Breast cancer survivors: return to work and wage loss in selected hospitals in Malaysia

Purpose This study aimed, firstly, to assess the determinants of return to work (RTW), secondly, to explore the amount of annual wage loss, and finally, to discover the determinants of wage loss among breast cancer (BC) survivors. Methods A cross-sectional study design was used in this research. The data was collected via interview using a validated questionnaire. Logistic regression models were developed to discover the significant determinants of RTW and of wage loss among BC survivors. Results A total of 256 BC survivors were included in this study. The analysis showed that there was a 21% loss of or reduction in mean income within 1 year after diagnosis. The significant predictors of RTW are being a government employee, having reduced wages or wage loss, and if the case had been diagnosed 1 year or more ago. Being a private sector employee and having a late stage of cancer was a barrier to RTW. The main risk factors for reduced wages or wage loss were belonging to the age group of 40-59 years, being of Chinese or Indian ethnicity, having low educational status, and not returning to work. However, belonging to the higher monthly income group (earning > RM 2000) is a protective factor against the risk of reduced wages or wage loss. Conclusions Non-RTW and wage loss after diagnosis of BC may result in the survivors experiencing a significant financial burden. Assessment of these patients is becoming more crucial because more women participate in the workforce in Malaysia nowadays and because BC is managed using multiple treatment modalities with their consequences could lead to long absences from work.

Source: Su TT, Azzani M, Tan FL, Loh SY, Supportive Care In Cancer: Official Journal of The Multinational Association of Supportive Care In Cancer, 2017 Dec.

Return-to-work intervention during cancer treatment - The providers' experiences

Purpose To explore in-depth understanding of providers' experiences when involved in a return-to-work (RTW) intervention offered during cancer treatment. Methods Semi-structured individual interviews and participant observations at a hospital department and two municipal job centers were carried out, including ten providers (physicians, nurses and social workers). A phenomenological-hermeneutic approach was applied, involving coding, identification of themes and interpretation of findings. Results Three major themes were identified: Treatment first, Work as an integrated component in cancer rehabilitation, and Challenges in bringing up work issues. Differences in providers' experiences of the RTW intervention offered to cancer patients were found: in the hospital setting RTW was a second priority, whereas in the municipality job centers it was an integrated component. Further studies are needed to investigate how and when occupational rehabilitation services can be implemented across sectors to support cancer patients' RTW. Conclusions In the future, work issues ought to be systematically presented by providers across sectors as early as possible to support cancer patients' RTW. Cancer patients' individual needs and thoughts about RTW are to be identified by both health care providers during treatment and social workers at the municipality level and shared across sectors.

Source: Petersen KS, Momsen AH, Stapelfeldt CM, Olsen PR, Nielsen CV, European Journal Of Cancer Care, 2017 Dec.

Three-Year Prospective Cohort Study of Factors Associated with Return to Work After Breast Cancer Diagnosis

Purpose The purpose of this prospective cohort study of breast cancer survivors was to identify factors before diagnosis, during treatment, and after treatment that are associated with return to work (RTW). Methods A total of 288 women with breast cancer (stage I-III) and whose age were 18-65 years-old answered questionnaires at 4-6, 12, 24, and 36 months after diagnosis. The surveys asked about performance of regular exercise and health-related quality of life issues. 'RTW at 36 months' was assigned to patients who reported any of the following: working at least twice; no job at baseline but working more than once; job at baseline, stopped working, and then started working again; and working during all 3 years. Results We classified 107 of 288 of the women (37.1%) as having returned to work. Analysis of pre-diagnostic factors indicated that more education and practice of regular endurance exercise were positively associated with RTW. Analysis of factors during treatment indicated that appetite loss and fatigue were negatively associated with RTW. Analysis of factors at post-treatment indicated that better body image, better physical function, better existential well-being, and participation in regular endurance and resistance exercise were positively associated with RTW. Childbirth at 12-24 months was negatively associated with RTW. Conclusions Women who participate in exercise before, during, and after treatment for breast cancer are more likely to RTW. A woman's need to care for children, perceived body image, and existential well-being may also affect her RTW.

Source: Lee M, Kang H, Lee K, Lee E, Journal of Occupational Rehabilitation, Vol. 27(4): 547-558, 2017 Dec.

