; A systematic review

Background

Colorectal cancer is diagnosed progressively in employed patients due to screening programs and increasing retirement age. The objective of this study was to identify prognostic factors for return to work and work disability in patients with colorectal cancer.

Methods

The research protocol was published at PROSPERO with registration number CRD42017049757. A systematic review of cohort and case-control studies in colorectal cancer patients above 18 years, who were employed when diagnosed, and who had a surgical resection with curative intent were included. The primary outcome was return to work or work disability. Potentially prognostic factors were included in the analysis if they were measured in at least three studies. Risk of bias was assessed according to the QUality In Prognosis Studies tool. A qualitative synthesis analysis was performed due to heterogeneity between studies. Quality of evidence was evaluated according to Grading of Recommendation Assessment, Development and Evaluation.

Results

Eight studies were included with a follow-up period of 26 up to 520 weeks. (Neo)adjuvant therapy, higher age, and more comorbidities had a significant negative influence on return to work. A previous period of unemployment, extensive surgical resection and postoperative complications significantly increased the risk of work disability. The quality of evidence for these prognostic factors was considered very low to moderate.

Conclusion

Health care professionals need to be aware of these prognostic factors to select patients eligible for timely intensified rehabilitation in order to optimize the return to work process and prevent work disability.

Assessing factors associated with long-term work disability after cancer in Belgium: a population-based cohort study using competing risks analysis with a 7-year follow-up

OBJECTIVES

The number of workers with cancer has dramatically increasing worldwide. One of the main priorities is to preserve their quality of life and the sustainability of social security systems. We have carried out this study to assess factors associated with the ability to work after cancer. Such insight should help with the planning of rehabilitation needs and tailored programmes.

PARTICIPANTS

We conducted this register-based cohort study using individual data from the Belgian Disability Insurance. Data on 15 543 socially insured Belgian people who entered into the long-term work disability between 2007 and 2011 due to cancer were used.

PRIMARY AND SECONDARY OUTCOME MEASURES

We estimated the duration of work disability using Kaplan-Meier and the cause-specific cumulative incidence of ability to work stratified by age, gender, occupational class and year of entering the work disability system for 11 cancer sites using the Fine and Gray model allowing for competing risks.

RESULTS

The overall median time of work disability was 1.59 years (95% CI 1.52 to 1.66), ranging from 0.75 to 4.98 years. By the end of follow-up, more than one-third of the disabled cancer survivors were able to work (35%). While a large proportion of the women were able to work at the end of follow-up, the men who were able to work could do so sooner. Being women, white collar, young and having haematological, male genital or breast cancers were factors with the bestlikelihood to be able to return to work.

CONCLUSION

Good prognostic factors for the ability to work were youth, woman, white collar and having breast, male genital or haematological cancers. Reviewing our results together with the cancer incidence predictions up to 2025 offers a high value for social security and rehabilitation planning and for ascertaining patients' perspectives.

Return-to-work intervention during cancer treatment - The providers' experiences

To explore in-depth understanding of providers' experiences when involved in a return-to-work (RTW) intervention offered during cancer treatment. Semi-structured individual interviews and participant observations at a hospital department and two municipal job centers were carried out, including ten providers (physicians, nurses and social workers). A phenomenological-hermeneutic approach was applied, involving coding, identification of themes and interpretation of findings. Three major themes were identified: Treatment first, Work as an integrated component in cancer rehabilitation, and Challenges in bringing up work issues. Differences in providers' experiences of the RTW intervention offered to cancer patients were found: in the hospital setting RTW was a second priority, whereas in the municipality job centers it was an integrated component. Further studies are needed to investigate how and when occupational rehabilitation services can be implemented across sectors to support cancer patients' RTW. In the future, work issues ought to be systematically presented by providers across sectors as early as possible to support cancer patients' RTW. Cancer patients' individual needs and thoughts about RTW are to be identified by both health care providers during treatment and social workers at the municipality level and shared across sectors.

