[Interventions to support the return-to-work process after cancer: a literature review]

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.

Effectiveness of Physical Activity Interventions on Return to Work After a Cancer Diagnosis: A Systematic Review and Meta-analysis

Purpose The aim of this study was to assess the effectiveness of physical activity (PA) interventions on return to work (RTW) in cancer survivors, compared to usual care, and to determine the dose of PA needed to improve this outcome. Methods A systematic review and meta-analysis were conducted according to PRISMA guidelines. Six electronic databases including PubMed, Embase, Web of Science, CENTRAL, PsycINFO, and Scopus were searched to identify studies, and completed by a search of grey literature and health organization websites. Two authors performed screening, selection, and data extraction independently. Study and intervention characteristics were extracted and summarized. Pooled risk ratio (RR) was estimated using a weight random-effects model with 95% confidence intervals (CIs). Results A total of 2655 records were identified, of which 8 intervention studies were included. The sample size of the included studies varied between 41 and 240, giving a total of 1087 participants aged between 18 and 75 years. Compared with usual care, PA interventions had a significant positive effect on RTW among cancer survivors with a pooled RR of 1.29 (95% CI 1.17, 1.42). We found that PA interventions (aerobic and resistance exercises) with an exercise dose between 7.6 METs.h/week and 15 METs.h/week, consisting in 50-60 min per session of moderate to vigorous physical exercise, twice a week seems relevant in improving RTW. Conclusions Our results showed, with moderate quality evidence that PA interventions are more effective than usual care in increasing the rate of RTW in cancer survivors. SYSTEMATIC REVIEW REGISTRATION: PROSPERO Registration Number, CRD42020203614.

Informing the development of multidisciplinary interventions to help breast cancer patients return to work: a qualitative study

PURPOSE

Return to work (RTW) after breast cancer (BC) can be a major challenge for patients. Multidisciplinary interventions seem to be effective but the role of digital solutions is under-developed and therefore not evaluated. We explored the preferences, needs, and barriers regarding RTW interventions, including opinions about the use of digital approaches to deliver such interventions.

METHODS

We conducted a qualitative study based on interviews with 30 patients with BC and 18 healthcare providers in four French regions. Emergent themes were identified using thematic content analysis.

RESULTS

Most providers declared that they did not proactively address RTW with patients, mainly due to having other priorities and a lack of knowledge. The following themes emerged: several development and deployment barriers regarding RTW interventions exist, multidisciplinary interventions are preferred, and there is a need to maintain contact between the patient and workplace during sick leave, including pathways and interlocutors that can facilitate RTW. Participants had mostly positive representations of using digital tools to facilitate RTW; however, fear of loss of human contact and the exacerbation of inequalities were identified as possible risks associated with the development of digital-only interventions.

CONCLUSIONS

Interventions blending the needs and preferences of patients with BC and the healthcare system are warranted. A personalized multimodal approach with mixed digital and in-person features has surfaced as a possible solution to address the weaknesses of existing interventions.

IMPLICATIONS FOR CANCER SURVIVORS

Since most women work at the time of diagnosis, it is of particular relevance to build interventions promoting RTW.

A systematic review of work-related interventions for breast cancer survivors: Potential contribution of occupational therapists

BACKGROUND: A high number of breast cancer survivors need to resume work. Therefore, interventions aimed at effective work-related transitions are important. OBJECTIVE: A systematic review to determine what occupational therapy interventions are effective in work-related transitions of breast cancer survivors. METHODS: Multiple databases were searched for studies on work-related interventions within the scope of occupational therapy. Studies were included if 70% or more study participants were working age (> 18 years) breast cancer survivors, and work-related transition outcome measures were used. RESULTS: The search yielded 2 872 articles, of which 12 met the inclusion criteria. When classified according to the International Classification of Function Framework, quantitative sources focussed on Body Structures and Functions component and Multicomponents (consists of the Body Structures and Functions Component and the Activities Component) showed positive effects on improving the work-related transitions of BC survivors, however, the effects were statistically insignificant and the strength of evidence was moderate. Participants in a qualitative source reported that after they underwent a physical exercise programme their work performance improved. A Multicomponents intervention study showed statistically significant improvements on self-reported work-related outcomes of BC survivors. Low evidence was found for implementing a vocational rehabilitation case management programme targeting the Activities component, which showed positive effects in reducing the sick leave days of BC survivors, but the effects were statistically insignificant. No evidence was found for programmes focussed on restoring the Participation component. CONCLUSION: The evidence included in this systematic review were insufficient to recommend occupational therapy interventions that are effective (showing statistically significant improvements) for work-related transitions of BC cancer survivors.

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

Promoting the return to work of breast cancer survivors is of major interest to patients, healthcare and occupational health professionals, companies, governments, and researchers worldwide. We previously conducted a French consensus study resulting in a model describing the multifactorial process of the return to work of breast cancer survivors (the REWORK-BC model). Other work has identified the transtheoretical model as a relevant theoretical framework for interventions to promote the return to work of cancer survivors. In this opinion paper, we provide a theoretically-based clinical framework describing how to support breast cancer survivors at each stage of the return-to-work process. This clinical framework considers several essential aspects of supportive care for breast cancer survivors returning to work, such as: (i) helping the patient actively self-manage, by considering her to be the main decision-maker; (ii) respecting and adapting to the patient’s choice of professional project; (iii) respecting the temporality of the patient’s choices; (iv) proposing tailored interventions; (v) implementing simple tools to promote the return to work, shared representation between the patient and a multidisciplinary team, and improvement of working conditions and the knowledge of health and occupational professionals, and managers or employers; and (vi) maintaining certain flexibility aimed at proposing, but never imposing, changes in practices. This clinical framework, specific to breast cancer survivors, could be extrapolated to other tumor types, offering a practical guide for healthcare and occupational health professionals to better understand the return-to-work process of cancer survivors. This clinical framework aims to be a usable tool for any hospital or cancer care center wishing to implement a patient-centered intervention that promotes returning to work, regardless of the country.