How to Identify and Manage Cognitive Dysfunction After Breast Cancer Treatment

Purpose Attention and memory dysfunction is a common complaint among patients with breast cancer that can be reported during and up to several years after treatment. It can negatively affect patients' quality of life and their ability to work. This phenomenon has mainly been studied in patients with breast cancer who are treated with adjuvant chemotherapy. Results Women describe concentration problems and difficulties with word finding, multitasking, or remembering new information, as well as more effort and time needed to accomplish these tasks. Such cognitive dysfunction is subtle or moderate and occurs in 15% to 25% of patients. Older patients seem more likely to experience cognitive decline with chemotherapy than do young women with breast cancer. Patients who report that cognitive dysfunction has affected their daily lives for 6 to 12 months after the end of chemotherapy or during hormone therapy may need referral to a neuropsychologist. During the cognitive assessment, the etiology of their cognitive complaints is sought and neuropsychological tests are administered to assess objective cognitive functioning. Psychological factors--fatigue and pain--should be assessed systematically with cognitive complaints to identify precisely the cause of the problems. A nonpharmacologic approach--mainly cognitive rehabilitation--seems to be the most promising for the management of these difficulties, but these preliminary results require confirmation. Conclusions In the future, early detection of cognitive impairment and cognitive rehabilitation should be included in the portfolio of oncology supportive care to facilitate the return to work of young women and to avoid potential repercussions on adherence to oral treatments and on autonomy in older patients.

Source: Lange M, Joly F, Journal of Oncology Practice, Vol. 13 (12), p.784-791, 2017 Dec.

Treatment decisions and employment of breast cancer patients: Results of a population-based survey

Purpose Many patients with breast cancer work for pay at the time of their diagnosis, and the treatment plan may threaten their livelihood. Understanding work experiences in a contemporary population-based sample is necessary to inform initiatives to reduce the burden of cancer care. Methods Women who were 20 to 79 years old and had been diagnosed with stage 0 to II breast cancer, as reported to the Georgia and Los Angeles Surveillance, Epidemiology, and End Results registries in 2014-2015, were surveyed. Of the 3672 eligible women, 2502 responded (68%); 1006 who reported working before their diagnosis were analyzed. Multivariate models evaluated correlates of missing work for >1 month and stopping work altogether versus missing work for ≤1 month. Results In this diverse sample, most patients (62%) underwent lumpectomy; 16% underwent unilateral mastectomy (8% with reconstruction); and 23% underwent bilateral mastectomy (19% with reconstruction). One-third (33%) received chemotherapy. Most (84%) worked full-time before their diagnosis; however, only 50% had paid sick leave, 39% had disability benefits, and 38% had flexible work schedules. Surgical treatment was strongly correlated with missing >1 month of work (odds ratio [OR] for bilateral mastectomy with reconstruction vs lumpectomy, 7.8) and with stopping work altogether (OR for bilateral mastectomy with reconstruction vs lumpectomy, 3.1). Chemotherapy receipt (OR for missing >1 month, 1.3; OR for stopping work altogether, 3.9) and race (OR for missing >1 month for blacks vs whites, 2.0; OR for stopping work altogether for blacks vs whites, 1.7) also correlated. Those with paid sick leave were less likely to stop working (OR, 0.5), as were those with flexible schedules (OR, 0.3). Conclusions Working patients who received more aggressive treatments were more likely to experience substantial employment disruptions.

Source: Jagsi R, Abrahamse PH, Lee KL, Wallner LP, Janz NK, Hamilton AS, Ward KC, Morrow M, Kurian AW, Friese CR, Hawley ST, Katz SJ, Cancer, Vol. 123 (24), p.4791-4799, 2017 Dec.

Time course of upper limb function and return-to-work post-radiotherapy in young adults with breast cancer: a pilot randomized control trial on effects of targeted exercise program

