Health and job-related factors associated with work ability in older working populations of Korea

BACKGROUND

Knowledge about determinants of workability is crucial for designing interventions to increase the participation of older employees in the workforce and maintain or increase their productivity levels at work.

AIMS

This study explored the impact of health conditions and job characteristics on poor work ability.

METHODS

This study used data from the Korean Longitudinal Study of Aging (KLoSA) from 2014 to 2020, which is a nationally representative population-based panel study of Korean citizens aged ≥45 years. The KLoSA survey assessed subjective work ability using work ability score. The participants were asked if they had been diagnosed with any underlying diseases by a physician. The job characteristics were assessed in terms of working conditions and satisfaction. Generalized estimating equations were used to calculate the odds ratios (ORs) and 95% confidence intervals for workers' health-related variables and job characteristics associated with poor work ability.

RESULTS

The results showed that workers' health-related factors were associated with poor work ability; poor vision (OR = 1.52) and bad hearing ability (OR = 2.37); low gripping strength (OR = 2.29); poor self-rated health (OR = 3.77) and various diseases such as hypertension, diabetes, cancer, chronic lung disease, liver disease, heart disease, cerebrovascular disease, mental illness, arthritis, prostate disease, gastrointestinal disease and disc disease. Additionally, high physical work demands (OR = 1.51) and low job satisfaction (OR = 4.23) were highly correlated with poor work ability.

CONCLUSIONS

The findings addressing poor work abilities caused by individuals' health- and job-related factors can help prioritize worker health management and the development of more effective human capital investment strategies at the workplace.

Return to work after chronic disease: A theoretical framework for understanding the worker-employer dynamic

OBJECTIVES

Return to work after chronic disease is important for workers, employers and society. The process, however, is challenging. This article provides an analytical and theoretical framework for explaining this process informed by the person-environment fit theory.

METHODS

This article uses a narrative method to (1) review the key concepts, benefits and influencing factors in the literature on return to work after chronic diseases, (2) analyse and critique the most important theoretical models used for explaining return to work after chronic diseases, and (3) review the person-environment fit theory and how it has been used so far.

RESULTS

The existing models highlight different aspects, but they overlook the relationship between the worker and the employer. An analytical and theoretical framework is proposed to comprehensively explain the worker-employer dynamic. The framework also considers the role of broader factors (policy, labour market) and other stakeholders (health professionals, civil society actors) emphasising the idea that return to work is a phased and cyclical process.

DISCUSSION

The framework can be used to guide future qualitative and quantitative studies, or as a map for identifying problematic areas related to the worker or the work environment. The model should be empirically tested in future studies.

Designing an evidence-based working method for medical work disability prognosis evaluation-an intervention mapping approach

Purpose

Performing evidence-based work disability prognosis evaluation (WDPE) of clients on sick leave is a difficult task for physicians. The aim was to develop a working method to support physicians in performing evidence-based WDPE and to improve WDPE quality.

Materials and methods

Intervention Mapping (IM) supplemented with elements of the Behavior Change Wheel (BCW) guided project planning for developing the working method. This approach allowed combination with other frameworks and, e.g., behavior change theories. WDPE quality challenges were analyzed on various ecological levels, e.g., the individual (i.e., the physician), interpersonal (i.e., the client) and organizational level, culminating into a multilevel logic model of the problem. Determinants that contributed to this problem, e.g., lack of physicians' knowledge on performing evidence-based WDPE, were identified. Performance objectives were formulated that could contribute to a desired change in WDPE quality. From the performance objectives and determinants (e.g., knowledge), change objectives were derived. In order to achieve these change objectives, suitable intervention functions (e.g., education) and policy categories (e.g., service provision) were identified, allowing the formulation of intervention components. Behavior change techniques (e.g., feedback on outcomes of a behavior) were selected to serve the intervention functions to deliver the desired change. This led to the conceptualization of an intervention plan.

