Successful return to work for cancer survivors

Experiences of unemployed and/or work-disabled cancer survivors who have pursued to return to paid employment: a focus group study

PURPOSE

To explore experiences of unemployed and/or work-disabled cancer survivors who have pursued to return to paid employment.

METHODS

Four digital focus group interviews were conducted with 16 cancer survivors (< 10 years post-diagnosis) who have pursued to return to work within the last 2 years. Interview topics included motivations, facilitators of and barriers to job seeking, and returning to and maintaining paid employment. Interview audio recordings were transcribed verbatim and analyzed using conventional content analyses.

RESULTS

Participants were mostly female (94%), and the majority had successfully returned to paid employment (56%). Both intrinsic factors (e.g., sense of purpose, social interactions) and extrinsic factors (e.g., financial necessity) motivated their return to paid employment. During job seeking, participants experienced facilitators including support, personal qualities (e.g., life experience), and trial workplaces. Barriers included inadequate support, perceived employer discrimination, and work ability uncertainty. Returning to and maintaining employment was facilitated by flexible work, supportive colleagues, and intrinsic drive, while barriers included side effects (e.g., fatigue) and overly demanding work.

CONCLUSIONS

Unemployed and/or work-disabled cancer survivors are generally motivated to return to paid employment by both intrinsic and extrinsic factors, but uncertainty about their ability and inadequate support may hinder this. These findings highlight the need for trial workplaces, support during every phase of return to paid employment, and a flexible, supportive workplace.

IMPLICATIONS FOR CANCER SURVIVORS

Tailored interventions addressing the needs identified in this study are urgently needed. The recommendations provided offer strategies for various stakeholders to enhance support for unemployed and work-disabled cancer survivors.

American Society for Transplantation and Cellular Therapy Return to Work Guidance Committee Recommendations for Health Care Providers Who Take Care of Hematopoietic Cell Transplantation Patients

Hematopoietic cell transplantation (HCT) health care providers report a desire to improve long-term outcomes and quality of life for their patients. One of the items frequently cited by patients in terms of transitioning from being a patient back to pre-HCT life is return to work (RTW). However, these patients report little support from their health care providers in facilitating this process, and only 50% to 60% achieve RTW, at a median of 3 years post-HCT. Barriers are physical, psychological, and logistical, as well as poor communication between the patient and their employer. We convened a group of experts in survivorship, rehabilitation, social work, and psychology to draft an evidence-based document to assist health care providers in guiding their patients' RTW journey. Guidance is drawn from the existing literature for HCT and general cancer patients and is divided into pre-HCT, peri-HCT, and post-HCT categories. Collaboration among health care providers, patients, and their employers is key to this transition. Suggested referrals and evaluations also are provided. The goal is for this guidance to be continually updated as we advance the field with more HCT-specific literature.

Work resumption and retention in patients with advanced cancer: Experiences and perspectives of general and occupational health care professionals

OBJECTIVE

The objectives of this study were to explore the experiences and perspectives of general and occupational health care professionals regarding work resumption and work retention of patients with advanced cancer, and to identify barriers and facilitators these professionals may encounter.

METHODS

A qualitative design was applied, and individual semistructured interviews were conducted. General and occupational health care professionals were eligible to participate if they were involved in the work participation guidance of patients with advanced cancer, and were recruited through the network of the research team. Interview data were transcribed verbatim and analysed thematically via ATLAS.ti 9.

RESULTS

Interviewees (N = 17) had various occupational backgrounds, for example, occupational physician, reintegration consultant, and general practitioner. Four main themes emerged from the data: (1) Assumptions and hesitations, (2) Patient initiates stakeholder communication, (3) Role dispersion: who is in charge of what? and (4) Experience with legislation creates opportunities.

CONCLUSION

Whereas most interviewees had positive experiences with, and/or optimistic expectations of, the work resumption and work retention of patients with advanced cancer, several barriers to the work participation guidance of these patients were identified. Suggestions for improvement include creating widespread awareness of the possibility of work participation of patients with advanced cancer and developing reintegration guidelines for advanced cancer.

A Multiple Case Study of Latina Breast Cancer Survivors Returning to Work With Breast Cancer-Related Lymphedema: Adaptation, Resilience, and Quality of Life

Introduction: Breast cancer-related lymphedema (BCRL), a side effect of cancer treatment, may negatively impact the ability to perform work. Factors such as delayed diagnosis, late-stage disease, and a high percentage of service occupations may challenge work choices for Latinas after BCRL diagnosis. Methods: Our multiple case study explored work experiences and quality of life (QOL) for Hispanic/Latina survivors. Participants completed demographic and short form-36 (SF-36) surveys. Semi-structured interviews focused on how work environment, self-management, and QOL were influenced by BCRL. Thematic analysis of cases used In Vivo and descriptive coding and constant cross-case comparative methods. Results: Analysis illustrated how Hispanic/Latina survivors perceive the influence of BCRL on work experience as requiring adaptation and personal resilience. Participants identified BCRL knowledge gap challenges and described coping with physical, psychosocial, and work activity changes. They described creative work adaptations and discussed BCRL's impact on both positive and negative interpersonal perceptions. Strong support from family, friends, and colleagues contributed to improved QOL and continued work activities. Conclusion: Future research should incorporate coping strategies and creative management of BCRL to optimize work activities across the lifespan. These strategies can provide guidance for the creation of survivorship care plans, education of healthcare professionals (HCPs), and lifelong occupational support.

Work ability 8 years after breast cancer: exploring the role of social support in a nation-wide survey

INTRODUCTION

As the 5-year survival rate after breast cancer in Norway is 92%, the population of breast cancer survivors (BCSs) is increasing. Knowledge of work ability in this population is scarce. In a population-based cohort of BCSs, we explored work ability 8 years after diagnosis and the association between work ability and social support, and cancer-related variables including late effects and lifestyle factors.

METHODS

In 2019, all Norwegian women < 59 years when diagnosed with stage I-III breast cancer in 2011 or 2012, were identified by the Cancer Registry of Norway and invited to participate in a survey on work life experiences. Work ability was assessed using the Work Ability Index (scale 0-10). Factors associated with excellent work ability (score ≥ 9) were identified using univariate and multivariate logistic regression analyses, and adjusted for socioeconomic-, health- and cancer-related variables.