Purpose Breast cancer (BC) diagnosis in young adults (YA) is rising, and both disease and treatments are aggressive in this population. Evidence supports the use of physical activity in reducing shoulder dysfunction, which is common among BC survivors. A pilot randomized clinical trial was performed to determine the effectiveness of a 12-week post-radiation exercise program in minimizing upper extremity dysfunction in YA with BC. Methods Participants were randomized to either an exercise arm or a control arm receiving standard care. Data was collected over six time points using: the Disability of Arm, Shoulder, and Hand (DASH); the Metabolic Equivalent of Task-hours per week (MET-hours/week), and a post hoc questionnaire on return to work. Results In total, 59 young women participated in the study (n = 29 exercise; n = 30 control). No statistically significant differences were found in overall DASH results between groups; however, those who underwent total mastectomy had residual upper limb dysfunction (p < 0.05). Both groups returned to pre-diagnosis activity levels by 18 months. Final evaluation showed that 86% of the women returned to work, and 89% resumed prior work activities with a decrease of 8.5 h/week. Conclusions Although the short-term targeted exercise program had no effect on long-term upper limb function post-radiation, timing and program specificity may require consideration of tissue healing post-radiation and surgery type. The majority of participants returned to work, however not returning to pre-diagnosis work hours. Implications for Cancer Survivors Exercise interventions alone may not reverse the long-term sequelae of breast cancer treatment and allow young adult patients to return to work.

Source: Marize Muanza I, Smirnow T, Sateren N, Fournier W, Kavan B, Palumbo P, Dalfen M, Dalzell R, Journal of Cancer Survivorship, Vol. 11(6), p.791-799, 2017 Dec.

Young adult cancer survivors and work: a systematic review

Purpose Sixty-three percent of cancer survivors continue to work, or return to work after treatment. Among this population, work ability and challenges encountered in the workplace by young adult cancer survivors have not been well established. The purposes of the study are to describe what is currently known about work-related issues for young adult cancer survivors diagnosed between ages 15 and 39, to identify gaps in the research literature, and to suggest interventions or improvements in work processes and occupational settings. Methods A narrative review of articles using PubMed, CINAHL, and PsychInfo was conducted without date limitations. Search phrases included young adult cancer survivors, long-term cancer survivors, young adults affected by cancer, further combined with key terms employment, work, and occupationally active. Inclusion criteria for publications were young adult cancer survivors initially diagnosed between the ages of 15 and 39, data about work or employment was presented, and articles written in English. Results Twenty-three publications met the inclusion criteria. Work-related issues included the potential for reduced work productivity from cancer-changed physical and cognitive functional ability that affected income, and resulted in distress. Coping style, support systems, and changing perspectives about work and life in general were also influential on career decisions among young adult cancer survivors. Conclusions More research is needed to study interventions to better manage health changes in young adult cancer survivors within the context of the workplace. Since financial hardship has been shown to be especially high among young cancer survivors, employment is essential to ensure payment of cancer-associated costs and continued medical care. Implications for Cancer Survivors While young adult cancer survivors may initially grapple with cancer-related physical and psychosocial changes that impact work productivity or influence choice of occupation, employment appears to enhance overall quality of life.

Source: Ganz D, Pavlish P, Robbins C, Stone W, SGanz G, Robbins PA, Journal of Cancer Survivorship, Vol.11 (6), p. 765-781, 2017 Dec.


Work Sustainability Among Male Cancer Survivors After Returning to Work 

Purpose Few studies have investigated the work continuance rate among cancer survivors after return to work (RTW). The objective of this study was to clarify work sustainability after RTW among Japanese male cancer survivors. Methods We collected data on male cancer survivors from an occupational health register. Inclusion criteria were as follows: employees who returned to work after an episode of sick leave due to clinically certified cancer diagnosed between January 1, 2000 and December 31, 2011. Results Of 1,033 male employees who were diagnosed with cancer, 786 employees (76.1%) returned to work after their first episode of sick leave due to cancer. Work continuance rates among all subjects were 80.1% 1 year after RTW and 48.5% 5 years after RTW. The mean duration of work after RTW was 4.5 years. The work continuance rates varied significantly by cancer type. The "Lung" and "Hepatic, Pancreatic" cancer groups had the shortest duration of work (0.9 year after RTW). Conclusions Of workers who returned to work after their first episode of leave after cancer, 50% continued to work after 5 years in large-scale companies. There was a steep decrease in work continuance rates during the first year after RTW, with considerable differences according to cancer site.

Source: Endo M, Haruyama Y, Muto G, Kiyohara K, Mizoue T, Kojimahara N, Yamaguchi N, Journal of Epidemiology, 2017 Oct.