Results

The intervention "Prognosable" is presented. It consists of a stepwise working method (SWM) for evidence-based WDPE. The SWM offers an overview of important aspects (e.g., medical condition, clients' confidence in return-to-work) to consider in individual clients' WDPE. The SWM helps physicians to identify crucial functional limitations, find and appraise evidence-based information, weigh all relevant prognostic aspects and it supports physicians to conclude with an evidence-based WDPE, tailored to the individual client. The intervention "Prognosable" was designed, which also includes an educational program and a supportive software tool to enable implementation of the SWM.

Conclusion

IM combined with BCW elements guided the development of a SWM for evidence-based WDPE. The SWM will be delivered through an educational program for physicians supported by a digital tool. The SWM, educational program and digital tool are ready to be implemented and evaluated in practice as the intervention "Prognosable."

Return to work of Italian cancer survivors: A focus on prognostic work-related factors

BACKGROUND: Return to work (RTW) enhances the general well-being and social participation of cancer survivors (CSs). OBJECTIVE: To describe the predictive value of work-related factors on the RTW process of CSs. The work accommodations, the perceived workload, and the barriers and facilitations of RTW are also reported. METHODS: This population-based cross-sectional survey was conducted in the Province of Reggio Emilia from July 2016 to July 2017. CSs who were 20–59 years old, first diagnosed with cancer, and employed at diagnosis were recruited. RESULTS: The majority of CSs (140/266, 53%) returned to work without difficulties, 42% reported difficulties, and 5% did not RTW. CSs who were shift workers (sex and age-adjusted Relative Risk [adj-RR] 1.30; 95% CI 0.94 –1.78) and who worked at night (adj-RR 1.36 95% CI 0.99 –1.86), in the evening (adj-RR 1.23; 95% CI 0.95 –1.57) and on Sundays (adj-RR 1.15; 95% CI 0.81 –1.63) perceived more difficulties. Physically demanding work and a long commute seemed to negatively impact RTW. Accommodations in work tasks (37%) or schedule (26%) were implemented. Workload was not acceptable for 18% of CSs. The main barriers concerned energy and drive functions, whereas remunerative employment was the foremost facilitation. CONCLUSIONS: Healthcare professionals should address work-related factors that might influence RTW with personalized interventions of vocational rehabilitation.

The perceived importance of prognostic aspects considered by physicians during work disability evaluation: a survey

Background

Assessing prognosis is challenging for many physicians in various medical fields. Research shows that physicians who perform disability assessments consider six areas when evaluating a prognosis: disease, treatment, course of the disease, external information, patient-related and physician-related aspects. We administered a questionnaire to evaluate how physicians rate the importance of these six prognosis areas during work disability evaluation and to explore what kind of support they would like during prognosis assessment.

Methods

Seventy-six physicians scored the importance of 23 prognostic aspects distributed over six prognosis areas. Participants scored the importance of each aspect both “in general” and from the perspective of a case vignette of a worker with a severe degenerative disease. The questionnaire also covered needs and suggestions for support during the evaluation of prognoses.

Results

Medical areas that are related to the disease, or the treatment or course of the disease, appeared important (scores of 7.0–9.0), with less differing opinions among participants (IQR 1.0–3.0). Corresponding verbatim remarks supported the importance of disease and treatment as prognostic aspects. In comparison, patient- and physician-related aspects scored somewhat lower, with more variability (range 4.0–8.0, with IQR 2.0–5.0 for patient- and physician-related considerations). Participants indicated a need for a tool or online database that includes prognostic aspects and prognostic evidence.

Conclusions

Despite some variation in scores, the physicians rated all six prognosis areas as important for work disability evaluations. This study provides suggested aids to prognosis assessment, including an online support tool based on evidence-based medicine features.

The Influence of Chronic Diseases on Self-Reported Work Disability: Evidence From the Korean Labor and Income Panel Study 2003-2018

OBJECTIVE

To investigate the relationship between the types of chronic diseases and self-reported work disability.