Return to work of breast cancer survivors: toward an integrative and transactional conceptual model

Purpose

To propose a conceptual framework of the return to work (RTW) of breast cancer survivors (BCS) according to the transactional perspective.

Methods

The Technique for Research of Information by Animation of a Group of Experts was implemented. For each determinant in an initial list established from the literature, experts selected for the consensus exercise were firstly asked to indicate their agreement level individually, via an online questionnaire. Determinants obtaining an agreement level of 80% or over during this first phase were retained. Determinants obtaining an agreement level below 80%, and additional determinants proposed by the experts, were then discussed collectively. After discussion, experts voted via a new online questionnaire to retain (or not) each determinant. Determinants obtaining an agreement level of 80% or over after this second phase were retained. Based on the determinants selected, a conceptual model was developed following the transactional approach.

Results

Eleven experts participated in the study. Forty of the 51 determinants listed initially from the literature achieved an agreement level over 80%, and 20 were added after the individual consultation phase. Twenty-two of the 31 determinants discussed collectively were retained. In total, 62 determinants were selected to construct the conceptual model.

Conclusions

This integrative, operational, and transactional conceptual model of the RTW of BCS, constructed following an expert consensus, will help to design more efficient patient-centered intervention studies.

Implications for Cancer Survivors

Identification of the 62 determinants associated with the RTW of BCS will help design tools that are easily used by all stakeholders involved in the RTW process.

Faciliter et soutenir le retour au travail après un cancer du sein : partenariat chercheurs-acteurs dans un processus de modélisation d’une intervention

Introduction :

La reprise du travail après un cancer favorise le rétablissement de la participation sociale mais se heurte à différents obstacles. Le projet FASTRACS vise à développer, implanter et évaluer une intervention pour faciliter le maintien en emploi après un cancer du sein. Le développement de l’intervention repose sur le protocole de l’Intervention Mapping. L’objectif de cet article est de décrire les contributions du partenariat chercheurs-acteurs dans le processus de modélisation de l’intervention durant les étapes du protocole de l’Intervention Mapping.

Méthodes :

Le processus de développement de l’intervention est reconstitué de façon chronologique en décrivant les méthodes mobilisées et les résultats obtenus à chaque étape du protocole grâce au partenariat chercheurs-acteurs.

Résultats :

Les membres du Comité stratégique (COS) ont été choisis par échantillonnage théorique parmi quatre catégories d’acteurs concernées. Une charte a été coécrite pour structurer durablement le partenariat. Les membres du COS ont contribué à l’échantillonnage des participants à l’enquête qualitative d’évaluation des besoins et à l’interprétation des résultats. Les objectifs de l’intervention ont été hiérarchisés selon leur importance et leur faisabilité perçues. Les chercheurs et membres du COS ont évalué les outils de l’intervention et débattu sur le modèle logique de l’intervention. Les professionnels de santé participant au COS ont facilité l’adhésion des équipes d’oncologie participant à l’intervention.

Discussion :

La construction du partenariat a permis de modifier les représentations des chercheurs. L’établissement de relations de confiance a nécessité du temps et de partager ses limites. Il a été difficile d’intégrer des patientes socialement défavorisées. Le recours accru à des patientes-expertes devrait être encouragé.

Conclusion :

La construction d’un partenariat de recherche collaborative entre chercheurs et acteurs nécessite du temps, des méthodes, et des financements dédiés. Cet investissement est de nature à améliorer la pertinence, l’acceptabilité, la légitimité et la pérennité des interventions développées.

The positive effect of workplace accommodations on the continued employment of cancer survivors five years after diagnosis

PURPOSE

To address the gap highlighted in the literature on the effect of professional interventions to facilitate continued employment, this study aims to evaluate the effect of workplace accommodations on the continued employment 5 years after a cancer diagnosis.

METHODS

This study is based on VICAN5, a French survey conducted in 2015-2016 to examine the living conditions of cancer survivors 5 years after diagnosis. Two subsamples, one with and one without workplace accommodations, were matched using a propensity score to control for the individual, professional, and medical characteristics potentially associated with receipt of workplace accommodations.

RESULTS

The study sample was composed of 1514 cancer survivors aged 18-54 and employed as salaried at diagnosis. Among them, 61.2% received workplace accommodations within 5 years after diagnosis: 35.5% received a modified workstation, 41.5% received a modified schedule, and 49.2% received reduced hours. After matching, receipt of workplace accommodations appeared to improve the continued employment rate 5 years after cancer diagnosis from 77.8% to 95.0%.

CONCLUSIONS

Receipt of workplace accommodations strongly increases the continued employment of cancer survivors 5 years after diagnosis. More research is needed to better understand the differences in receipt of workplace accommodations along with the related selection effect.