Predictors for Earlier Return to Work of Cancer Patients

Purpose This study aims to investigate how perceived work ability, job self-efficacy, value of work, and fatigue predict return to work (RTW) in cancer patients who received chemotherapy. Methods Data of a before-after study on a multidisciplinary intervention that aimed to enhance RTW was used, consisting of four assessments up to 18 months. Time to partial and full RTW of 76 and 81 participants, respectively, was analyzed in Cox proportional hazard analysis with time-dependent variables. Univariate analyses of work ability, job self-efficacy, value of work, or fatigue as covariates were succeeded by multivariate analyses of work ability and either job self-efficacy, value of work, or fatigue as covariates. Results Participants were mostly female (93%), and diagnosed with breast cancer (87%). Most participants were permanently employed (84%) and 48% was sole breadwinner. When adjusted for timing variables and prognostic factors, all hypothesized factors were predictive for earlier RTW (p < .05). In models that also included work ability, only job self-efficacy significantly predicted earlier full RTW: hazard ratio = 1.681; p = .025. Conclusions Lower fatigue and higher value of work, work ability, and job self-efficacy of cancer survivors are associated with earlier RTW. Work ability and job self-efficacy seem to be key predictors. Implications for Cancer Survivors Limiting fatigue, increasing value of work, job self-efficacy, and perceived work ability are promising goals for enhancing earlier RTW. Occupational rehabilitation should empower patients to organize appropriate conditions for work and to educate them on rights and obligations during sick leave.

Source: Wolvers MDJ, Leensen MCJ, Groeneveld IF, Frings-Dresen MHW, De Boer AGEM, Journal of Cancer Survivorship: Research and Practice, 2017 Oct. 

Functional Impairments and Work-Related Outcomes in Breast Cancer Survivors: A Systematic Review

Purpose Work participation after breast cancer treatment is generally negatively affected. Occupational health professionals might improve work-related outcomes by bridging the gap between sick-listed employees' levels of functioning and work demands. To aid them in this task, this review explored the association between functional impairments and work-related outcomes in breast cancer survivors. Methods Publications from January 2000-March 2016 were identified through five online databases (i.e. Pubmed, EMBASE, PsycINFO, CINAHL and the Cochrane Library). Quantitative and qualitative studies were included if they focused on functional impairments and work-related outcomes in breast cancer survivors. Two reviewers independently selected studies, extracted data and performed quality assessment. Results The search identified 998 studies, of which 20 studies met eligibility criteria. Impairments in physical functioning negatively affected return to work (RTW) and work ability in quantitative and qualitative studies. Studies measuring cognitive functioning with tests found no association with work-related outcomes, whereas the results of studies using self-reported measures were ambiguous. Social functioning was less commonly investigated and findings differed across work-related outcomes. Emotional functioning was not associated with work-related outcomes in quantitative studies, while in qualitative studies feelings such as insecurity were described as influencing RTW. Conclusions Functional impairments can severely hamper work participation in breast cancer survivors. This provides important opportunities for occupational health professionals to enhance RTW in breast cancer survivors, such as adequately addressing illness perceptions and work expectations. Ongoing research is warranted to aid occupational health professionals in providing effective vocational guidance and improve work-related outcomes in breast cancer survivors.

Source: Bijker R, Duijts SFA, Smith SN, de Wildt-Liesveld R, Anema JR, Regeer BJ, Journal of Occupational Rehabilitation, 2017 Oct.

Sickness absence following breast cancer surgery: a two-year follow-up cohort study

Purpose Most women of working ages with limited breast cancer (BC) have returned to work within the first year after diagnosis. However, little is known about what is happening during this year regarding sickness absence and return to work. Also, the knowledge is very limited about the occurrence of part-time sickness absence after BC diagnosis. Therefore, the aim of this study was to describe occurrence, extent and length of SA during a two-year follow-up after BC surgery and to analyse the association between being SA and type of cancer treatment. Methods In this prospective cohort study, 497 women responded to questionnaires about different aspects of sickness absence at six occasions during two years after primary BC surgery (at baseline and after 4, 8, 12, 18 and 24 months). Treatment information was obtained from the National breast cancer register. Multinomial logistic regression was used to calculate odds ratios (OR) for likelihood of being sickness absent more than once. Results Two-thirds of the women were sickness absent at baseline; this proportion decreased, especially during the first eight months. At 24 months, 13% were sickness absent. Of all women, 27% never reported sickness absence and 14% were sickness absent at most of the six survey times. At eight months, many had shifted from full- to part-time sickness absence. Women with chemotherapy and/or advanced BC surgery had higher ORs for being sickness absent at most of the follow-ups. Conclusions Most women returned to work within the first eight months after BC surgery and of those sickness absent after that, most had been part-time sickness absent. Thus, it is important to differentiate between part- and full-time sickness absence in future studies. Special attention should be paid to the impact of chemotherapy and type of surgery on the likelihood of being sickness absent.