METHODS

We used data from the Korean Labor and Income Panel Study from waves 6 to 21 conducted from 2003 to 2018. New cases of work disability were defined as those who reported that they had work limitations due to their health problems. Information on chronic disease was collected using a questionnaire during the sixth wave of the survey. To evaluate the effects of chronic disease on self-reporting work disability, Cox proportional hazard models were used.

RESULTS

The three most influential diseases on work disability were ophthalmologic diseases, chronic kidney diseases, and cardiovascular diseases during the 15-year follow-up period.

CONCLUSION

Work disability is strongly and significantly associated with the aforementioned chronic diseases.

Perspectives on returning to work of multiple myeloma patients: A qualitative interview study

Objective

Multiple myeloma (MM) is a rare and incurable disease. Because new treatments improved survival rates, return to work (RTW) became more relevant to MM patients of working age. Also, (health care) experts may be confronted with specific obstacles in guiding MM patients' RTW. Therefore, we aimed to qualitatively explore perspectives and experiences of MM patients and (health care) experts regarding RTW and participation at work.

Methods

Semi‐structured interviews were conducted with patients (N = 9) and (health care) experts (N = 15). Interviews were transcribed verbatim and analysed using thematic analysis.

Results

Four themes resulted from the interviews with patients and (health care) experts: (1) severity of diagnosis and treatment impact RTW, (2) step‐by‐step reintegration facilitates RTW, (3) meaning of work differs between MM patients and experts and (4) lack of tailored counselling by experts.

Conclusion

Although MM patients' work ability may be limited due to the severity of diagnosis and side effects from treatment, most patients consider RTW important. Both patients and (health care) experts emphasise the benefits from early work ability assessment (in the hospital setting) and specialised RTW counselling, especially in those with physically demanding jobs.

Use of a Decision Support Tool on Prognosis of Work Ability in Work Disability Assessments: An Experimental Study Among Insurance Physicians

Purpose Assessment of prognosis of work disability is a challenging task for occupational health professionals. An evidence-based decision support tool, based on a prediction model, could aid professionals in the decision-making process. This study aimed to evaluate the efficacy of such a tool on Dutch insurance physicians' (IPs) prognosis of work ability and their prognostic confidence, and assess IPs' attitudes towards use of the tool. Methods We conducted an experimental study including six case vignettes among 29 IPs. For each vignette, IPs first specified their own prognosis of future work ability and prognostic confidence. Next, IPs were informed about the outcome of the prediction model and asked whether this changed their initial prognosis and prognostic confidence. Finally, respondents reported their attitude towards use of the tool in real practice. Results The concordance between IPs' prognosis and the outcome of the prediction model was low: IPs' prognosis was more positive in 72 (41%) and more negative in 20 (11%) cases. Using the decision support tool, IPs changed their prognosis in only 13% of the cases. IPs prognostic confidence decreased when prognosis was discordant, and remained unchanged when it was concordant. Concerning attitudes towards use, the wish to know more about the tool was considered as the main barrier. Conclusion The efficacy of the tool on IPs' prognosis of work ability and their prognostic confidence was low. Although the perceived barriers were overall limited, only a minority of the IPs indicated that they would be willing to use the tool in practice.

Physicians' Perspectives on Person-Related Factors Associated With Work Participation and Methods Used to Obtain Information About These Factors

OBJECTIVE

Person-related factors influencing work participation of employees with health problems are important. However, the best method to obtain information about them, according to occupational physicians (OPs) and insurance physicians (IPs), is unknown.

METHODS

Questionnaires in which OPs and IPs rated the importance of and described methods to obtain information about 10 person-related factors: expectations regarding recovery or return to work, optimism/pessimism, self-efficacy, motivation, feelings of control, perceived health, coping strategies, fear-avoidance beliefs, perceived work-relatedness, and catastrophizing.

RESULTS

OPs and IPs perceived all person-related factors, except for optimism/pessimism and perceived health as important for work participation. Information about the factors could best be obtained with use of a topic list during consultations.

CONCLUSIONS

OPs and IPs should take person-related factors into account during consultations and it is best to use a topic list when discussing them.