RESULTS

Of the 1951 eligible BCSs, 1007 (52.8%) responded. After excluding survivors with relapse (n = 1), missing information on work ability score (n = 49), or work status (n = 31), the final sample comprised 926 BCSs within working age at survey (< 67 years). Mean age at survey was 56 years and 8 years (SD 0.7) had passed since diagnosis. Work ability had been reduced from 8.9 (SD 2.3) at diagnosis to 6.3 (SD 3.1). One in three BCSs reported poor work ability (WAS ≤ 5), and seven out of ten reported that their physical work ability had been reduced due to cancer. Social support from colleagues during cancer therapy was associated with excellent work ability, which was not observed for social support provided by supervisors or the general practitioner. Cognitive impairment and fatigue were inversely associated with work ability. None of the cancer-related variables, including treatment, were associated with work ability 8 years after diagnosis.

CONCLUSION

In this population-based sample, one in three BCSs reported poor work ability 8 years after diagnosis. Collegial social support during cancer therapy appears to be a protective factor for sustained work ability, whilst survivors struggling with fatigue and cognitive impairments may represent a particularly vulnerable group for reduced work ability.

Co-design of a return-to-work intervention after breast cancer treatments: feasibility study protocol (Preprint)

Background

The mortality rate from breast cancer has been declining for many years, and the population size of working-age survivors is steadily increasing. However, the recurrent side effects of cancer and its treatment can result in multiple disabilities and disruptions to day-to-day life, including work disruptions. Despite the existing knowledge of best practices regarding return to work (RTW) for breast cancer survivors, only a few interdisciplinary interventions have been developed to address the individualized needs and multiple challenges of breast cancer survivors, health care professionals, and employer and insurer representatives. Thus, it seems appropriate to develop RTW interventions collaboratively by using a co-design approach with these specific stakeholders.

Objective

This paper presents a protocol for developing and testing an innovative, interdisciplinary pilot intervention based on a co-design approach to better support RTW and job retention after breast cancer treatment.

Methods

First, a participatory research approach will be used to develop the intervention in a co-design workshop with 12 to 20 participants, including people affected by cancer, employer and insurer representatives, and health care professionals. Next, a pilot intervention will be tested in a primary care setting with 6 to 8 women affected by breast cancer. The acceptability and feasibility of the pilot intervention will be pretested through semistructured interviews with participants, health care professionals, and involved patient partners. The transcribed data will undergo an iterative content analysis.

Results

The first phase of the project—the co-design workshop—was completed in June 2021. The pilot test of the intervention will begin in spring 2022. The results from the test will be available in late 2022.

Conclusions

The project will offer novel data regarding the use of the co-design approach for the development of innovative, co-designed interventions. In addition, it will be possible to document the acceptability and feasibility of the pilot intervention with a primary care team. Depending on the results obtained, the intervention could be implemented on a larger scale.

International Registered Report Identifier (IRRID)

DERR1-10.2196/37009

Risk factors for return to work in colorectal cancer survivors

Background: The increasing incidence of colorectal cancer among individuals in the productive age‐group has adversely affected the labor force and increased healthcare expenses in recent years. Return to work (RTW) is an important issue for these patients. In this study, we explored the factors that influence RTW and investigated the influence of RTW on survival outcomes of patients with colorectal cancer.

Methods: Data of individuals (N = 4408) in active employment who were diagnosed with colorectal cancer between 2004 and 2010 were derived from 2 nationwide databases. Subjects were categorized into 2 groups according to their employment status at 5‐year follow‐up. Logistic regression analysis was performed to identify the factors associated with RTW. Survivors were further followed up for another 8 years. Propensity score matching was applied to ensure comparability between the two groups, and survival analysis was performed using the Kaplan–Meier method.

Results: In multivariable regression analysis for 5‐year RTW with different characteristics, older age (OR: 0.57 [95% CI, 0.48–0.69]; p < 0.001), treatment with radiotherapy (OR: 0.69 [95% CI, 0.57–0.83]; p < 0.001), higher income (OR: 0.39 [95% CI, 0.32–0.47]; p < 0.001), medium company size (OR: 0.78 [95% CI, 0.63–0.97]; p = 0.022), and advanced pathological staging (stage I, OR: 16.20 [95% CI, 12.48–21.03]; stage II, OR: 13.12 [95% CI, 10.43–16.50]; stage III, OR: 7.68 [95% CI, 6.17–9.56]; p < 0.001 for all) revealed negative correlations with RTW. In Cox proportional hazard regression for RTW and all‐cause mortality, HR was 1.11 (95% CI, 0.80–1.54; p = 0.543) in fully adjusted model.

Conclusion: Older age, treatment with radiotherapy, higher income, medium company size, and advanced pathological stage showed negative correlations with RTW. However, we observed no significant association between employment and all‐cause mortality. Further studies should include participants from different countries, ethnic groups, and patients with other cancers.

Development and evaluation of a training program for occupational health nurses regarding support for workers with cancer and their workplaces

Objectives

This study aimed to develop and evaluate a training program for occupational health nurses (OHNs) regarding support for workers with cancer and their workplaces.

Methods

Based on our prior research, we engaged in multiple discussions on the development of training program for OHNs. For examining the effectiveness of the developed training program, we collected and analyzed the data from three repeated surveys conducted before, immediately after, and 3 months after the training on self‐confidence levels of the participants regarding 23 items associated with support for workers with cancer and their workplaces.

Results

We made a 3‐hour training program including a lecture and a group work. First, we gave a lecture explaining the support scheme consisting of 4 parts and the 12 hints in action phrase while using the guidebook. Second, we conducted the group work regarding the case of a female worker diagnosed with breast cancer. Of the participants who supported workers with cancer in actuality during the 3‐month post‐training, 86% acknowledged the utility of the training in implementing support. As for the pre‐post evaluation of the training program, most items of the participants’ self‐confidence significantly increased from pretraining to immediately after and 3 months post‐training.

Discussion

This study demonstrated that the developed training program was effective in that the participants learned the support schemes and skills and gained self‐confidence in implementing supports in real‐work settings. We hope that this training program will be extensively used in the future, enabling OHNs to contribute toward balancing cancer treatment and work.

