Supporting the Return to Work of Breast Cancer Survivors: From a Theoretical to a Clinical Perspective

Return to work and psychosocial trajectories after breast cancer: a longitudinal and sequential approach

PURPOSE

We aimed to describe the psychosocial adjustments according to return to work (RTW) trajectories in breast cancer survivors (BCS) using a sequential and temporal approach.

METHODS

We used BCS data included from February 2015 to April 2016 in the Longitudinal Study on Behavioural, Economic and Sociological Changes after Cancer (ELCCA) cohort. RTW trajectories were identified using the sequence analysis method followed by a clustering. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale and the EORTC quality of life questionnaire was used at inclusion and all follow-up visits to assess Health-Related Quality of Life (HRQoL).

RESULTS

Fifty-two BCS were included in the study among whom four clusters of RTW trajectories were identified and labeled: slow RTW (N = 10), quick RTW (N = 27), partial RTW (N = 8), and part-time work (N = 7). Quick and slow RTW clusters showed slightly lower baseline mean levels of anxiety and higher levels of HRQoL. In the 4 years following diagnosis, BCS in the quick RTW cluster tended to report higher HRQoL in terms of functioning and less symptoms of pain and fatigue while those in the partial RTW cluster showed a lower HRQoL on almost all dimensions. All clusters showed an increase in pain and fatigue symptoms until 6 months followed by a tendency to recover baseline levels.

CONCLUSIONS

The results of this study suggest that BCS who return to full-time work (slow and quick RTW patterns) recover better than patients who return to part-time work (partial and part-time RTW patterns).

Comparison of Machine Learning Methods in the Study of Cancer Survivors' Return to Work: An Example of Breast Cancer Survivors with Work-Related Factors in the CONSTANCES Cohort

PURPOSE

Machine learning (ML) methods showed a higher accuracy in identifying individuals without cancer who were unable to return to work (RTW) compared to the classical methods (e.g. logistic regression models). We therefore aim to discuss the value of these methods in relation to RTW for cancer survivors.

METHODS

Breast cancer (BC) survivors who were working at diagnosis within the CONSTANCES cohort were included in the study. RTW was assessed five years after the BC diagnosis (early retirement was considered as non-RTW). Age and occupation at diagnosis, and physical occupational job exposures assessed using the Job Exposure Matrix, JEM-CONSTANCES, were evaluated as predictors of RTW five years after BC diagnosis. The following four ML methods were used: (i) k-nearest neighbors; (ii) random forest; (iii) neural network; and (iv) elastic net.

RESULTS

The training sample included 683 BC survivors (RTW: 85.7%), and the test sample 171 (RTW: 85.4%). The elastic net method had the best results despite low sensitivity (accuracy = 76.6%; sensitivity = 31.7%; specificity = 90.8%), and the random forest model was the most accurate (= 79.5%) but also the least sensitive (= 14.3%).

CONCLUSION

This study takes a first step towards opening up new possibilities for identifying the occupational determinants of cancer survivors' RTW. Further work, including a larger sample size, and more predictor variables, is now needed.

Prospective evaluation of return to work, health-related quality of life and psychosocial distress after radical cystectomy: 1-year follow-up in 230 employed German bladder cancer patients

PURPOSE

To evaluate return to work (RTW), health-related quality of life (HRQoL) and psychosocial distress (PD) after radical cystectomy (RC) and creation of an ileal conduit (IC) or an orthotopic ileal neobladder (NB) for bladder cancer.

METHODS

The study relied on prospectively collected data for 842 patients, who underwent 3 weeks of inpatient rehabilitation (IR) after surgery between April 2018 and December 2019. HRQoL (EORTC QLQ-C30) and PD (Questionnaire on Stress in Cancer Patients [QSC-R10]) were evaluated at the beginning (T1) and end (T2) of IR as well as both 6 (T3) and 12 months after surgery (T4). Regression analyses were performed to identify predictors of HRQoL and RTW, respectively.