Assessing work capacity - reviewing the what and how of physicians' clinical practice

Background

Although a main task in the sickness certification process, physicians’ clinical practice when assessing work capacity has not been thoroughly described. Increased knowledge on the matter is needed to better understand and support the certification process. In this review, we aimed to synthesise existing qualitative evidence to provide a clearer description of the assessment of work capacity as practiced by physicians.

Method

Seven electronic databases were searched systematically for qualitative studies examining what and how physicians do when they assess work capacity. Data was analysed and integrated using thematic synthesis.

Results

Twelve articles were included. Results show that physicians seek to form a knowledge base including understanding the condition, the patient and the patient’s workplace. They consider both medical and non-medical aspects to affect work capacity. To acquire and process the information they use various skills, methods and resources. Medical competence is an important basis, but not enough. Time, trust, intuition and reasoning are also used to assess the patient’s claims and to translate the findings into a final assessment. The depth and focus of the information seeking and processing vary depending on several factors.

Conclusion

The assessment of work capacity is a complex task where physicians rely on their non-medical skills to a higher degree than in ordinary clinical work. These skills are highly relevant but need to be complemented with access to appropriate resources such as understanding of the associations between health, work and social security, enough time in daily work for the assessment and ways to better understand the patient’s work place. Also, the notion of an “objective” evaluation is questioned, calling for a greater appreciation of the complexity of the assessment and the role of professional judgement.

Preferences regarding the way of use and design of a work ability prognosis support tool: a focus group study among professionals

PURPOSE

To explore the preferable way of use and design of a work ability prognosis support tool for insurance physicians (IPs) and labour experts (LEs), based on a prediction model for future changes in work ability among individuals applying for a work disability benefit.

METHODS

We conducted three focus groups with professionals of the Dutch Social Security Institute (17 IPs and 7 LEs). Data were audio recorded and qualitatively analysed according to the main principles of thematic analysis.

RESULTS

Clarity and ease of use were mentioned as important features of the tool. Most professionals preferred to make their own judgement during the work disability assessment interview with the claimant and afterwards verify their evaluation with the tool. Concerning preferences on the design of the tool, dividing work disability claimants into categories based on the outcome of the prediction model was experienced as the most straightforward and clear way of presenting the results. Professionals expected that this encourages them to use the tool and act accordingly.

CONCLUSIONS

The tool should be easy to access and interpret, to increase the chance that professionals will use it. This way it can optimally help professionals making accurate prognoses of future changes in work ability.Implications for rehabilitationA work ability prognosis support tool based on a prediction model for changes in work ability at one-year follow-up can help occupational health professionals in making accurate prognosis of individuals applying for a work disability benefit.To be used in occupational health practice, these tools should have a simple and easy-to-use design.Graphical risk presentation can be used to provide intuitive meaning to numerical information and support users' understanding.Taking professionals' preferences into account when developing these tools encourages professionals to use the tools and act accordingly.

Recurrent sick leave and resignation rates among female cancer survivors after return to work: the Japan sickness absence and return to work (J-SAR) study

Background

To date, there have not been any workforce-based Japanese cohort studies investigating work sustainability after return to work (RTW). The objective of this study was to investigate the post-RTW cumulative recurrent sick leave rate and cumulative resignation rate among female cancer survivors.

Methods

Among Japanese employees who were registered in the Japan sickness absence and return to work (J-SAR) study, the subjects were those female employees who returned to work after sick leave due to newly clinically diagnosed cancer (C01-C99; ICD-10), based on a physician’s certificate, between 2000 and 2011. The last day of the follow-up period was December 31, 2012. The recurrent sickness leave rate and resignation rate were calculated using competing risk survival analysis.