Employment pathways of cancer survivors-analysis from administrative data

The incidence of cancer and its survival rate have been increasing worldwide, resulting in a greater number of cancer survivors. Since one's job often forms a central basis for self-esteem and provides financial security, knowing whether and how cancer can affect the employment of employed cancer survivors are important issues. While the past studies generally used survey data, this study utilizes pre-existing administrative data and employs the difference-in-differences model. We take newly diagnosed cancer patients in 2012, aged from 15 to 60 years and employed upon diagnosis, as the study group (N = 12694) and the propensity-score matching-adjusted non-cancer employed population as the control group. Monthly employment information for 2011-2014 was retrieved for both groups. We define the pre-event period as the months before the diagnosis and the post-event period as the months from the diagnosis and afterwards. A pseudo-date symbolizing the index point for cancer diagnosis is assigned to the control group. The logistic regression results show that the impact of cancer on the employment status of cancer survivors is significantly negative for both genders. However, if the differences in employment status between the study and control groups prior to the incidence of cancer are significant, then some past research that used only post-period observations might have rendered biased estimates. The employment pathways indicate that 88% of female cancer survivors employed upon diagnosis continue to work during the full 12 months after diagnosis. Further analyses on earnings demonstrate the possibility of cancer survivors retaining their job, but at lower pay.

Recent Status and Methodological Quality of Return-to-Work Rates of Cancer Patients Reported in Japan: A Systematic Review

Cancer patients’ return-to-work rates in Japan and their methodological quality have been little reported. We conducted a systematic review to explore the recent return-to-work rates and to assess the methodological quality of the existing literature. We selected 13 papers (2 in English and 11 in Japanese) published between 2005 and 2017. The return-to-work rates ranged from 53.8% to 95.2%. Of the selected papers, 12 papers employed a cross-sectional design, possessing high risk of selection bias due to participant selection. A total of 8 papers did not fully report the subjects’ sex, age, employment status at cancer diagnosis, cancer site, stage, and treatment, suggesting high risk of selection bias due to confounding variables. High or unclear risk of attrition bias due to incomplete outcome data was detected in 12 papers in which data on return to work were not collected from all participants. High risk of reporting bias due to selective outcome reporting was pointed out in 6 studies in which the subjects’ employment status at return to work or the duration between cancer diagnosis and assessment of return to work was unclear. Future studies must reduce the risk of selection, attrition, and reporting biases for specifying accurate return-to-work rates.

Breast Cancer Survivors Report Similar Concerns Related to Return to Work in Developed and Developing Nations

Aim To determine whether breast cancer survivors (BCS) at work following the diagnosis and/or treatment of breast cancer, in a rapidly developing country such as China experience similar to return to work challenges as reported in nations with established return to work (RTW) policy and procedures for employees with cancer. Methods Semi-structured interviews were conducted with 16 BCS who returned to work following diagnosis and/or primary cancer treatment. An Interpretative Phenomenological Analysis was used to investigate responses. Results Three recurring themes emerged: (1) challenges at work related to residual effects of diagnosis and/or primary treatment; (2) positive and negative responses from employers and/or supervisors; and (3) positive and negative responses from co-workers/colleagues. Although several participants experienced a high level of workplace support, there was a subgroup that did report challenges related to symptom burden, cognitive limitations, and both positive and negative responses by employers and co-workers were reported. Conclusions Findings indicate similar challenges in BCS who RTW during and/or following cancer treatment in both rapidly developing and developed nations. Results suggest that regardless of the existence of workplace policies and practices related to RTW for workers with a history of cancer, a subgroup of BCS experience similar challenges when returning to work. These findings highlight the international nature of RTW challenges and suggest the need for more global efforts to develop and evaluate workplace interventions to assist with these similarities.

Returning to work after cancer: Survivors', caregivers', and employers' perspectives

OBJECTIVE

The Return to Work Initiative was launched to build a comprehensive understanding of issues, needs, current resources, and available supports for Canadian cancer survivors returning to work as the basis for developing a national action plan.

METHODS

This Initiative drew on perspectives of stakeholders through a survey and consultations with cancer survivors and caregivers to learn about challenges regarding return to work and interviews and focus groups with workplace representatives and employers to determine issues encountered in the workplace. Common perspectives across stakeholder groups were identified.

RESULTS

Cancer survivors (n = 410) described reduction in income, positive and negative experiences returning to work, and work-related issues regarding side effects. Caregivers (n = 60) described loss of concentration and productivity, stress, and lack of support from coworkers. Employer representatives (n = 68) revealed challenges for managers knowing how best to support cancer survivors as there are few of them of which they are aware. All stakeholders agreed that returning to work for cancer survivors is challenging. Multiple strategies are needed to achieve success: in-depth understanding of the issues, consideration of accommodation, communication among stakeholders, education, resources, and financial support.

CONCLUSIONS

The work provided a foundation for making decisions about how to proceed to improve return to work for Canadian cancer survivors.

The impact of chronic myeloid leukemia on employment: the French prospective study

Patients with chronic myeloid leukemia treated with breakpoint cluster region-Abelson tyrosine kinase inhibitors are likely to survive in excess of 20 years after diagnosis. New challenges appear as we consider life after the disease, including professional challenges and the social reintegration of patients. The purpose of this study was to determine the impact of chronic myeloid leukemia on employment within 2 years after diagnosis. This prospective, observational study included patients diagnosed with chronic myeloid leukemia and treated with a tyrosine kinase inhibitor. Two populations were defined as patients who reported modifications in their professional activity during the study (Acti-Pro+) and patients who did not report a modification (Acti-Pro-). Cancer survivors received a self-assessment questionnaire. The primary endpoint was to determine the professional status of patients. One hundred patients completed the questionnaire. Sixty-six patients out of 100 reported professional activity within 2 years after their diagnosis. During the 2 years after the diagnosis, 65.2% (95% confidence interval (CI), 53.7-76.7) of patients faced modifications in their professional activity due to chronic myeloid leukemia or adverse effects of drug treatments (group Acti-Pro+); in contrast, 34.8% of patients did not report any impact on their occupational activity (group Acti-Pro-). Among modifications to work organization, a change in the number of working hours was the most represented. Other modifications comprised changes in status or work pace. A majority of chronic myeloid leukemia patients face professional consequences of their disease and treatments. Our findings suggest that adverse drug reactions are a major factor affecting the occurrence of work modifications in this context.