RESULTS

Two hundred thirty patients (IC n = 51, NB n = 179) were employed before surgery (27.3%). HRQoL improved steadily, while high PD was present in 51.0% of patients at T4. RTW rate was 86.8 and 80.6% at T3 and T4, respectively. Linear regression analysis identified RTW as the only predictor for better HRQoL at T4 (OR [odds ratio] 12.823, 95% CI [confidence interval] 2.927-22.720, p = 0.012). Multivariate regression analysis identified age ≤ 59 years (OR 7.842; 95% CI 2.495-24.645; p < 0.001) as an independent positive predictor and lymph node metastasis (OR 0.220; 95% CI 0.054-0.893; p = 0.034) as an independent negative predictor of RTW at T4.

CONCLUSION

Global HRQoL improved steadily during the follow-up and RTW rates are high. However, patients often reported high PD, reflecting a need for additional psychosocial support within aftercare.

Return-to-work self-efficacy questionnaire: Cross-cultural adaptation and validation in China

AIM

To develop a Chinese version of the return-to-work self-efficacy (RTW-SE-11) and verify its reliability and validity.

DESIGN

A validation study.

METHODS

The RTW-SE-11 was translated into Chinese according to the Brislin's model, and then the semantic adjustment of questionnaire was carried out through multi-field expert evaluation and preliminary investigation.

RESULTS

All 11 items of the original questionnaire were retained. Content validity index (CVI) of the Chinese version of RTW-SE-11 indicated good validity, with Inter-rater Agreement (IR) of 0.97, item CVI of 0.90-1.00 and questionnaire CVI of 0.91. Cronbach's α coefficient of RTW-SE-11 (Chinese version) was 0.923, suggesting high internal consistency, with test-retest reliability of 0.799 and half-fold reliability of 0.926. Patient or public contribution: The Chinese version of the RTW-SE-11 questionnaire confirmed good reliability and validity for the assessment of return to work self-efficacy in Chinese breast cancer patients.

Supporting Return to Work after Breast Cancer: A Mixed Method Study

Breast cancer (BC) is the most common invasive cancer in the world. Most BC survivors (BCSs) continue working while dealing with cancer-related disabilities. BCSs' return-to-work (RTW) after cancer treatment is an important stage of their recovery and is associated with a higher survival rate. In this study, we addressed the RTW of BCSs with the intention of facilitating this process through direct action in the workplace. Thirty-two women who requested assistance from January to December 2022 were enrolled in the study. Semi-structured interviews and medical examinations were conducted by a team of three physicians. Interviews were analyzed using Thematic Analysis. Moreover, a quantitative cross-sectional study was conducted to compare the health status of BCSs with that of a control group of 160 working women, using standardized questionnaires on work ability, fatigue, sleep problems, anxiety, depression, and happiness. BCSs were also asked to rate the level of organizational justice they perceived at work prior to their illness. From the qualitative analysis emerged three facilitating/hindering themes: (1) person-related factors, (2) company-related factors, and (3) society-related factors. In the quantitative analysis, BCSs had significantly higher scores for anxiety, depression, sleep problems and fatigue, and lower levels of happiness than controls. The RTW of BCSs entails adapting working conditions and providing adequate support. The work-related analysis of each case made it possible to highlight the measures that need to be taken in the workplace to promote RTW. The treatment of cancer should be paired with advice on the best way to regain the ability to work.

Supporting the return to work of breast cancer survivors: perspectives from Canadian employer representatives

PUR POSE: A significant proportion of women with breast cancer want to RTW (return to work) after treatment. Employers play a key role in facilitating RTW for these employees who face distinct challenges. However, the portrait of these challenges remains to be documented from the perspective of employer representatives. The purpose of this article is to describe the perceptions of Canadian employer representatives regarding the management of the RTW of BCSs (breast cancer survivors).

METHODS

Thirteen qualitative interviews were conducted with representatives from businesses of various sizes (< 100 employees, 100-500 employees, > 500 employees). Transcribed data were subjected to iterative data analysis.