Source: Petersson LM, Vaez M, Nilsson MI, Saboonchi F, Alexanderson K, Olsson M, Wennman-Larsen A, Scandinavian Journal of Caring Sciences, 2017 Oct. 

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.

Source: Armaou M, Schumacher L, Grunfeld EA, Journal of Occupational Rehabilitation, 2017 Oct.

Employers' experience of employees with cancer: trajectories of complex communication

Purpose Remaining in paid work is of great importance for cancer survivors, and employers play a crucial role in achieving this. Return to work (RTW) is best seen as a process. This study aims to provide insight into (1) Dutch employers' experiences with RTW of employees with cancer and (2) the employers' needs for support regarding this process. Methods Thirty employer representatives of medium and large for-profit and non-profit organizations were interviewed to investigate their experiences and needs in relation to employees with cancer. A Grounded Theory approach was used. Results We revealed a trajectory of complex communication and decision-making during different stages, from the moment the employee disclosed that they had been diagnosed to the period after RTW, permanent disability, or the employee's passing away. Employers found this process demanding due to various dilemmas. Dealing with an unfavorable diagnosis and balancing both the employer's and the employee's interests were found to be challenging. Two types of approach to support RTW of employees with cancer were distinguished: (1) a business-oriented approach and (2) a care-oriented approach. Differences in approach were related to differences in organizational structure and employer and employee characteristics. Employers expressed a need for communication skills, information, and decision-making skills to support employees with cancer. Conclusions The employers interviewed stated that dealing with an employee with cancer is demanding and that the extensive Dutch legislation on RTW did not offer all the support needed. We recommend providing them with easily accessible information on communication and leadership training to better support employees with cancer. Implications for cancer survivors Supporting employers by training communication and decision-making skills and providing information on cancer will contribute to improving RTW support for employees with cancer. Knowing that the employer will usually be empathic when an employee reveals that they have been diagnosed with cancer, and that the employer also experiences difficulties and dilemmas, might lower the threshold to discuss wishes regarding disclosure, communication, and work issues. 3- The interests of employer and employee in relation to RTW are interrelated; both have responsibility and a role to play, and are in need of support.

Source: Tiedtke C, Dierckx de Casterlé B, Frings-Dresen M, Boer A, Greidanus M, Tamminga S, Rijk A, Journal of Cancer Survivorship, Vol. 11(5), p. 562-577, 2017 Oct.

Cancer survivors’ perspectives and experiences regarding behavioral determinants of return to work and continuation of work

Purpose Supportive interventions to enhance return to work (RTW) in cancer survivors hardly showed positive effects so far. Behavioral determinants might have to be considered in the development of interventions to achieve sustained employability. This study aimed to explore cancer survivors’ perspectives and experiences regarding behavioral determinants of RTW and continuation of work. Methods In this qualitative study, semi-structured telephone interviews were held with 28 cancer survivors. All participants were at working age, 1–2 years after diagnosis and employed at time of diagnosis. Thematic content analysis was performed. Results Work turned out to be a meaningful aspect of cancer survivors’ life, and most participants reported a positive attitude towards their job. Social support to RTW or to continue working was mainly received from family and friends, but pressure to RTW from the occupational physician was also experienced. Changes in expectations regarding work ability from negative to positive during the treatment process were observed. Those who applied active coping mechanisms felt equipped to deal with difficulties regarding work. Conclusions Behavioral determinants should be taken into account in the development of future interventions to support cancer survivors’ RTW. However, the causal relationship still has to be determined. Implications for rehabilitation Factors influencing occupational motivation among cancer survivors need to be understood in more detail. Previous studies in non-cancer populations have demonstrated that behavioral determinants, such as a positive attitude towards work, high social support and self-efficacy may increase return to work rates or shorten the time to return to work. Addressing behavioral determinants in future development of work-related interventions for cancer survivors is essential in achieving sustained employability.

Source: Duijts SFA, van Egmond MP, Gits M, van der Beek AJ, Bleiker EM, Disability & Rehabilitation, Vol. 39 (21), p.2164-2172, 2017 Oct.