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.

Predictors of Unemployment After Breast Cancer Surgery: A Systematic Review and Meta-Analysis of Observational Studies

Purpose Breast cancer surgery is associated with unemployment. Identifying high-risk patients could help inform strategies to promote return to work. We systematically reviewed observational studies to explore factors associated with unemployment after breast cancer surgery. Methods We searched MEDLINE, EMBASE, CINAHL, and PsycINFO to identify studies that explored risk factors for unemployment after breast cancer surgery. When possible, we pooled estimates of association for all independent variables reported by more than one study. Results Twenty-six studies (46,927 patients) reported the association of 127 variables with unemployment after breast cancer surgery. Access to universal health care was associated with higher rates of unemployment (26.6% v 15.4%; test of interaction P = .05). High-quality evidence showed that unemployment after breast cancer surgery was associated with high psychological job demands (odds ratio [OR], 4.26; 95% CI, 2.27 to 7.97), childlessness (OR, 1.30; 95% CI, 1.11 to 1.53), lower education level (OR, 1.15; 95% CI, 1.05 to 1.25), lower income level (OR, 1.46; 95% CI, 1.24 to 1.73), cancer stage II, III or IV (OR, 1.43; 95% CI, 1.13 to 1.82), and mastectomy versus breast-conserving surgery (OR, 1.18; 95% CI, 1.07 to 1.30). Moderate-quality evidence suggested an association with high physical job demands (OR, 2.11; 95%CI, 1.52 to 2.93), African-American ethnicity (OR, 1.89; 95% CI, 1.21 to 2.96), and receipt of chemotherapy (OR, 1.95; 95% CI, 1.36 to 2.79). High-quality evidence demonstrated no significant association with part-time hours, blue-collar work, tumor size, positive lymph nodes, or receipt of radiotherapy or endocrine therapy; moderate-quality evidence suggested no association with age, marital status, or axillary lymph node dissection. Conclusion Addressing high physical and psychological job demands may be important in reducing unemployment after breast cancer surgery.

Perceptions of Breast Cancer Survivors on the Supporting Practices of Their Supervisors in the Return-to-Work Process: A Qualitative Descriptive Study

Purpose Supervisors are known to be key actors in ensuring the success of absent employees in their return-to-work process. However, to date, little is known about the perceptions of breast cancer survivors on the practices put in place by their supervisors to support them during this process. The objective of this study was to describe the perceptions of breast cancer survivors on the practices put in place by their supervisors to support them during their return-to-work process. Method A qualitative descriptive study was conducted. Semi-structured interviews were carried out with breast cancer survivors (n = 10) who had returned to work after treatment and were still at work more than 18 months later. Each interview was audio recorded and then transcribed verbatim for qualitative thematic content analysis using a semi-open codification framework. Results Participants identified three main practices put in place by their supervisors to support them and which they perceived as particularly helpful during the return-to-work process: (1) maintaining communication during their period of absence; (2) working with them to structure their return-to-work process before their actual return; and (3) allowing them flexibility in their schedule for a certain period, particularly at the beginning of the return-to-work process. Breast cancer survivors also identified an omission in the practice of employers: lack of follow-up over time. Conclusion Knowledge about the practices perceived as helpful by breast cancer survivors during their return-to-work process lays the groundwork for the eventual development of services to help breast cancer survivors in their return to work.

Exploration of the contexts surrounding the implementation of an intervention supporting return-to-work after breast cancer in a primary care setting: starting point for an intervention development

BACKGROUND

Many recommendations have been made regarding survivorship care provided by teams of primary care professionals. However, the nature of that follow-up, including support for return-to-work (RTW) after cancer, remains largely undefined. As implementation problems are frequently context-related, a pilot study was conducted to describe the contexts, according to Grol and Wensing, in which a new intervention is to be implemented. This pilot study is the first of three steps in intervention development planning.

METHOD

In-depth semi-structured interviews (n=6) were carried out with stakeholders selected for their knowledgeable perspective of various settings, such as hospitals, primary care, employers, and community-based organizations. Interviews focused on participants' perceptions of key contextual facilitators and barriers to consider for the deployment of an RTW intervention in a primary care setting. Data from interviews were transcribed and analyzed. A content analysis was performed based on an iterative process.

RESULTS

An intervention supporting the process of RTW in primary care makes sense for participants. Results suggest that important levers are present in organizational, professional, and social settings. However, many barriers, mainly related to organizational settings, have been identified, eg, distribution of tasks for survivor follow-up, continuity of information, and coordination of care between specialized oncology care and general primary care.

CONCLUSION

To develop and deploy the intervention, recommendations that emerged from this pilot study for overcoming barriers were identified, eg, training (professionals, survivors, and employers), the use of communication tools, and adopting a practice guide for survivor care. The results were also helpful in focusing on the relevance of an intervention supporting the RTW process as a component of primary care for survivors.

Exploring the Lived Experience of Women Immediately Following Mastectomy: A Phenomenological Study

BACKGROUND

In 2014, it is estimated that 232,670 new cases of breast cancer occurred in the United States. Unilateral or bilateral mastectomy is a frequently chosen option for treating this disease.

OBJECTIVE

The purpose of this study was to explore, through an in-depth interview process, the lived experience of women immediately following mastectomy when they see their scars for the first time.

METHODS

Purposeful sampling was used until saturation was reached. In-depth interviews were conducted with 10 women related to their mastectomy experience. The data were analyzed using a phenomenological approach.

RESULTS

The following 8 themes emerged from the data; lasting impact, personal impact, relational impact, gratitude, support system, coping strategies, timing, and discomfort.

CONCLUSIONS

The results of the study provide evidence that women face ongoing challenges following seeing their mastectomy scars for the first time that is not adequately addressed by healthcare professionals.

IMPLICATIONS FOR PRACTICE

Nurses and other healthcare professionals need to gain a better understanding of the difficulties perceived by women following seeing the scars from mastectomy and implement strategies to assist in successful adaptation to the experience.