Three-Year Prospective Cohort Study of Factors Associated with Return to Work After Breast Cancer Diagnosis

Purpose The purpose of this prospective cohort study of breast cancer survivors was to identify factors before diagnosis, during treatment, and after treatment that are associated with return to work (RTW). Methods A total of 288 women with breast cancer (stage I-III) and whose age were 18-65 years-old answered questionnaires at 4-6, 12, 24, and 36 months after diagnosis. The surveys asked about performance of regular exercise and health-related quality of life issues. "RTW at 36 months" was assigned to patients who reported any of the following: working at least twice; no job at baseline but working more than once; job at baseline, stopped working, and then started working again; and working during all 3 years. Results We classified 107 of 288 of the women (37.1%) as having returned to work. Analysis of pre-diagnostic factors indicated that more education and practice of regular endurance exercise were positively associated with RTW. Analysis of factors during treatment indicated that appetite loss and fatigue were negatively associated with RTW. Analysis of factors at post-treatment indicated that better body image, better physical function, better existential well-being, and participation in regular endurance and resistance exercise were positively associated with RTW. Childbirth at 12-24 months was negatively associated with RTW. Conclusion Women who participate in exercise before, during, and after treatment for breast cancer are more likely to RTW. A woman's need to care for children, perceived body image, and existential well-being may also affect her RTW.

Work Sustainability Among Male Cancer Survivors After Returning to Work

Background

Few studies have investigated the work continuance rate among cancer survivors after return to work (RTW). The objective of this study was to clarify work sustainability after RTW among Japanese male cancer survivors.

Methods

We collected data on male cancer survivors from an occupational health register. Inclusion criteria were as follows: employees who returned to work after an episode of sick leave due to clinically certified cancer diagnosed between January 1, 2000 and December 31, 2011.

Results

Of 1,033 male employees who were diagnosed with cancer, 786 employees (76.1%) returned to work after their first episode of sick leave due to cancer. Work continuance rates among all subjects were 80.1% 1 year after RTW and 48.5% 5 years after RTW. The mean duration of work after RTW was 4.5 years. The work continuance rates varied significantly by cancer type. The “Lung” and “Hepatic, Pancreatic” cancer groups had the shortest duration of work (0.9 year after RTW).

Conclusions

Of workers who returned to work after their first episode of leave after cancer, 50% continued to work after 5 years in large-scale companies. There was a steep decrease in work continuance rates during the first year after RTW, with considerable differences according to cancer site.

Effectiveness of a tailored return to work program for cancer survivors with job loss: results of a randomized controlled trial

BACKGROUND

Up to 53% of cancer survivors (CSs) experiences job loss during or after treatment. To support CSs with job loss in the Netherlands, a tailored return to work (RTW) program was developed. The objective of this study was to assess the effectiveness of the program on duration until sustainable RTW in CSs with job loss.

MATERIAL AND METHODS

This study employed a two-armed (intervention/control) randomized controlled design with one-year follow-up. The primary outcome measure was duration until sustainable RTW. The secondary outcome measures were: rate of RTW, fatigue, quality of life, and participation in society. Descriptive analyses, Kaplan-Meier estimators and Cox regression analyses were conducted.

RESULTS

Participants (N = 171) had a mean age of 48.4 years (SD = 8.6). The majority was female (69%) and breast cancer survivor (40%). The crude hazard ratio (HR) for duration until sustainable RTW was 0.86 (95% CI 0.46-1.62; p = 0.642). In the adjusted model, the intervention group had a slight, but statistically non-significant, improvement in duration until sustainable RTW compared to the control group (HR 1.16; 95% CI 0.59-2.31; p = 0.663). The program did not have any significant effects on secondary outcome measures.

CONCLUSION

As the tailored RTW program did not demonstrate a statistically significant effect on duration until sustainable RTW in CSs with job loss, implementation of the program in its current form is not recommended.

Effectiveness of work-related medical rehabilitation in cancer patients: study protocol of a cluster-randomized multicenter trial

Background

Work is a central resource for cancer survivors as it not only provides income but also impacts health and quality of life. Additionally, work helps survivors to cope with the perceived critical life event. The German Pension Insurance provides medical rehabilitation for working-age patients with chronic diseases to improve and restore their work ability, and support returning to or staying at work, and thus tries to sustainably avoid health-related early retirement. Past research showed that conventional medical rehabilitation programs do not support returning to work sufficiently and that work-related medical rehabilitation programs report higher return-to-work rates across several health conditions, when compared to medical rehabilitation. Therefore, the current study protocol outlines an effectiveness study of such a program for cancer survivors.