Results

Of 223 cancer survivors, 61 took further physician-certified sick leave after their RTW. The median duration of the post-RTW work period among all cancer survivors was 10.6 years. The work continuance rates of the female cancer survivors were 83.2 and 60.4% at 1 and 5 years after they returned to work, respectively. There was a steep reduction in the work continuance rate during the first post-RTW year. There were considerable differences in the work continuance rate according to the primary cancer site. Cumulative recurrent sick leave rates of 11.8 and 28.9% were seen at 1 and 5 years after the subjects returned to work. The cumulative resignation rate was 5.0 and 10.7% at 1 and 5 years after the subjects returned to work. Most recurrent sick leave occurred in the first year after the subjects returned to work, followed by the second year.

Conclusions

Sixty percent of female cancer survivors were still working at 5 years after returning to work, although the work continuance rates for different types of cancer varied significantly.

Obtaining person-related information from employees with chronic health problems: a focus group study

Purpose

The objective of this focus group study is to assess how occupational physicians (OPs) and insurance physicians (IPs) can best obtain information concerning person-related factors from employees. The research question was: what is the most effective way for OPs and IPs to obtain information concerning person-related factors, in the opinion of employees with chronic health problems?

Methods

Three focus group discussions were conducted comprising of a total of 23 employees with work limitations due to chronic health problems. Employees discussed how physicians could best obtain information related to ten person-related cognitions and perceptions that are associated with work participation. The discussions were recorded, transcribed verbatim and analyzed through qualitative content analysis.

Results

Employees indicated that information addressing person-related factors could best be obtained through discussing them directly during consultations, as opposed to the use of questionnaires or diaries. Important prerequisites to having fruitful conversations include a mutual trust between employee and physician, a sense of genuine physician interest, and the understanding of the physician of employees and their health concerns. Employees described various factors that influence these conversations, including the knowledge and communication skills of physicians, employee anxiety, and the atmosphere and time frame of the consultation.

Conclusions

Information concerning the person-related factors of employees can best be obtained by discussing them during consultations. However, there has to be mutual trust, interest and understanding before employees feel comfortable to talk about these factors with a physician. OPs and IPs should consider these, and other identified factors, when asking about person-related factors during consultations.

Changes in employment status, barriers to, and facilitators of (return to) work in breast cancer survivors 5-10 years after diagnosis

Purpose: To qualitatively investigate changes in employment status, barriers to and facilitators of (return to) work in breast cancer survivors 5-10 years after diagnosis.Materials and methods: Women were eligible to participate in the focus groups if they were younger than 55 years and were employed at time of diagnosis. Data were analysed by two independent researchers using thematic content analysis.Results: Nineteen women participated in three semi-structured focus groups, of whom 18 reported a change in employment status 5-10 years after diagnosis. Perceived barriers to (return to) work shortly after breast cancer diagnosis tended to be disease- and treatment-related, while 5-10 years later, they were personal- and work-related. Participants recommended open communication and support at the workplace, and comprehensive information from (occupational) health care professionals to facilitate dealing with breast cancer at work.Conclusions: Breast cancer survivors still experience changes in employment status 5-10 years after diagnosis. (Occupational) health care professionals should be alert that perceived barriers for returning to work change over time. Future research should focus on increasing awareness (at work) of breast cancer survivors' needs, providing adequate information and support to all involved, and developing interventions to sustain survivors' work ability at the long term.IMPLICATIONS FOR REHABILITATIONEven long after diagnosis and treatment, a sizeable number of breast cancer survivors report a change in employment status, such as job loss.(Occupational) health care professionals should be alert that barriers for returning to work and retaining work change over time.There is a lack of awareness and a shortage of interventions regarding work-related issues for breast cancer survivors at long-term follow-up.

Assessment of prognosis by physicians involved in work disability evaluation: A qualitative study

Background

Assessment of prognosis of work functioning is a challenging aspect of work disability evaluations. To gain insight into this process, we conducted a qualitative study to determine the aspects considered and the difficulties, needs and potential solutions affecting the prognosis assessment by physicians performing disability evaluations.