Return to work after cancer and pre-cancer job dissatisfaction

Purpose We investigate the association between pre-cancer job dissatisfaction and return-to-work probability 3 years after a cancer diagnosis. We use a Danish data set combining administrative data and a survey to breast and colon cancer survivors. We find that the return-to-work probability has a negative correlation with pre-cancer job dissatisfaction with mental demands (where the correlation is driven by the high-educated) and with physical demands and the superior (where the correlation is driven by the low-educated). Educational gradients in the probability of returning to work after cancer are not significantly affected by controlling for pre-cancer job dissatisfaction and pre-cancer ability to work.

Source: Heinesen E, Kolodziejczyk C, Ladenburg J, Andersen I, Thielen K, Applied Economics, Vol. 49 (49), p.4982-4998, 2017 Oct.


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. Previous research indicated that effective RTW interventions start early, are participatory and contain adjuvant occupational therapy (OT). This paper aims at developing an OT oriented RTW intervention to be embedded as usual care with the objective to bridge the gap between health care and workplace. Material/patients and methods The intervention mapping (IM) protocol was followed to develop a RTW intervention by combining evidence regarding RTW in BC patients with insights regarding OT and RTW. Four development steps were taken, ranging from needs assessment to the development of intervention components and materials. Results A five-phased RTW intervention is proposed that is guided by an occupational therapist available at the hospital. Characteristics are: engaging all stakeholders, goal-setting, progressively developing tailored actions, continuous evaluations and adjustments of goals and actions. Discussion – conclusions Using IM enables to set up a RTW oriented intervention that fits seamlessly to OT interventions, in a tailor-made sense. This unique intervention forms a bridge between individual BC patient needs, the input of stakeholders at the hospital and those at the workplace. A feasibility study and process evaluation (funded by Kom Op Tegen Kanker) is enrolled from February 2015 till October 2017 at Jessa Ziekenhuis in Hasselt (Be). Preliminary results of this study will be presented.

Source: Désiron H, Crutzen R, Godderis L, Hoof E, Rijk A, Annals of Physical & Rehabilitation Medicine, Vol. 60, p.e58-e58, 2017 Sep.

Job resignation after cancer diagnosis among working survivors in Japan: timing, reasons and change of information needs over time

Purpose Despite advances in work-related policies for cancer survivors, support systems for working survivors in healthcare settings in Japan remain underdeveloped. We aimed to reveal (i) the present situation of cancer survivors' job resignation, the timing of resignation, and reasons for resignation; (ii) healthcare providers' screening behaviors of cancer survivors' work-related difficulties and (iii) changes to cancer survivors' information/support needs over time since diagnosis. Methods We conducted an anonymous, cross-sectional survey using a convenience sample of re-visiting outpatients at three cancer centers in Japan in 2015. The questionnaire covered participants' demographic and clinical characteristics, change to job status, timing of and reasons for job resignation, screening experience regarding work-related difficulties by healthcare providers, and information/support needs at four distinct timings (at diagnosis, between diagnosis and initial treatment, between initial treatment and return-to-work, and after return-to-work). The results of 950 participants were eligible for statistical analysis. Results Only 23.5% of participants were screened about work-related issues by healthcare providers despite 21.3% participants reporting resigning at least once. Among participants who resigned, 40.2% decided to do so before initial treatment began. Regarding reasons for resignation, self-regulating and pessimistic reasons were ranked highly. Respondents' work-related information and support needs were observed to change over time. While treatment-related information (schedule and cost) was ranked highly at diagnosis, the need for more individually tailored information and support on work increased after treatment began. Conclusions This study provides important basic data for developing effective support systems for working survivors of cancer in hospital settings.

Source: Takahashi M, Tsuchiya M, Horio Y, Funazaki H, Aogi K, Miyauchi K, Arai Y, Japanese Journal of Clinical Oncology, p. 1-9, 2017 Sep.

Barriers and facilitators for return to work in cancer survivors with job loss experience: a focus group study

Purpose Over 50% of cancer survivors lose their job or quit working. Cancer survivors who experience job loss may face different challenges regarding return to work, compared to cancer survivors with employers. This qualitative study aimed to explore barriers and facilitators for return to work in cancer survivors with job loss and in insurance physicians who assist cancer survivors in their return to work. We conducted five focus groups and one interview (cancer survivors, n=7; insurance physicians, n=23). Topics included, among others, experience of job loss and barriers and facilitators for return to work. Data were audio recorded and analysed using thematic analysis. Our main finding was that cancer survivors experienced a double loss: loss of job on top of loss of health. As a result, cancer survivors feared for job applications, lacked opportunities to gradually increase work ability, and faced reluctance from employers in hiring them. Insurance physicians expressed a need for more frequent and longer consultations with cancer survivors with job loss. We conclude that cancer survivors who experience double loss encounter specific barriers in the return to work process.