Methods

To evaluate the effectiveness of work-related medical rehabilitation in cancer patients we conduct a cluster-randomized multicenter trial. In total, 504 rehabilitation patients between 18 and 60 years with a Karnofsky Performance Status of ≥70 %, a preliminary positive social-medical prognosis of employability for at least 3 h/day within the next 6 months and an elevated risk of not returning to work will be recruited in four inpatient rehabilitation centers. Patients are randomized to the work-related medical rehabilitation program or the conventional medical rehabilitation program based on their week of arrival at each rehabilitation center. The work-related medical rehabilitation program comprises additional work-related diagnostics, multi-professional team meetings, an introductory session as well as work-related functional capacity training, work-related psychological groups, and social counseling. All additional components are aimed at the adjustment of the patients’ capacity in relation to their individual job demands. Role functioning defines the main study outcome and will be assessed with the EORTC-QLQ30. Secondary outcome measures are the remaining scales of the EORTC-QLQ30, fatigue, self-rated work ability, disease coping, participation in working life, realization of work-related goals and therapies during rehabilitation, and treatment satisfaction.

Discussion

A positive evaluation of work-related medical rehabilitation in cancer patients is expected due to the promising findings on the effectiveness of such programs for patients with other health conditions. Results may support the dissemination of work-related medical rehabilitation programs in German cancer rehabilitation.

Trial registration

German Clinical Trials Register DRKS00007770. Registered 13 May 2015.

Electronic supplementary material

The online version of this article (doi:10.1186/s12885-016-2563-z) contains supplementary material, which is available to authorized users.

Working with cancer: health and employment among cancer survivors

PURPOSE

Cancer affects a growing proportion of US workers. Factors contributing to whether they continue or return to work after cancer diagnosis include: age, physical and mental health, health insurance, education, and cancer site. The purpose of this study was to assess the complex relationships between health indicators and employment status for adult cancer survivors.

METHODS

We analyzed pooled data from the 1997-2012 US National Health Interview Survey (NHIS). Our sample included adults with a self-reported physician diagnosis of cancer (n = 24,810) and adults with no cancer history (n = 382,837). Using structural equation modeling (SEM), we evaluated the relationship between sociodemographic factors, cancer site, and physical and mental health indicators on the overall health and employment status among adults with a cancer history.

RESULTS

The overall model for cancer survivors fit the data well (χ(2) (374) = 3654.7, P < .001; comparative fit index = 0.98; root mean square error of approximation = 0.04). Although black cancer survivors were less likely to report good-to-excellent health, along with Hispanic survivors, they were more likely to continue to work after diagnosis compared with their white counterparts. Health insurance status and educational level were strongly and positively associated with health status and current employment. Age and time since diagnosis were not significantly associated with health status or employment, but there were significant differences by cancer site.

CONCLUSIONS

A proportion of cancer survivors may continue to work because of employment-based health insurance despite reporting poor health and significant physical and mental health limitations. Acute and long-term health and social support are essential for the continued productive employment and quality of life of all cancer survivors.

Municipal return to work management in cancer survivors undergoing cancer treatment: a protocol on a controlled intervention study

Background

Cancer survivors are often left on their own to deal with the challenges of resuming work during or after cancer treatment, mainly due to unclear agreements between stakeholders responsible for occupational rehabilitation. Social inequality exists in cancer risk, survival probability and continues with regard to the chance of being able to return to work.

The aim is to apply an early, individually tailored occupational rehabilitation intervention to cancer survivors in two municipalities parallel with cancer treatment focusing on enhancing readiness for return to work.

Methods/Design

In a controlled trial municipal job consultants use acceptance and commitment therapy dialogue and individual-placement-and-support-inspired tools with cancer survivors to engage them in behaviour changes toward readiness for return to work. The workplace is involved in the return to work process.