RESULTS

Three major themes emerged to describe employer representatives' perceptions of managing RTW of BCS. These are (1) providing tailored support; (2) remaining 'human' while managing RTW; and (3) facing the challenges of RTW management after breast cancer. The first two themes were perceived as facilitating RTW. The challenges identified concern uncertainty, communication with the employee, maintaining a supernumerary work position, balancing employee and organizational interests, reconciling with colleagues' complaints, and collaboration among stakeholders.

CONCLUSIONS

Employers can adopt a humanistic management style by offering flexibility and increased accommodation for BCS who RTW. They can also be more sensitive to this diagnosis, leading some to seek more information from those around them who have experienced it. Employers require increased awareness about diagnosis and side effects, be more confident to communicate, and improved collaboration between stakeholders to facilitate the RTW of BCS.

IMPLICATIONS FOR CANCER SURVIVORS

Employers who focus on the individual needs of cancer survivors during RTW can facilitate creative and personalized solutions for a sustainable RTW and help survivors recover their lives after cancer.

Accompagner la vie professionnelle des personnes suivies en cancérologie : une expérience en centre de lutte contre le cancer

Le maintien ou le retour à l’emploi pour les personnes atteintes d’un cancer est un enjeu majeur. Une personne sur cinq est en perte d’emploi à cinq ans du diagnostic. La problématique est complexe, en lien avec les conséquences de la maladie, des traitements, des connaissances partielles des dispositifs d’aide et des particularités socioprofessionnelles. Tout d’abord, une mise au point sur l’état des lieux en France est faite, pour comprendre la situation sur le plan démographique, les conséquences matérielles et psychologiques. Ensuite, l’article retrace l’expérience d’un centre de lutte contre le cancer dans la mise en place d’un dispositif d’accompagnement de la vie professionnelle des personnes suivies en cancérologie. Ce projet s’appuie sur plusieurs travaux d’enquêtes préalables et fait l’objet d’une aide à la mise en place grâce à une subvention de l’Institut national du cancer. Il s’articule autour de trois axes : ceux des professionnels, des patients et de l’entreprise. Enfin, la synthèse des travaux entrepris tente de dresser des recommandations transférables aux établissements accueillant des personnes atteintes de cancer.

Enjeux psychologiques du retour à l’emploi après un cancer : illustrations autour de deux cas cliniques

Du fait des changements tant physiques que psychologiques induits par la maladie et les traitements oncologiques, le retour au travail après un cancer peut être perçu comme un véritable enjeu pour les patients. Étant donné la prédominance des questionnements, les ajustements psychologiques nécessaires et les diverses possibilités de réorganisation du temps de travail, les patients peuvent régulièrement solliciter ou être orientés vers une consultation psychologique pour aborder le retour à leur emploi. Cette thématique, parfois présente dès le début de la prise en charge médicale, nécessite d’être prise en considération par les professionnels de santé, et ce à tout moment du parcours de soins. Il convient pour ces derniers d’avoir une certaine connaissance des dispositifs d’aides proposés pour pouvoir orienter au mieux les patients. Cela peut faciliter le sentiment de légitimité quant à leurs interrogations et à leur vécu émotionnel, permettant ainsi de les aider à se réajuster. C’est pourquoi la stratégie décennale de lutte contre les cancers 2021–2030 a parmi ses ambitions celle de réduire les séquelles liées au cancer et prévoit ainsi des évolutions pour proposer des dispositifs du droit du travail et de la sécurité sociale plus adaptés. Ces évolutions montrent bien que les enjeux pour les patients s’insèrent dans une dimension plus globale, dans laquelle le milieu hospitalier et les employeurs sont notamment impliqués, ce qui en fait un enjeu sociétal. Afin de mettre en perspective ces enjeux, cet article présente deux situations cliniques de patientes, actuellement en rémission d’un cancer du sein, ayant été suivies sur le plan psychologique et dont la question du retour à l’emploi a été un sujet important dans la prise en charge globale de leur pathologie.