Work-related barriers, facilitators, and strategies of breast cancer survivors working during curative treatment

BACKGROUND

Research has identified barriers and facilitators affecting cancer survivors' return to work (RTW) following the end of active treatment (surgery, chemotherapy and/or radiation therapy). However, few studies have focused on barriers and facilitators that cancer survivors experience while working during active treatment. Strategies used by cancer survivors to solve work-related problems during active treatment are underexplored.

OBJECTIVE

The aim of this study was to describe factors that impact, either positively or negatively, breast cancer survivors' work activities during active treatment.

METHODS

Semi-structured, recorded interviews were conducted with 35 breast cancer survivors who worked during active treatment. Transcripts of interviews were analyzed using inductive content analysis to identify themes regarding work-related barriers, facilitators and strategies.

RESULTS

Barriers identified included symptoms, emotional distress, appearance change, time constraints, work characteristics, unsupportive supervisors and coworkers, family issues and other illness. Facilitators included positive aspects of work, support outside of work, and coworker and supervisor support. Strategies included activities to improve health-related issues and changes to working conditions and tasks.

CONCLUSIONS

Breast cancer survivors encounter various barriers during active treatment. Several facilitators and strategies can help survivors maintain productive work activities.

Exploration of return-to-work interventions for breast cancer patients: a scoping review

PURPOSE

Many women who have been diagnosed with breast cancer (BC) would like to return to work after undergoing cancer treatment. This review explores the nature of interventions addressing return to work (RTW) for this population.

METHOD

A scoping review was conducted using the Arksey and O'Malley framework. A search was conducted in five bibliographic databases from 2005 to 2015 to identify intervention studies. Article selection and characterization were performed by two reviewers using systematic grids. Themes were identified to construct a narrative summary of the existing literature.

RESULTS

The literature search identified 17 articles published between 2005 and 2015. The interventions (n = 16) vary in terms of objectives, methodology, description of intervention activities, and period of deployment. Only one intervention referred to a theory linked to RTW. The results further show that nearly 44% of the interventions found provided only information on RTW (information booklet, individual meeting, group session). Only 38% of the interventions were work-directed and offered other activities, such as coordination of services and information, as well as instructions for drawing up an RTW plan. More than 80% of the interventions were provided by health care professionals. Interventions took place during the survivorship period (75%), at the hospital (44%), or an external rehabilitation center (38%).

CONCLUSION

The variability of interventions found indicates the need to clarify the concept of RTW after a BC diagnosis. Recommendations are made for the development of multicomponent interventions that include both the clinic and the workplace to meet the particular needs of this population.

Return to work experience among military officers with cancer

PURPOSE

This study was done to describe the return to work experience of military officers with cancer.

METHODS

Individual in-depth interviews with 15 participants were conducted between September 2013 and April 2014. Participants were interviewed 1~4 times; interviews continued until the data became saturated. Data were analyzed using Strauss and Corbin's grounded theory.

RESULTS

The core category emerged as "living a new life after enduring difficulties". The return to work process consisted of four sequential phases: chaos, positive thought formation, behavior practices, and reformation. Action/interaction strategies used by military officers with cancer to resolve enduring difficulties were controlling emotions, accepting reality, prioritizing health, making efforts to improve relationships, and looking for future jobs.

CONCLUSION

These results will promote understanding of military officers' return to work experience following cancer survival, and will be helpful in developing more effective nursing interventions through enhanced perspectives and insights of practitioners.

Bridging Health Care and the Workplace: Formulation of a Return-to-Work Intervention for Breast Cancer Patients Using an Intervention Mapping Approach

Purpose An increasing number of breast cancer (BC) survivors of working age require return to work (RTW) support. Objective of this paper is to describe the development of a RTW intervention to be embedded in the care process bridging the gap between hospital and workplace. Method The Intervention Mapping (IM) approach was used and combined formative research results regarding RTW in BC patients with published insights on occupational therapy (OT) and RTW. Four development steps were taken, starting from needs assessment to the development of intervention components and materials. Results A five-phased RTW intervention guided by a hospital-based occupational therapist is proposed: (1) assessing the worker, the usual work and contextual factors which impacts on (re-)employment; (2) exploration of match/differences between the worker and the usual work; (3) establishing long term goals, broken down into short term goals; (4) setting up tailored actions by carefully implementing results of preceding phases; (5) step by step, the program as described in phase 4 will be executed. The occupational therapist monitors, measures and reviews goals and program-steps in the intervention to secure the tailor-made approach of each program-step of the intervention. Conclusion The use of IM resulted in a RTW oriented OT intervention. This unique intervention succeeds in matching individual BC patient needs, the input of stakeholders at the hospital and the workplace.

Am I ready to return to work? Assisting cancer survivors to determine work readiness

PURPOSE

A critical initial step in work re-entry involves the determination of work readiness. Cancer survivors have requested increased health care provider involvement in their work readiness decisions. However, there has been no exploration of current practices in determining work readiness, and thus no specific recommendations regarding how to assist survivors in answering the question: Am I ready to return to work?

METHODS

To explore return to work following cancer and the workplace supports survivors require, we completed an exploratory qualitative study. We conducted semi-structured interviews with (i) cancer survivors (n = 16) and (ii) health care/vocational service providers (n = 16). Data were analyzed using thematic analysis. Themes specific to work readiness are discussed.

RESULTS

Three key processes were deemed relevant to determining work readiness by health care providers and survivors: (1) assessing functional abilities in relation to job demands; (2) identifying survivor strengths and barriers to return to work; and (3) identifying supports available in the workplace. Challenges to work readiness determinations, were described by survivors and providers, related to: (i) the complexity of cancer, (ii) the accuracy of work readiness determinations, and (iii) the lack of established processes for addressing work goals.

CONCLUSIONS

Health care providers need to work collaboratively with survivors to determine if they are physically, cognitively, and emotionally ready to return to work, and with workplaces to determine if they are prepared to provide the necessary supports. Further stakeholder collaboration is also warranted.

IMPLICATIONS FOR CANCER SURVIVORS

Supports from health care providers in determining work readiness can ensure survivors do not return to work either "too early" or "too late."

Quality of working life issues of employees with a chronic physical disease: a systematic review

PURPOSE

To assess issues that contribute to the Quality of Working Life (QWL) of employees with a chronic physical disease.