Patients referred to surgery, radiotherapy or chemotherapy at the Oncology Department, Aarhus University Hospital, Denmark for the diagnoses; breast, colon-rectal, head and neck, thyroid gland, testicular, ovarian or cervix cancer are eligible for the study. Patients must be residents in the municipalities of Silkeborg or Randers, 18–60 years of age and have a permanent or temporary employment (with at least 6 months left of their contract) at inclusion. Patients, for whom the treating physician considers occupational rehabilitation to be unethical, or who are not reading or talking Danish are excluded. The control group has identical inclusion and exclusion criteria except for municipality of residence.

Return to work is the primary outcome and is indentified in a social transfer payment register. Effect is assessed as relative cumulative incidences within 52 weeks and will be analysed in generalised linear regression models using the pseudo values method. As a secondary outcome; co-morbidity and socio-economic status is analysed as effect modifiers of the intervention effect on return to work.

Discussion

The innovative element of this intervention is the timing of the occupational rehabilitation which is much earlier initiated than usual and the active involvement of the workplace. We anticipate that vulnerable cancer survivors will benefit from this approach and reduce the effects of social inequality on workability.

Trial registration

Current Controlled Trials ISRCTN50753764. Registered August 21^st, 2014.

Use of an employment advisory service by cancer survivors

Employment issues for cancer survivors (CS) were investigated from the perspective of Northern Ireland government general employment advisors. An e-survey was designed and developed based on the results of a scoping search of journal articles, previously validated questionnaires and relevant related surveys; discussions of draft versions of the e-survey and method with lead representatives of stakeholder organizations; and a pilot study with seven prospective respondents. The e-survey and subsequent reminder to employment advisors were distributed internally by the government employment advisory agency. The e-survey was completed by 78/156 (50%) advisors, the majority of whom (74%) received a request for advice in the last year from at least one CS. Most CS used the employment service less than 1 year (52%) or 1 year or more after treatment (32%). Fatigue was the most commonly reported barrier to returning to work (10%) and staying in work (14%), and a supportive employer was the top facilitating factor in returning to (21%) and continuing in (27%), employment. Although most advisors had a positive attitude about a CS's capacity to return to work, half were uncertain about how best to advise cancer survivors.

Returning to work following curative chemotherapy: a qualitative study of return to work barriers and preferences for intervention

PURPOSE

This study aimed to explore barriers to return to work (RTW) and preferences for intervention and support for cancer patients treated with curative intent from the perspectives of cancer survivors and oncology health professionals.

METHODS

Participants attended a focus group (N = 24) or an individual interview (N = 14). A topic guide and a semi-structured recorded interview format were used to gather data, which were later transcribed and analysed for global themes and subthemes.

RESULTS

With regard to barriers, the global theme 'work capacity' captured an array of barriers encompassing financial pressure, preparedness for work, lack of confidence as well as other key physical, practical and psychosocial barriers. Participants expressed a preference for RTW models that focus on objective and structured assessment whilst allowing for flexibility to address individual needs.

CONCLUSIONS

Cancer survivors perceive multiple barriers when attempting to RTW. These barriers were perceived to impact upon work capacity, where 'capacity' was defined broadly to include practical, physical and psychosocial concerns. RTW is an important concern for cancer survivors and structured RTW interventions should be incorporated into the care of cancer survivors.

Long-term workforce participation patterns following head and neck cancer

PURPOSE

This analysis describes the long-term workforce participation patterns of individuals diagnosed with head and neck cancer (HNC).

METHODS

Survivors of HNC (ICD10 C00-C14, C32) diagnosed at least 8 months previously were identified from the National Cancer Registry Ireland and sent a survey including questions about working arrangements before and since diagnosis. Descriptive statistics and multivariate logistic regression were used to examine the factors that influence workforce participation at 0, 1 and 5 years after diagnosis.

RESULTS

Two hundred sixty-four individuals employed at the time of diagnosis responded to the survey, an average 6 years post-diagnosis. Seventy-seven percent took time off work after diagnosis, with a mean work absence of 9 months (range 0-65 months). Fifty-two percent of participants reduced their working hours (mean reduction 15 h/week). The odds of workforce participation following HNC were increased by not being eligible for free medical care (OR 2.61, 95% CI 1.15-5.94), having lip, mouth or salivary gland cancer (compared to cancer of the pharynx or cancer of the larynx, OR 2.79, 1.20-6.46), being self-employed (OR 2.01, 1.07-3.80), having private health insurance (OR 2.06, 1.11-3.85) and not receiving chemotherapy (OR 2.82, 1.31-6.06). After 5 years, only the effect of medical card remained (i.e., medical insurance) (OR 4.03, 1.69-9.62).

