Qualitative Assessment of Perceived Organizational Support for Employed Breast Cancer Survivors

OBJECTIVE

A more detailed understanding of unmet organizational support needs and workplace-based best practices for supporting cancer survivors is needed.

METHODS

Ninety-four working breast cancer survivors responded to an open-ended survey question regarding the desired types of organizational support that were and were not received during early survivorship. We performed content-analysis of qualitative data.

RESULTS

Major themes included instrumental support, emotional support, and time-based support. The need for flexible arrangements and reduced workloads was mostly met. Unmet needs included navigation/coordination, understanding/empathy, and time off for treatment and recovery.

CONCLUSIONS

Organizational support can help cancer survivors manage their health and work roles, diminishing work-health conflict and turnover intent. Study findings can be used to design targeted interventions to fulfill cancer survivors' unmet organizational support needs, which may also apply to workers with other chronic health conditions.

Precarious Work Schedules and Sleep: A Study of Unionized Full-Time Workers

Unlike precarious employment which is temporary and insecure, with inadequate pay, benefits, and legal protections, precarious work schedules can affect workers with permanent full-time jobs in sectors where employment has historically been secure, well-compensated, and even unionized. Precarious work schedules - characterized by long shifts, non-daytime hours, intensity and unsocial work hours - are increasingly prevalent. Relations between precarious work schedules and poor health are not well understood, and less is known about how to attenuate this relation. We examined the indirect effects of precarious work schedules on fatigue and depressive symptoms through sleep quantity. Two moderators - schedule flexibility and sleep quality - were examined as buffers of these associations. Workers from the Departments of Correction and Transportation in a northeast state (N = 222) took surveys and reported on demographics, work schedule characteristics, schedule flexibility, sleep quality and quantity, fatigue, and depressive symptoms. Results revealed that precarious work schedules had indirect effects on fatigue and depressive symptoms through sleep quantity. Schedule flexibility moderated the relation between precarious work schedules and sleep quantity, such that workers with greater schedule flexibility had more hours of sleep. Sleep quality moderated the association between sleep quantity and fatigue and depressive symptoms, such that workers reported greater fatigue and depressive symptoms when they had poorer sleep quality. Findings have direct applicability for developing initiatives that enhance Total Worker Health® through individual and organizational changes.

Supplementary Information

The online version contains supplementary material available at 10.1007/s41542-022-00114-y.

Working Time Characteristics and Mental Health among Corrections and Transportation Workers

OBJECTIVES

Mental health disorders are a leading cause of work disability and while the psychosocial workplace environment plays a critical role, working time characteristics are also implicated. We sought to examine the association between working time characteristics and mental health in a cohort of two unionized, full-time worker populations, correctional supervisors, and transportation maintainers.

METHODS

Using a cross-sectional study design, we surveyed workers on working time characteristics across seven domains including length of the shift, the intensity or proximity of sequential shifts, the time of day, and social aspects of work hours including predictability, variability, control, and free time. Burnout symptoms (Oldenburg Burnout Inventory) and depressive symptoms (eight-item Centers for Epidemiologic Studies Depression Scale) were assessed along with the psychosocial work environment and health behaviors. We used log-binomial regression models to estimate prevalence ratios and 95% confidence intervals after adjusting for age, gender, and company.

RESULTS

A total of 318 workers were surveyed. The majority (72%) of workers reported a fixed shift. The prevalence of burnout symptoms was higher among workers reporting more frequent shift intensity (working 6 or more days in a row) (PR: 1.15, 95% CI: 1.01, 1.31; P = 0.04). Low psychological demands and high worker social support were associated with fewer burnout symptoms, independent of working time characteristics. The prevalence of depressive symptoms was higher in workers reporting more frequent unpredictable work (PR: 1.17, 95% CI: 1.01, 1.35; P = 0.04) and was lower among workers reporting increased schedule control (PR: 0.86, 95% CI: 0.77, 0.96; P = 0.01). Higher worker social support as well as sufficient sleep and adequate exercise were associated with fewer depressive symptoms, independent of working time characteristics.