Methods

In-depth, semi-structured individual interviews were conducted with 20 physicians performing disability evaluations for the Dutch social security institute: the national institute for employee benefit schemes. Verbatim transcripts were independently analyzed by two researchers using MAXQDA software until significant themes emerged and data saturation was achieved.

Results

The responses that emerged from the interviews were clustered in three primary themes. The first theme was “Aspects considered by physicians in assessing prognosis.” When making a prognosis, physicians considered the following medical issues: nature and severity of disease, the role of treatment, course of the disease, external information, and medical evidence. Patient-related issues and physician-related aspects were also distinguished. Patient-related aspects concerned the patients’ work perspectives and coping or recovery behavior. Physician-related aspects concerned awareness of the physician’s own role and reflection on aspects such as empathy for clients and ethical considerations. The second theme was “Difficulties physicians face in assessing prognosis,” which included challenges during the assessment of diseases of a complex or less concrete nature, applying prognostic evidence to the individual, and lack of time when seeking prognostic evidence. The third theme concerned “Needs and solutions” formulated by physicians that facilitated the prognostic assessment. It consisted of continuous education, better collaboration with medical specialists and/or labor experts, and the use of prognostic tools such as checklists, apps or internet applications incorporating evidence on prognosis.

Conclusions

Physicians identified several medical and patient-related aspects that elucidated the prognosis assessment. Given the variety of challenges and the need for further support found in the current study, future research should focus on the development and evaluation of training, tools, and guidelines to improve prognosis assessment by physicians.

Predictors of fatigue and work ability in cancer survivors

Background

Workers diagnosed with cancer are at risk for job loss or work disability.

Aims

To determine predictors of fatigue and work ability at 36 months after diagnosis in a population of cancer survivors.

Methods

Individuals diagnosed with cancer and who applied for work disability benefit at 24 months of sick leave were surveyed at the time of application and again 12 months later. Fatigue was measured using the Functional Assessment of Chronic Illness-Fatigue scale questionnaire and work ability was measured using the work ability index. Linear regression analyses were applied to identify predictors.

Results

There were 336 participants. Participants who were divorced or widowed had more physical limitations, more depressive symptoms and were more fatigued at baseline, and who worked in health care demonstrated higher levels of fatigue. Lower fatigue was predicted by having received chemotherapy. A higher level of work ability was predicted by having received chemotherapy, better global health and better work ability at baseline. Lower work ability was predicted by being principal wage earner, insecurity about being free of disease, having more physical limitations and having greater wage loss.

Conclusions

Socio-demographic, health- and work-related factors were associated with fatigue and work ability in cancer survivors on long-term sick leave. As fatigue and poor work ability are important risk factors for work disability, addressing the identified predictive factors may assist in mitigation of work disability in cancer survivors.

Higher incidence of screening-related cancers in the employed population

Background

Employment may confound the risk of a cancer diagnosis in both directions. We hypothesized that a higher baseline rate of employment among cancer patients may explain the lack of association between a cancer diagnosis and later unemployment in many studies.

Aims

To assess the unemployment rate among cancer patients before diagnosis compared with a matched cancer-free control group.

Methods

Using data from the Israeli National Central Bureau of Statistics 1995 census (persons aged between 15 and 60 years old), the Israeli Tax Authority database and the Israel Cancer Registry, cancer patients (diagnosed between the years 2000 and 2007 and alive at 2011) were compared with matched cancer-free controls.

Results

There were 8797 cancer patients and 26166 cancer-free controls. We found that, in general, cancer was not associated with unemployment 2 years before diagnosis (adjusted odds ratio [OR] = 0.96, 95% confidence interval [CI] 0.90-1.009, P = NS) after adjustment for age, gender, ethnicity, educational years and residential socioeconomic position. However, the diagnoses associated with screening (breast, prostate, colorectal and cervix cancers) were inversely associated with unemployment 2 years before diagnosis (adjusted OR = 0.90, 95% CI 0.84-0.97, P < 0.01).

Conclusions

The results from the current study suggest that a higher baseline rate of employment among cancer patients, mainly those who were diagnosed with screening-associated cancers, explains false negative results in previous studies assessing cancer survivors' work issues.