CONCLUSIONS

Workforce participation patterns after HNC are complex and are influenced by cancer, treatment and employment factors.

IMPLICATIONS FOR CANCER SURVIVORS

Patients should be informed of the potential impacts of HNC on workforce participation, and clinicians, policy makers and employers should be aware of these potential longer-term effects and related variables.

Patients' experiences following breast cancer treatment: an exploratory survey of personal and work experiences of breast cancer patients from three European countries

Improved treatments for early breast cancer have led to a significant increase in overall survival. While evidence regarding potential long-term sequelae of adjuvant treatments exists, relatively little research reports patients' own perceptions of change before and after adjuvant chemotherapy (AC). This study aimed to identify key ongoing issues associated with AC in daily life. An online survey developed for this study was completed by 198 women (mean age 49.7 years) in the UK, France and Germany who had AC 1-5 years previously for oestrogen receptor positive, HER2 negative early breast cancer. Women without AC and endocrine therapy, those treated with Trastuzumab or who had recurrent disease were excluded. A third of women who responded were currently unable to perform their former family role. The majority had needed support, particularly with child care, during treatment. While 54% were in full-time employment before diagnosis this had reduced to 32% following AC. Of those women still working, over half reported difficulties with tiredness or concentration. Most (85.8%) were satisfied with healthcare professionals' treatment information, but only 29.7% received information about returning to work. This exploratory survey highlights areas of women's lives affected 1-5 years following AC for early breast cancer. The impact on returning to work and issues surrounding childcare particularly, require further study.

What is the value of occupational therapy in return to work for breast cancer patients? A qualitative inquiry among experts

An increasing number of patients are confronted with breast cancer (BC) and functional limitations after treatment. Occupational therapy (OT) is successful in return to work (RTW), but not yet available for BC patients. This paper explores experts' opinions on OT interventions for RTW in BC patients in the Belgian context. Primary data were topic-interviews with all heads of OT departments in Flemish University Hospitals (n = 5). Secondary data were four focus group interviews with care professionals in oncological rehabilitation (n = 41). All data were transcribed and thematic analysis was used. Integrated in multidisciplinary teamwork, OT interventions should have a holistic and client-centred approach, start early in the rehabilitation process, include workplace visits and contacts with relevant stakeholders, and use goal setting to start up tailor made rehabilitation, linking assessment of abilities and work. Occupational therapists are regarded as professionals who can effectively answer BC patients unmet needs regarding RTW due to their skill to bridge between care and workplace. According to the experts, OT interventions supporting RTW in BC patients are useful when integrated in regular healthcare. They agree on the components but organisational barriers should be removed, for example not providing reimbursement for including this type of support trough healthcare insurance.

A Narrative Review of the Confluence of Breast Cancer and Low-wage Employment and Its Impact on Receipt of Guideline-recommended Treatment

Breast cancer is the leading cause of cancer among women in the United States, costing the healthcare system, employers, and society billions of dollars each year. Despite improvements in screening and treatment, significant breast cancer treatment and survivorship disparities exist among various groups of women. One variable that has not been explored extensively as a possible contributor to breast cancer treatment disparities is employment. This is concerning, given the changing economic and employment trends in the United States favoring low-wage employment. Currently, one-quarter to one-third of all US workers are considered to be working poor, and women are disproportionally represented in this group. Characteristics of low-wage work-limited paid time off, minimal health benefits, schedule inflexibility, and economic insecurity-may become even more significant in the event of a breast cancer diagnosis. To date, there has been limited research into how job conditions inherent to low-wage work may influence working poor survivors' receipt of guideline-recommended breast cancer treatment. Therefore, the purpose of this narrative review was to critically examine the current literature to further our understanding of how employment context may impact treatment decisions and adherence-and therefore receipt of guideline-recommended care-among newly diagnosed, working poor breast cancer survivors. After undertaking a comprehensive review, we failed to identify any published literature that explicitly addressed low-wage employment and receipt of guideline-recommended breast cancer treatment. Four articles reported circumstances where women delayed, missed, or quit treatments due to work interference, or alternatively, developed strategies that allowed them to continue to work and obtain their breast cancer treatment concurrent with medical and economic challenges. An additional five articles, while focused on other cancer and employment outcomes, described the need for increased patient-provider communication about the influence of work on treatment decisions and the development of alternative treatment plans. Due to the paucity of research in this area, future policy, practice, and research efforts should focus on the employment context of working poor breast cancer survivors as a potential contributor to cancer disparities. Engagement of women, employers, oncology providers, healthcare systems, and interdisciplinary researchers is warranted to improve cancer outcomes among this disparate population of working women.