METHODS

A systematic literature search was conducted using the databases PubMed, PsycINFO and EMBASE. Experiences and perceptions during the working life of employees with a chronic physical disease were extracted and synthesized into issues that contributed to their QWL. We organized these synthesized QWL issues into higher order themes and categories with qualitative data analysis software.

RESULTS

From a total of 4,044 articles identified by the search, 61 articles were included. Data extraction and data synthesis resulted in an overview of 73 QWL issues that were classified into 30 themes. The following five categories of themes were identified: (1) job characteristics with issues such as job flexibility and work-site access; (2) the social structure and environment containing issues about disclosure, discrimination, misunderstanding, and awareness by employers or colleagues; (3) organizational characteristics with issues such as requesting work accommodations; (4) individual work perceptions including issues about enjoyment and evaluating work or life priorities; and (5) effect of the disease and treatment including issues about cognitive and physical health and work ability.

CONCLUSION

This systematic review offers an extensive overview of issues that might contribute to the QWL of employees with a chronic physical disease. This overview may function as a starting point for occupational support, such as monitoring and evaluating the QWL of employees with a chronic physical disease during return-to-work and work continuation processes.

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.

Renegotiating environments to achieve participation: A metasynthesis of qualitative chronic disease research

BACKGROUND

Qualitative studies describe environmental influences on participation in adults with chronic disease, but translating these findings into practice can be difficult.

PURPOSE

This study sought to synthesize qualitative research findings regarding the influence of environmental factors on participation among adults with chronic disease.

METHODS

Searching revealed 31 I articles that describe the link between environment and participation for adults with osteoarthritis, rheumatoid arthritis, diabetes mellitus, heart disease, cancer, chronic obstructive pulmonary disease, and/or depression. Study findings were analyzed using metasynthesis methods to identify themes.

FINDINGS

For adults with chronic disease, renegotiating their environments and occupations to achieve, maintain, or rework their participation involves understanding support processes, being ordinary and able, navigating systems, and navigating physical environments.

IMPLICATIONS

Key areas that occupational therapy interventions can target are facilitating constructive collaboration between client and support person, fostering connections with others, recognizing cultural pressure to be ordinary and able, and advocating for supportive policy and practice.

Return to work and cancer: the Australian experience

PURPOSE

Research suggests that for many cancer survivors, returning to work has a range of benefits. However, considerable barriers have been identified as influencing the quality of return to work outcomes. This study explored the perspectives of Australian cancer survivors, managers and employee assistance program (EAP) professionals to gain an understanding of the return to work process and factors that affect the experience.

METHODS

Focus groups and interviews were conducted with cancer survivors (n = 15), managers (n = 12), and EAP professionals / psychologists (n = 4) from public and private sectors. Thematic analysis was used to analyse the data to identify common and unique themes from the three participant groups.

RESULTS

A range of drivers were identified including maintaining normality and regaining identity, which could act positively or negatively depending on survivors' coping ability and self awareness. Analysis revealed communication difficulties in the workplace that impact on emotional and practical support. Negotiating an employee's return is complex, influenced by the level of consultation with the employee and use of an ad hoc or structured process. Direct and indirect ways of supporting employees with cancer were identified, as was the need for colleague and manager support.

CONCLUSION

This study supports previous research findings of the impact of cancer on work, and reveals managers' lack of knowledge on how to respond appropriately. The process of returning to work is complex, influenced by employees' and managers' attitudes, communication skills and coping abilities. Areas for workplace interventions to optimise support for the cancer survivor are described.

Supporting 'work-related goals' rather than 'return to work' after cancer? A systematic review and meta-synthesis of 25 qualitative studies

BACKGROUND

This study aimed to systematically review and synthesise qualitative studies of employment and cancer.

METHODS

A rigorous systematic review and meta-synthesis process was followed. A total of 13,233 papers were retrieved from eight databases; 69 were deemed relevant following title and abstract appraisal. Four further publications were identified via contact with key authors. Screening of full texts resulted in the retention of 25 publications from six countries, which were included in the synthesis.

RESULTS

Studies consistently indicate that for people with cancer, 'work' forms a central basis for self-identity and self-esteem, provides financial security, forms and maintains social relationships, and represents an individual's abilities, talents and health. Work is therefore more than paid employment. Its importance to individuals rests on the relative value survivors place on these constituent functions. The desirability, importance and subsequent interpretation of individuals' experience of 'return to work' appears to be influenced by the ways in which cancer affects these functions or goals of 'work'. Our synthesis draws these complex elements into a heuristic model to help illustrate and communicate these inter-relationships.

CONCLUSION

The concept of 'return to work' may be overly simplistic, and as a result, misleading. The proposed benefits previously ascribed to 'return to work' may only be achieved through consideration of the specific meaning and role of work to the individual. Interventions to address work-related issues need to be person-centred, acknowledging the work-related outcomes that are important to the individual. A conceptual and operational shift towards supporting survivors to identify and achieve their 'work-related goals' may be more appropriate.

Impact of cancer on work and education among adolescent and young adult cancer survivors

PURPOSE

To examine the impact of cancer on work and education in a sample of adolescent and young adult (AYA) patients with cancer.

PATIENTS AND METHODS

By using the Adolescent and Young Adult Health Outcomes and Patient Experience Study (AYA HOPE)-a cohort of 463 recently diagnosed patients age 15 to 39 years with germ cell cancer, Hodgkin's lymphoma, non-Hodgkin's lymphoma, sarcoma, and acute lymphocytic leukemia from participating Surveillance, Epidemiology, and End Results (SEER) cancer registries-we evaluated factors associated with return to work/school after cancer diagnosis, a belief that cancer had a negative impact on plans for work/school, and reported problems with work/school after diagnosis by using descriptive statistics, χ(2) tests, and multivariate logistic regression.

RESULTS

More than 72% (282 of 388) of patients working or in school full-time before diagnosis had returned to full-time work or school 15 to 35 months postdiagnosis compared with 34% (14 of 41) of previously part-time workers/students, 7% (one of 14) of homemakers, and 25% (five of 20) of unemployed/disabled patients (P < .001). Among full-time workers/students before diagnosis, patients who were uninsured (odds ratio [OR], 0.21; 95% CI, 0.07 to 0.67; no insurance v employer-/school-sponsored insurance) or quit working directly after diagnosis (OR, 0.15; 95% CI, 0.06 to 0.37; quit v no change) were least likely to return. Very intensive cancer treatment and quitting work/school were associated with a belief that cancer negatively influenced plans for work/school. Finally, more than 50% of full-time workers/students reported problems with work/studies after diagnosis.