Patient engagé : faire de mon expérience une réelle opportunité

L’accompagnement professionnel des patients en âge de travailler est d’une importance de santé publique majeure en cancérologie. Toutefois, qu’ils reprennent le travail ou non, la priorité reste de préserver leur qualité de vie. D’ailleurs, pour certains patients, un arrêt de la carrière professionnelle peut avoir lieu au profit d’un engagement associatif et/ou auprès des services de soin et de recherche scientifique. Il s’agit d’un vrai retour à l’activité qui peut être également synonyme de tremplin professionnel lorsque les patients concernés sont en mesure de se construire une nouvelle trajectoire professionnelle en cumulant leurs compétences professionnelles initiales et leurs savoirs expérientiels acquis ; tel est l’éclairage que nous souhaitons apporter dans cet article, à l’aide d’une étude de cas. De nouvelles questions de recherche seront proposées.

Proceedings of the International Scientific Conference “Cancer, Work & Employment”

This paper is an overview of the International Scientific Conference on “Cancer, Work & Employment” that was held in Paris on November 21 and 22, 2022, and organized by the French National Cancer Institute (INCa). The conference was structured around four keynote presentations and two roundtables, with renowned international speakers. The focus of this conference was to discuss the challenges of return or access to work and job retention when facing cancer, from interdisciplinary perspectives (e.g., psychology, sociology, economics). Speakers analyzed return-to-work (RTW) determinants for cancer patients, with a particular focus on specific forms of cancer, working conditions (e.g., self-employment, adaptations at work when returning), and the influence of differences in social welfare systems. Current interventions to support RTW were analyzed, from the patient’s point of view and in terms of improving healthcare professionals’ practices. Prospects for future research in the field were also discussed (e.g., focus on underrepresented populations, considering the influence of longer treatments, incorporating changes in career paths). Finally, the broad spectrum of disciplines and the diversity in involved countries offered a rare opportunity to exchange ideas and helped initiate collaboration between participants.

Cancer survivors and adverse work outcomes: associated factors and supportive interventions

INTRODUCTION

The number of cancer survivors in a working age is rising. An awareness of factors associated with adverse work outcomes, and of supportive interventions, is needed.

SOURCES OF DATA

A narrative review of research obtained via several databases, including Medline and PsycINFO, was conducted.

AREAS OF AGREEMENT

A range of factors is associated with adverse work outcomes such as prolonged sick leave, delayed return to work, disability pension and unemployment in cancer survivors. They include the cancer type and treatment, fatigue, cognitive functioning, work factors and elements of health care systems. Effective supportive interventions encompass physical and multicomponent interventions.

AREAS OF CONTROVERSY

The role of behaviour determinants and legislative and insurance systems is unclear. It is furthermore uncertain what the optimal timing of delivering supportive interventions is.

GROWING POINTS

Further focus on vulnerable groups, including specific cancer types and those with lower income, lower educational level and in precarious employment, is needed.

AREAS TIMELY FOR DEVELOPING RESEARCH

Recent developments are tailored and timely interventions.

Self-Management About Adjuvant Therapy in Breast Cancer Survivors: A Qualitative Study

OBJECTIVE

This study aims to describe the experience and connotations of self-management about adjuvant therapy (AT) in Chinese breast cancer survivors (BCS) and explore possible factors that affect their self-management level.

METHODS

Semi-structured interviews were conducted in postoperative BCS undergoing AT using a qualitative description method. The conceptual structure and connotations were extracted after researchers collected and coded interview transcripts.

RESULTS

After interviewing 29 patients, the conceptual framework of self-management in BCS during AT was optimized with three major themes: medical-related, emotion, and role management. Medical-related management includes AT-related adverse reactions; medical cooperation and knowledge acquisition; recovery and protection of affected limb; medical compliance; body image; sexual function and fertility; healthy lifestyle; catheter daily protection; and AT-related financial burdens. Emotion management includes recognition, prevention, and regulation of negative emotions. Role management consists of three aspects: family role, social role, and work role.

CONCLUSION

The conceptual structure and connotations formed in this study can help researchers to evaluate and intervene in the self-management ability of BCS during AT, so as to formulate the best model of care to improve their quality of life and clinical outcomes.