Personal financial effects of multiple myeloma and its treatment

BACKGROUND

Improvements in some treatment programs for multiple myeloma (MM) are increasing survival. As patients live longer with MM as a chronic disease, the personal financial effects of MM treatment become a serious concern.

OBJECTIVE

The objective of this study was to identify the personal financial effects of MM and its treatment in 5 areas: employment, disability, health/medical and life insurance, retirement, and out-of-pocket expenses.

METHODS

We mailed a questionnaire about financial issues to 1015 patients who had received intensive treatment for MM at the study site. Data analysis included descriptive statistics and comparisons using independent t tests.

RESULTS

Our sample (n = 762; mean age, 61 [SD, 9.26] years) experienced issues with employment (66% employed at diagnosis and treatment; 33% employed at questionnaire time), disability (35% applied), health/medical and life insurance (29% lost coverage and 8% changed coverage), retirement (13% retired during treatment), and out-of-pocket expenses (36% of income in first treatment year and 28% of income during most recent 12 months).

CONCLUSIONS

Issues of employment, disability, health insurance, retirement, and out-of-pocket costs for treatment are major challenges for patients.

IMPLICATIONS FOR PRACTICE

In the midst of assessing physical needs during clinical trials for chemotherapy and stem cell transplants, healthcare providers must keep sight of patients' personal financial needs so that we can intervene promptly with referrals to social work, rehabilitation therapy, and other healthcare professions to help patients decrease the personal financial effects of MM and its treatment.

Decrease social inequalities return-to-work: development and design of a randomised controlled trial among women with breast cancer

Background

Despite the improvement in the care management, women cancer patients who are still in employment find themselves for the most part obliged to stop working while they are having treatment. Their return-to-work probability is impacted by numerous psychosocial factors. The objective is to describe the development and the content of an intervention aimed to facilitate the return to work of female breast cancer patients and in particular the women in the most precarious situations through early active individualised psychosocial support (APAPI).

Methods

The intervention proposed is made up of 4 interviews with a psychologist at the hospital, distributed over the year according to the diagnosis and conducted on the same day as a conventional follow-up consultation, then a consultation with a specialist job retention physician. We expect, in the first instance, that this intervention will reduce the social inequalities of the return-to-work rate at 12 months. The EPICES score will enable the population to be broken down according to the level of social precariousness. The other expected results are the reduction of the social inequalities in the quality of the return to work at 18 and 24 months and the disparities between the individual and collective resources of the patients. This intervention is assessed in the context of a controlled and randomised multi-centre study. The patients eligible are women aged between 18 and 55 years with a unilateral breast cancer with local extension exclusively, having received surgery followed by adjuvant chemotherapy, in employment at the time of the diagnosis and dealt with by one of the 2 investigating centres.

Discussion

It is essential to assess this type of intervention before envisaging its generalisation. The study set in place will enable us to measure the impact of this intervention aiming to facilitate the return to work of breast cancer patients, in particular for those who suffer from social fragility, compared with the standard care.

Prognostic factors of work disability in sick-listed cancer survivors

PURPOSE

Sick-listed cancer survivors may face lasting side-effects, even after a successful completion of treatment. As a consequence, they are at risk of work disability, which may lead to job loss. Knowledge of prognostic factors of work disability may support cancer survivors in their trajectory of vocational rehabilitation. The purpose of this study was to identify prognostic factors of work disability in sick-listed cancer survivors.