CONCLUSION

Although most AYA patients with cancer return to work after cancer, treatment intensity, not having insurance, and quitting work/school directly after diagnosis can influence work/educational outcomes. Future research should investigate underlying causes for these differences and best practices for effective transition of these cancer survivors to the workplace/school after treatment.

Awareness and behavior of oncologists and support measures in medical institutions related to ongoing employment of cancer patients in Japan

OBJECTIVE

Improved outcomes of cancer treatment allow patients to undergo treatment while working. However, support from oncologists and medical institutions is essential for patients to continue working. This study aimed to clarify oncologists' awareness and behavior regarding patients who work during treatment, support in medical institutions and their association.

METHODS

A questionnaire was mailed to all 453 diplomates and faculty of the subspecialty board of medical oncology in the Japanese Society of Medical Oncology and all 1016 surgeons certified by the Japanese Board of Cancer Therapy living in the Kanto area. The questionnaire assessed demographics, oncologist awareness and behavior regarding patient employment and support measures at their medical institutions. Logistic regression analysis was used to examine the association of awareness and behavior of oncologists with support measures at their institutions.

RESULTS

A total of 668 individuals participated. The overall response rate was 45.5%. Only 53.6% of respondents advised patients to tell their supervisors about prospects for treatment and ask for understanding. For medical institutions, 28.8% had a nurse-involved counseling program and adjustments in radiation therapy (28.0%) and chemotherapy (41.9%) schedules to accommodate patients' work. There was a significant correlation between awareness and behavior of oncologists and medical institutions' measures to support employed cancer patients.

CONCLUSIONS

There is room for improvement in awareness and behavior of oncologists and support in medical institutions for cancer patients continuing to work. Oncologists could support working patients by exerting influence on their medical institutions. Conversely, proactive development of support measures by medical institutions could alter the awareness and behavior of oncologists.

Early work patterns for gynaecological cancer survivors in the USA

BACKGROUND

Little is known about the balance between work demands and treatment plans for >4.3 million working-age cancer survivors in the USA.

AIMS

To describe changes in work status for gynaecological cancer survivors during the first 6 months following diagnosis and their experience with their employers' programmes and policies.

METHODS

One hundred and ten gynaecological cancer survivors who were working at the time of their cancer diagnosis completed a survey. Case record reviews documented their clinical characteristics and treatment details.

RESULTS

Ninety-five women (86%) had surgery; 81 (74%) received chemotherapy, radiotherapy or both in addition to surgery. Nine per cent of women said that they changed their treatment plan because of their jobs; in contrast, 62% of women said that they changed their work situation to accommodate their treatment plan. Overall, the most common month for women to stop working was Month 1 (41%), to decrease hours was Month 2 (32%) and to increase hours was Month 6 (8%). Twenty-eight per cent of women were aware of employer policies that assisted the return to work process; 70% of women were familiar with the Family and Medical Leave Act (FMLA) and 56% with the Americans with Disabilities Act (ADA). Only 26% completed a formal request for work accommodations. After 6 months, 56 of 83 women (67%) remained working or had returned to work.

CONCLUSIONS

Work patterns varied for these gynaecological cancer survivors over the first 6 months following diagnosis. Opportunities exist to improve communication about work and treatment expectations between cancer survivors, occupational health professionals, employers and treating clinicians.

Social welfare and legal constraints associated with work among breast and prostate cancer survivors: experiences from Ireland

INTRODUCTION

Around 40% of cancer survivors are of working age. We investigated employment outcomes among survivors in Ireland where sick leave and sick pay are at the employers' discretion and the law affords no protection against dismissal following extended absence.

METHODS

A questionnaire was mailed to 1,373 survivors, identified from the National Cancer Registry, 6-24 months post-diagnosis. The analysis included breast and prostate cancer respondents who were working at diagnosis. Factors associated with work continuation post-diagnosis and work resumption after cancer-related absence were identified using logistic regression.

RESULTS

The response rate was 54%. Three hundred forty-six respondents were working at diagnosis (breast cancer = 246; prostate cancer = 100). Sixty-two (18%) continued working post-diagnosis. Factors significantly associated with work continuation were: self-employment, prostate cancer, lower pre-diagnosis household income, and not having surgery. Two hundred eighty-four took time off work post-diagnosis; of these, 51 (18%) had left the workforce, 187 (66%) had resumed working, and 46 (16%) planned to resume working. Factors significantly associated with work resumption were: tertiary education, not having chemotherapy, receiving sick pay, and not having a medical card (which provides free access to public health services). Among those who resumed working, the median absence was 30.1 weeks (inter-quartile range = 12.9-51.6). The length of absence varied significantly by socio-demographic, financial, medical, and job- and social welfare-related factors. Median working hours pre- and post-diagnosis differed significantly (pre-diagnosis = 38/week; post-diagnosis = 30/week; p<0.001).

CONCLUSIONS

The high level of workforce departure and associations between self-employment, sick pay and medical cards, and employment outcomes suggest that social welfare and legal provisions are important determinants of the survivors' workforce participation. IMPLICATIONS FOR SURVIVORS: In formulating strategies to optimise survivors' employment outcomes, it is important that policy- and decision-makers are aware of the influence of social welfare and legal provisions.

Principles of cancer screening: lessons from history and study design issues

Early detection of cancer has held great promise and intuitive appeal in the medical community for well over a century. Its history developed in tandem with that of the periodic health examination, in which any deviations--subtle or glaring--from a clearly demarcated "normal" were to be rooted out, given the underlying hypothesis that diseases develop along progressive linear paths of increasing abnormalities. This model of disease development drove the logical deduction that early detection, by "breaking the chain" of cancer development, must be of benefit to affected individuals. In the latter half of the 20th century, researchers and guidelines organizations began to explicitly challenge the core assumptions underpinning many clinical practices. A move away from intuitive thinking began with the development of evidence-based medicine. One key method developed to explicitly quantify the overall risk-benefit profile of a given procedure was the analytic framework. The shift away from pure deductive reasoning and reliance on personal observation was driven, in part, by a rising awareness of critical biases in cancer screening that can mislead clinicians, including healthy volunteer bias, length-biased sampling, lead-time bias, and overdiagnosis. A new focus on the net balance of both benefits and harms when determining the overall worth of an intervention also arose: it was recognized that the potential downsides of early detection were frequently overlooked or discounted because screening is performed on basically healthy persons and initially involves relatively noninvasive methods. Although still inconsistently applied to early detection programs, policies, and belief systems in the United States, an evidence-based approach is essential to counteract the misleading--even potentially harmful--allure of intuition and individual observation.