CONCLUSIONS

Different working time characteristics were associated with work-related mental health (i.e. burnout) as well as general mental health (i.e. depressive symptoms). Work intensity was associated with the prevalence of burnout symptoms and the results suggest that the mechanism may be through the need for recovery from the psychosocial exposures of work. Both schedule control and predictability were associated with depressive symptoms and the results suggest that work-life imbalance and lack of recovery may be implicated. Comprehensive prevention policies that consider work organization along with the psychosocial work environment and work-life balance may help to improve workers' mental health.

Perceptions of clinical support for employed breast cancer survivors managing work and health challenges

PURPOSE

A substantial portion of breast cancer survivors are active in the workforce, yet factors that allow survivors to balance work with cancer management and to return to work are poorly understood. We examined breast cancer survivors' most valued/desired types of support in early survivorship.

METHODS

Seventy-six employed breast cancer survivors answered an open-ended survey question assessing the most valued/desired support to receive from healthcare providers during early survivorship to manage work and health. Cutrona's (Journal of Social and Clinical Psychology 9:3-14, 1990) optimal matching theory and House's (1981) conceptualization of social support types informed our analyses. Data were content-analyzed to identify themes related to support, whether needed support was received or not, and the types of healthcare providers who provided support.

RESULTS

We identified six themes related to types of support. Informational support was valued and mostly received by survivors, but they expected more guidance related to work. Emotional support was valued but lacking, attributed mainly to providers' lack of personal connection and mental health support. Instrumental (practical) support was valued but received by a small number of participants. Quality of life support to promote well-being and functionality was valued and often received. Other themes included non-specific support and non-support.

CONCLUSIONS

This study expands our understanding of how breast cancer survivors perceive work-related support from healthcare professionals. Findings will inform targeted interventions designed to improve the support provided by healthcare professionals.

IMPLICATIONS FOR CANCER SURVIVORS

Breast cancer survivors managing work and health challenges may benefit by having their unmet support needs fulfilled.

Investigating the relationship between working time characteristics on musculoskeletal symptoms: a cross sectional study

How working hours are organized can have a substantial effect on workers' health. Using a questionnaire and cross-sectional study design, we evaluated the relationship between working time characteristics, job demands, and health behaviors on musculoskeletal symptoms among 316 Department of Transportation (N = 174) and Department of Corrections (N = 142) workers. Low schedule control was associated with neck/shoulder musculoskeletal symptoms (prevalence ratio: 1.20, 95% confidence interval: 1.06-1.34, p < 0.01), and working long (>48 hours per week) hours more frequently was associated with leg/foot musculoskeletal symptoms (prevalence ratio: 1.26 95% confidence interval: 1.06-1.50, p = 0.02). Some working time characteristics were associated with musculoskeletal symptoms, and should be taken into consideration as part of interventions to prevent musculoskeletal disorders and promote health of workers.

Prophylaxis to avert exacerbation/relapse of multiple sclerosis in affected patients undergoing surgery. Surgical observations and recommendations

To provide the neurological and neurosurgical communities with case evidence of postoperative multiple sclerosis (MS) relapse, literature review to support operative stress-induced relapse and recommendations for perioperative prophylaxis to prevent relapse in patients undergoing surgery. Two case studies are presented with recommendations based on an extensive review of the medical literature and personal experience to support perioperative prophylactic suggestions. Both patients fully recovered to preoperative functional status after treatment. We now routinely implement perioperative prophylaxis to MS patients undergoing surgery at our institution with no complications to date. Perioperative prophylaxis in patients with MS undergoing surgery can prevent relapse. It is of utmost importance that the surgical community realizes that prophylactic treatment is available and should be utilized during elective and emergent surgical situations.

Chiasmal compression from fat packing after transsphenoidal resection of intrasellar tumor in two patients

After transsphenoidal resection of a pituitary (or other) tumor, the remaining intrasellar cavity, and sphenoid sinus are usually packed with exogenous fat or muscle to prevent cerebrospinal leak and prolapse of the optic chiasm into an empty sella. We treated two patients in whom chiasmal compression occurred postoperatively because of packing of fat. In one patient, the expected visual improvement in the postoperative period was suboptimal. The subsequent removal of fat resulted in total visual recovery. In the other patient, chiasmal compression persisted from intrasellar fat and residual tumor. Iatrogenic compression of the optic nerves or chiasm should be considered in all patients in whom visual recovery is incomplete.