METHODS

From the first day of sick leave, a cohort of 131 cancer survivors was followed for 24 months. Included participants were aged between 20 and 63 years. Data were collected, using questionnaires, at 10 months after reporting sick. The level of work disability, i.e., entitlement for disability compensation, was assessed by an insurance physician and a labour expert at 24 months. Univariate and multiple logistic regression analyses were performed.

RESULTS

In the univariate analysis, 14 variables were found to be associated with the level of work disability at 24 months. These factors were related to socio-demographics, health characteristics, work-related characteristics, and return to work (RTW) expectations. Multiple logistic regression showed that at 10-month sick leave, perception of health care providers on cancer survivors' work ability and experienced influence on RTW, both reported by workers, were significantly associated with the level of work disability at 24 months.

CONCLUSION

It seems in the interest of cancer survivors to take an active role in planning their RTW trajectory and to discuss RTW with their health care providers.

IMPLICATIONS FOR CANCER SURVIVORS

The potential role healthcare providers may play in counselling cancer survivors on RTW must not be underestimated. Cancer survivors may benefit in having control on their RTW trajectory.

Illness perceptions in the context of differing work participation outcomes: exploring the influence of significant others in persistent back pain

Background

Previous research has demonstrated that the significant others of individuals with persistent back pain may have important influences on work participation outcomes. The aim of this study was to extend previous research by including individuals who have remained in work despite persistent back pain in addition to those who had become incapacitated for work, along with their significant others. The purpose of this research was to explore whether the illness beliefs of significant others differed depending on their relative’s working status, and to make some preliminary identification of how significant others may facilitate or hinder work participation for those with persistent back pain.

Methods

Interviews structured around the Illness Perception Questionnaire (chronic pain version) were conducted with back pain patients recruited from a hospital pain management clinic along with their significant others. Some patients had remained in work despite their back pain; others had ceased employment. Data were analysed using template analysis.

Results

There were clear differences between beliefs about, and reported responses to, back pain symptoms amongst the significant others of individuals who had remained in employment compared with the significant others of those who had ceased work. Three overarching themes emerged: perceived consequences of back pain, specific nature of employment and the impact of back pain on patient identity.

Conclusions

Significant others of employed individuals with back pain focused on the extent to which activity could still be undertaken despite back pain symptoms. Individuals out of work due to persistent back pain apparently self-limited their activity and were supported in their beliefs and behaviours by their significant others. To justify incapacity due to back pain, this group had seemingly become entrenched in a position whereby it was crucial that the individual with back pain was perceived as completely disabled. We suggest that significant others are clearly important, and potentially detrimental, sources of support to individuals with back pain. The inclusion of significant others in vocational rehabilitation programmes could potentially be a valuable way of mobilising readily accessible resources in a way that supports optimal functioning.

Occupational stress and its association with early retirement and subjective need for occupational rehabilitation in cancer patients

OBJECTIVE

Returning to work often plays an important role for cancer survivors. Occupational stress may hamper a successful return to work, so cancer survivors should be given the opportunity to address occupational stress issues before returning to work. We investigated the amount of occupational stress among cancer patients and whether it is associated with their well-being, their subjective need for occupational rehabilitation and elevations in their risk of early retirement.

METHODS

At the beginning of rehabilitation, we asked cancer patients to respond to occupation-related and health-related questionnaires. We used t-tests, chi-square tests, and logistic regression analyses to address our research questions.

RESULTS

A total of 477 patients participated in the study. Of these, 19% were occupationally stressed, and 26% reported subjective need for occupational rehabilitation. Patients who reported work-related stress had a diminished quality of life, were more likely to report subjective need for occupational rehabilitation (OR = 2.16), and had a higher risk of early retirement (OR = 5.44). Furthermore, cancer patients reported deficits in both active coping abilities and mental stability at work.

CONCLUSIONS

Because occupational stress is associated with a higher risk of early retirement, both patients and physicians should take work-related problems seriously. Screening patients for occupational stress may help physicians identify patients who are at risk of experiencing problematic work re-entries. Furthermore, the results of the study suggest that cancer patients might have problems maintaining confidence in their abilities to solve work-related problems. Therefore, facilitating the development of a perception of self-efficacy might be an important treatment goal.