Occupational rehabilitation of male breast cancer patients: Return patterns, motives, experiences, and implications-A qualitative study

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

INTRODUCTION

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

METHODS

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

RESULTS

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

DISCUSSION

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

Men's Lived Experiences of Breast Cancer and Changes in Occupation

Introduction

Male breast cancer is rare and frequently diagnosed at later stages of disease with low survival rates. There is a lack of knowledge of how breast cancer impacts men's occupations.

Objectives

This study is aimed at understanding the lived experiences of men with breast cancer and their changes in occupation. Methodology. Twenty-four men with breast cancer participated in semistructured phone interviews. Data was open-coded and analyzed for themes. Findings. The six major themes are as follows: (1) death as a reality, (2) unique personal insights, (3) social environment, (4) interactions with the healthcare system, (5) decreased engagement in occupations, and (6) finding meaning in new occupations.

Conclusion

The healthcare team can improve the patient experience by discussing and responding to the client's experience throughout the diagnosis, intervention, and survival continuum. The scope of occupational therapy is well suited to address the needs of men with breast cancer to maintain optimal levels of functioning.

Involuntariness of job changes is related to less satisfaction with occupational development in long-term breast cancer survivors

PURPOSE

Considering that breast cancer survivors (BCSs) have been dealing with unwanted job changes after diagnosis, this study aimed to investigate involuntary job changes (unwanted modifications in employment since diagnosis) and explore the association between job changes, involuntariness, and occupational development satisfaction in BCSs 5-6 years after diagnosis.

METHODS

Data were drawn from the mixed-methods breast cancer patients' return to work (B-CARE) study. We surveyed 184 female BCSs who were working at the time of study enrollment during hospitalization (T1), 10 weeks after discharge (T2), 40 weeks after discharge (T3), and 5-6 years after diagnosis (T4) and used descriptive measures and stepwise linear regression models for data analysis.

RESULTS

The mean age of BCSs was 57 years. A total of 105 participants reported 410 job changes, of which 16.1% were reportedly (rather) involuntary. The most commonly reported involuntary changes were increased workload (15.2%) and increased scope of work (15.2%). In the final model, significant predictors of satisfaction with occupational development 5-6 years after diagnosis were age, state of health ΔT2-T3, state of health ΔT3-T4, and involuntariness of job changes.

CONCLUSIONS

Although the number of job changes alone is not substantially associated with BCSs' satisfaction with occupational development, experiencing involuntary job changes is. Sociodemographic, disease-related, and work(place)-related factors may influence occupational satisfaction among BCSs.

IMPLICATIONS FOR CANCER SURVIVORS

The findings indicate the importance of strengthening one's ability to work as desired to prevent involuntary job changes and enable desired work participation in long-term support. The significance of workplace characteristics highlights the need for employers to encourage satisfying work participation.

TRIAL REGISTRATION NUMBER

German Clinical Trials Register (DRKS00016982), 12 April 2019.

Conflicting demands, coping, and adjustment: A grounded theory to understand rehabilitation processes in long-term breast cancer survivors

OBJECTIVE

This study explores rehabilitation processes in long-term cancer survivors (CSs) and explains the causes, contexts, and consequences under which decisions related to rehabilitation are made.

METHODS

Within the mixed-methods Breast Cancer Patients' Return to Work (B-CARE) project, conducted from 2018-2020, data were collected through a written survey and semi-structured interviews with CSs 5-6 years after their diagnosis. In total, 184 female CSs participated in the survey, and 26 were interviewed. A qualitative grounded theory approach was applied.

RESULTS

The 26 interviewees were 57 years old on average, 70% were married, and 65% had children. The participants experienced incompatibilities caused by the cancer disease in their areas of life and the demands that arose from it. To reconcile demands from the areas family, work, leisure time, household, and disease, the interviewed CSs used different coping mechanisms and adjusted their lives by prioritizing certain areas as a consequence. This prioritizing was often to the detriment of work and rehabilitation. Furthermore, it worked as a barrier for participation in rehabilitation programs and explains why CSs experienced job changes after their return to work.

CONCLUSIONS

Physical and mental long-term effects were observed in the interviewees' lives 5-6 years into survival. The study results stress the importance of individualized and needs-oriented survivorship care.

Survivorship, Version 1.2021

The NCCN Guidelines for Survivorship are intended to help healthcare professionals working with cancer survivors to ensure that each survivor's complex and varied needs are addressed. The Guidelines provide screening, evaluation, and treatment recommendations for consequences of adult-onset cancer and its treatment; recommendations to help promote healthful lifestyle behaviors, weight management, and immunizations in survivors; and a framework for care coordination. This article summarizes the recommendations regarding employment and return to work for cancer survivors that were added in the 2021 version of the NCCN Guidelines.