The mediating role of coping between self-reported health complaints and functional limitations, self-assessed work ability and work status of long-term sick-listed cancer survivors

Our purpose was to investigate the possible mediating role of active coping and passive coping between self-reported health complaints and functional limitations, as assessed by an insurance physician (IP), self-assessed work ability and work status in cancer survivors on long-term sick leave. Validated questionnaires were used for self-reported health complaints, work ability and work status. The functional limitations of the respondents were transformed into scales for mental and physical limitations and limitations in working hours. Using LISREL, we constructed a model with coping in a mediating role. Active coping mediated between fewer self-reported physical limitations, more depressive symptoms, better cognitive functioning and more fatigue on the one hand, and more physical limitations and limitations in working hours on the other hand. Passive coping played no mediating role and was associated with more self-reported depressive symptoms only. More functional limitations were associated with lower self-assessed work ability of cancer survivors, and with not being at work, whereas higher self-assessed work ability was associated with being at work. Regarding the role of active and passive coping strategies in cancer survivors on long-term sick leave, more longitudinal research is needed to confirm causality.

Functional Impairments and Work-Related Outcomes in Breast Cancer Survivors: A Systematic Review

Purpose Work participation after breast cancer treatment is generally negatively affected. Occupational health professionals might improve work-related outcomes by bridging the gap between sick-listed employees' levels of functioning and work demands. To aid them in this task, this review explored the association between functional impairments and work-related outcomes in breast cancer survivors. Methods Publications from January 2000-March 2016 were identified through five online databases (i.e. Pubmed, EMBASE, PsycINFO, CINAHL and the Cochrane Library). Quantitative and qualitative studies were included if they focused on functional impairments and work-related outcomes in breast cancer survivors. Two reviewers independently selected studies, extracted data and performed quality assessment. Results The search identified 998 studies, of which 20 studies met eligibility criteria. Impairments in physical functioning negatively affected return to work (RTW) and work ability in quantitative and qualitative studies. Studies measuring cognitive functioning with tests found no association with work-related outcomes, whereas the results of studies using self-reported measures were ambiguous. Social functioning was less commonly investigated and findings differed across work-related outcomes. Emotional functioning was not associated with work-related outcomes in quantitative studies, while in qualitative studies feelings such as insecurity were described as influencing RTW. Conclusions Functional impairments can severely hamper work participation in breast cancer survivors. This provides important opportunities for occupational health professionals to enhance RTW in breast cancer survivors, such as adequately addressing illness perceptions and work expectations. Ongoing research is warranted to aid occupational health professionals in providing effective vocational guidance and improve work-related outcomes in breast cancer survivors.

Evaluating Disability Insurance Assistance as a Specific Intervention by Physiatrists at a Cancer Center

Because of their expertise, physiatrists provide disability insurance assistance for cancer survivors. In this brief report, we perform a descriptive retrospective analysis of all new (354) outpatient physiatry consultations from January 1, 2009, to December 31, 2013, at a National Cancer Institute Comprehensive Cancer Center. Disability and/or work accommodations were brought up at some point with the physiatrist during the duration of their care for 131 (37%) of 354 patients. More than 90% of the discussions took place during the first visit. Of those patients who had a documented disability/employment discussion, 58 (44.3%) of 131 patients were originally referred for disability assistance specifically, and 58 (44.3%) of 131 also had disability insurance paperwork completed by the physiatrist. Outcomes of initial physiatry disability insurance assistance were 45 (77.6%) of 58 approved/renewed, 5 (8.6%) of 58 denied, and 8 (13.8%) of 58 unknown/died during the disability application process. The median form size was 33 (SD, 25.95) items. This study is the first of its kind and provides an initial look at work-related discussions and support with disability insurance paperwork as a specific intervention provided by physiatrists at a cancer center. The results are compelling and demonstrate that physiatrists frequently provide these interventions. These interventions take considerable time and effort but are generally successful.