The course of lymphocytic hypophysitis

A 27-year-old woman presented to our institution in her seventh month of pregnancy with complaints of headache and visual field disturbance. Workup revealed bitemporal hemianopia, a markedly enlarged pituitary gland on computed tomography scan, and biochemical evidence of partial hypopituitarism. At surgery, a biopsy specimen of the pituitary gland was taken revealing lymphocytic hypophysitis. The patient was treated with steroids and replacement doses of thyroid hormone. Visual fields improved postoperatively. A repeat computed tomography scan obtained 2 months after an uneventful pregnancy showed that her pituitary had regained normal size and contour. Over the next 9 months she had gradual recovery of all pituitary function. This case allowed us to follow and document the course of lymphocytic hypophysitis from its presentation as a macroadenoma with partial hypopituitarism to full recovery of both size and hormonal function of the pituitary. Lymphocytic hypophysitis should be considered in the differential diagnosis of a pituitary mass or pituitary dysfunction presenting in pregnancy. In patients with suspected lymphocytic hypophysitis and a pituitary mass, a trial of steroids may be therapeutic.

Intradural disc herniations in the cervical, thoracic, and lumbar spine: report of three cases and review of the literature

The clinical, neuroradiological, and surgical management of three cases of intradural disc herniations--one each in the cervical, thoracic, and lumbar regions--are presented. Intradural disc herniations comprise only 0.27% of all herniated discs. Three percent occur in the cervical, 5% in the thoracic, and 92% in the lumbar spinal canal. Those with cervical or thoracic lesions frequently exhibit profound myelopathy, whereas those with lumbar lesions demonstrate radicular or cauda equina syndromes. Although varying combinations of the MRI, non-contrast CT, myelogram, and myelo-CT scans may at times fail to accurately establish the diagnosis of an intradural disc herniation prior to surgery, the index of suspicion raised by the lack of clinical correlation with surgical findings justifies an intradural exploration.

Primitive neuroectodermal tumor presenting as a delayed sequela to cranial irradiation and intrathecal methotrexate

A patient developed a primitive neuroectodermal tumor (PNET) many years after therapeutic cerebral radiation and methotrexate treatment for leukemia. The differential radiologic and histologic diagnoses, as well as the possible co-oncogenic effects of radiation and methotrexate, are evaluated.

Extensive surgical excision of large hemispheric "malignant" astrocytoma in a 6-week-old infant

A massive hemispheric "high"-grade astrocytoma, diagnosed in a 6-week-old infant, was totally excised by means of two craniotomies. The child is still alive and well with minimal neurological dysfunction 1.5 years after operation. This case report illustrates the benefit of aggressive surgical excision (without radiation or chemotherapy) of massive malignant neonatal astrocytomas. While surgical deficits may be minimized by the plasticity of the developing nervous system, extensive excision may yield occasional long-term palliation.

The ectopic pituitary gland in cases of craniopharyngioma. Report of two cases

✓ The author reports two apparently unique cases in which displaced pituitary gland was found at surgery for the resection of a craniopharyngioma. An embryological explanation for this association is proposed.

Paraganglioma of the cauda equina. A histologic, immunohistochemical, and ultrastructural study and review of the literature

We report a case of paraganglioma of the cauda equina and filum terminale. Diagnosis was established by the histologic organoid pattern, immunohistochemical staining for neuron-specific enolase and ultrastructural dense-core neurosecretory granules. A survey of the literature yielded 16 previously reported cases, five of which were described in 1983. This suggests that heightened awareness of this entity will result in a corresponding increase in the reported incidence.