Coping with breast cancer: a phenomenological study

BACKGROUND

Breast cancer is the most common malignancy affecting women worldwide. In Lebanon, a country of 4 million people, breast cancer is also the most prevalent type of cancer among Lebanese women.

OBJECTIVE

The purpose of this study was to gain a more in-depth understanding of the coping strategies espoused by Lebanese women with breast cancer.

METHODS

The study followed purposeful sampling and saturation principles in which 10 female participants diagnosed as having breast cancer were interviewed. Data were analyzed following a hermeneutical process as described by Diekelmann and Ironside (Encyclopedia of Nursing Research. 1998:50-68).

RESULTS

Seven main themes and 1 constitutive pattern emerged from the study describing the Lebanese women's coping strategies with breast cancer. The negative stigma of cancer in the Lebanese culture, the role of women in the Lebanese families, and the embedded role of religion in Lebanese society are bases of the differences in the coping strategies of Lebanese women with breast cancer as compared to women with breast cancer from other cultures.

CONCLUSION

These findings cannot be directly generalized, but they could act as a basis for further research on which to base a development of a framework for an approach to care that promotes coping processes in Lebanese women living with breast cancer.

IMPLICATIONS FOR PRACTICE

Nursing and medical staff need to have a better understanding of the individual coping strategies of each woman and its impact on the woman's well being; the creation of informal support group is indispensable in helping these women cope with their conditions.

Returning to work after cancer: quantitative studies and prototypical narratives

OBJECTIVE

A combination of quantitative data and illustrative narratives may allow cancer survivorship researchers to disseminate their research findings more broadly. We identified recent, methodologically rigorous quantitative studies on return to work after cancer, summarized the themes from these studies, and illustrated those themes with narratives of individual cancer survivors.

METHODS

We reviewed English-language studies of return to work for adult cancer survivors through June 2008, and identified 13 general themes from papers that met methodological criteria (population-based sampling, prospective and longitudinal assessment, detailed assessment of work, evaluation of economic impact, assessment of moderators of work return, and large sample size). We drew survivorship narratives from a prior qualitative research study to illustrate these themes.

RESULTS

Nine quantitative studies met four or more of our six methodological criteria. These studies suggested that most cancer survivors could return to work without residual disabilities. Cancer site, clinical prognosis, treatment modalities, socioeconomic status, and attributes of the job itself influenced the likelihood of work return. Three narratives-a typical survivor who returned to work after treatment, an individual unable to return to work, and an inspiring survivor who returned to work despite substantial barriers-illustrated many of the themes from the quantitative literature while providing additional contextual details.

CONCLUSION

Illustrative narratives can complement the findings of cancer survivorship research if researchers are rigorous and transparent in the selection, analysis, and retelling of those stories.

Received and needed social support at the workplace in Norwegian and Finnish stage 1 breast cancer survivors: a study from the Nordic Study Group of Cancer and Work (NOCWO)

BACKGROUND

Cross-cultural studies of comparable patients can identify differences of health care services and point to issues of possible improvement. In this cross-sectional study we compared self-reported received and needed social support at the workplace of disease-free breast cancer survivors (BCSs) stage I from Norway and Finland.

METHODS

Age-matched samples of 135 BCSs from Norway and 148 from Finland were examined using a questionnaire including socio-demographic factors, employment data, measurements of social support at work from supervisors, colleagues and the occupational health service (OHS), and several other measurements.

RESULTS

Finnish BCSs had significantly higher education and a higher rate of full-time employment than Norwegian ones. With adjustment for education and work time, Finnish compared to Norwegian BCSs reported significantly less received social support from supervisors, while they received significantly more social support from OHS. No differences were observed in received support from colleagues between Finnish and Norwegian BCSs. Somatic health was most strongly associated with received and needed support from supervisors, colleagues and OHS.

CONCLUSIONS

The differences in received and needed social support at work observed between Norwegian and Finnish BCSs treated for stage I disease challenge strengthening of OHS for Norwegian BCSs and increased attention by supervisors in Finnish BCSs.

Return to work of breast cancer survivors: a systematic review of intervention studies

Background

Breast cancer management has improved dramatically in the past three decades and as a result, a population of working age women is breast cancer survivor. Interventions for breast cancer survivors have shown improvements in quality of life and in physical and psychological states. In contrast, efforts aimed at stimulating re-employment and return-to-work interventions for breast cancer survivors have not kept pace. The objective of this review was to study the effects and characteristics of intervention studies on breast cancer survivors in which the outcome was return to work.

Methods

The Cochrane Controlled Trials Register (The Cochrane Library, Issue 4, 2006), Medline, Ovid, EMBASE and PsychInfo were systematically searched for studies conducted between 1970 to February 2007. Intervention studies for female breast cancer survivors that were focused on return to work were included.

Results

Our search strategy identified 5219 studies. Four studies out of 100 potentially relevant abstracts were selected and included 46–317 employed women who had had mastectomy, adjuvant therapy and rehabilitation, with the outcome return to work. The intervention programs focused on improvement of physical, psychological and social recovery. Although a substantial percentage (between 75% to 85%) of patients included in these studies returned to work after rehabilitation, it is not clear whether this proportion would have been lower for patients without counseling or exercise, or any other interventions, as three out of four studies did not include a comparison group.

Conclusion

The most important finding of this review is the lack of methodologically sound intervention studies on breast cancer survivors with the outcome return to work. Using evidence from qualitative and observational studies on cancer and the good results of intervention studies on return to work programs and vocational rehabilitation, return to work interventions for breast cancer survivors should be further developed and evaluated.