Neurosarcoidosis with computerized tomographic visualization and transsphenoidal excision of a supra- and intrasellar granuloma. Case report

✓ Neurological involvement in sarcoidosis frequently causes dysfunction of the optic nerves and neurohypophysis. Sarcoid granulomas in the suprasellar region have been previously diagnosed by pneumoencephalograms. A case is reported of visualization of a sarcoid granuloma by computerized tomography, followed by transsphenoidal excision. Resection of a localized granuloma should be entertained in very selective cases.

Spinal epidural venous angioma causing foraminal enlargement and erosion of vertebral body. Case report

A case history of a segmental epidural venous angioma is presented. Findings included foraminal enlargement and vertebral body erosion. Routine computerized tomography with contrast enhancement should be helpful in diagnosis of vascular anomalies in patients with radicular symptoms.

Obliterative arachnoiditis complicating lumbar spinal stenosis

The authors report five patients with spinal stenosis who had a total myelographic block at the level of the obliterated subarachnoid space. Arachnoiditis had not been considered as a primary diagnosis until laminectomy revealed a non-pulsating, thickened dural sac that conformed to the internal configuration of the involved spinal canal. Two patients had stenosis complicated by spondyloarthrosis over multiple lumbar levels, one had a previous spinal fusion, another had degenerative spondylolisthesis, and the fifth had a large midline extruded disc at L2-3 that completely blocked the spinal canal. The dura was opened in two patients, confirming the lesion. Despite obliteration of the subarachnoid space, significant relief for approximately 1 year followed decompressive laminectomy, foraminotomy, and discectomy, with disappearance of neurogenic claudication in three patients. Postoperative erect films showed no caudad passage of contrast. While further observations are required, an awareness of this complication of spinal stenosis is important in the diagnosis and management of such patients and in evaluating their ultimate prognosis.

Microsurgical treatment of internal carotid artery aneurysms

Seventy consecutive cases of internal carotid artery aneurysm were operated on utilizing the surgical microscope. There were three deaths (4.3% mortality), one of which occurred in a deeply comatose apneic patient. Fifty-nine patients (84%) had excellent results. Four (6%) had postoperative morbidity directly related to their operation; three of them were operated on within 2 weeks after subarachnoid hemmorrhage and had neurological deficits attributed to cerebrovascular spasm. The low morbidity and mortality rates are partially related to patient selection but also significantly influenced by improved surgical techniques made possible by the microscope and microsurgical instrumentation. It is the authors' opinion that microsurgery should be standard procedure for craniotomy for intracranial aneurysm. It is suggested that future reported series of aneurysm therapy, regardless of the method of treatment employed, should be compared with the anticipated natural history.

Transsphenoidal chiasmapexy for correction of posthypophysectomy traction syndrome of optic chiasm. Case report

Postoperative improvement occurred as a result of transsphenoidal chiasmapexy in a patient with posthypophysectomy visual loss. Traction injury of the optic chiasm may have been caused by a deficient diaphragma sellae and inadequate packing and repair of the sella floor. A cartilaginous seal is recommended.

Complete embolization of artery of Adamkiewicz to obliterate an intramedullary arteriovenous aneurysm. Case report

A case history of an intramedullary arteriovenous aneurysm of the thoracolumbar junction is presented, and an unusual 14-year follow-up after the original sub-arachnoid bleeding episode is detailed. Embolization of anterior and mixed angiomas involving the artery of Adamkiewicz may be feasible when the artery is large and shunting is present.

Effectiveness of microsurgery for intracranial aneurysms. Postoperative angiographic study of 50 cases

✓ The authors report postoperative angiographic results in a series of 50 patients who had undergone microsurgery for intracranial aneurysms. The aneurysmal body and fundus were obliterated in every case. The neck was visualized postoperatively in three cases, or 6%; in one of these, later follow-up angiography demonstrated subsequent total aneurysm occlusion. No postoperative rebleeding occurred. The incidence of postoperative occlusion of the parent vessel was small, with complete occlusion in only one case and partial branch occlusion in another. These results confirm the impression that a high degree of accuracy in clip placement is possible with microsurgical technique. Routine postoperative angiography does not appear to be necessary if the surgeon has become skilled in the use of the microscope for aneurysm surgery.