Source: Egmond MP, Duijts SFA, Loyen A, Vermeulen SJ, Beek AJ, Anema JR, European Journal of Cancer Care, Vol. 26 (5), 2017 Sep.

Predictors of early retirement after cancer rehabilitation-a longitudinal study 

Purpose This longitudinal study was designed to assess patients' desire for early retirement and investigate which cancer-related and psychosocial characteristics are associated with early retirement. Methods We assessed 750 cancer patients at the beginning (t0) and end (t1) of, and 12 months after (t2) inpatient cancer rehabilitation. Results At t0, 22% had a desire to retire early. These patients reported significantly longer sick leave periods, less favourable workplace environments, lower work ability, higher psychological distress and lower quality of life than other patients. At t2, 12.5% of patients received temporary or permanent early retirement pensions. Of all patients with a desire for early retirement at t0, 43% had returned to work at t2. This subgroup had a significantly lower physical quality of life than other patients returning to work. The most influential predictors of early retirement were being on sick leave (OR = 6.50, 95% CI = 1.97-21.47) and a desire for early retirement (OR = 5.61, 95% CI = 2.73-11.52). Inverse predictors of early retirement were cancer remission (OR = 0.23, 95% CI = 0.10-0.53), perceived productivity (OR = 0.38, 95% CI = 0.18-0.83), work satisfaction (OR = 0.36, 95% CI = 0.17-0.77) and mental quality of life (OR = 0.94, 95% CI = 0.91-0.98). Conclusions This underlines the need for cancer-specific multi-professional rehabilitation and occupational therapy programmes.

Source: Mehnert A, Barth J, Gaspar M, Leibbrand B, Kegel CD, Bootsveld W, Friedrich M, Hartung TJ, Berger D, Koch U, European Journal of Cancer Care, Vol. 26 (5), 2017 Sep.

Supporting cancer patients with work-related problems through an oncological occupational physician: a feasibility study

Purpose To evaluate the feasibility of an oncological occupational physician (OOP) who is trained in oncological work-related problems, and in providing work-related support to cancer patients within the curative setting. We assessed facilitators and barriers that affect the activities of an OOP, and the satisfaction of the OOPs and patients with this new form of health care. Methods Interviews were held with (1) OOPs (n=13) to assess facilitators, barriers and their satisfaction with their ability to give supportive care and (2) cancer patients (n=8) to assess their satisfaction concerning consulting an OOP.Results The main facilitators were positive feedback from health care providers and patients about the received care and support that the OOP had given, and the additional knowledge of the OOPs about cancer and work-related problems. Major barriers for being active as an OOP were lack of financial support for the OOP and the unfamiliarity of patients and health care providers with the specialised occupational physician. Conclusions Both OOPs and the specialised knowledge and additional training of the OOPs facilitated providing support to cancer patients and survivors with work-related problems. Familiarity with the specialised occupational physician and financial support should be improved.

Source: Zaman, ACGNM, Bruinvels DJ, Boer AGEM, Frings-Dresen MHW, European Journal of Cancer Care, Vol. 26 (5), 2017 Sep.

Perceived employerrelated barriers and facilitators for work participation of cancer survivors: A systematic review of employers' and survivors' perspectives

Purpose To identify employer‐related barriers and facilitators for work participation of cancer survivors from the perspective of both employers and cancer survivors, and to synthesise these perceived barriers and facilitators to understand their perceived consequences. Methods A systematic review of qualitative studies focusing on employers' and cancer survivors' perspectives on the work participation of cancer survivors was performed. Four databases (MEDLINE, EMBASE, PsycINFO, and Business Source Premier) were systematically searched, and the quality of studies included was assessed using the CASP checklist. Perceived barriers and facilitators were extracted and synthesised to conduct a content analysis. Results Five studies representing the employers' perspectives and 47 studies representing the cancer survivors' perspectives were included. Employers perceived barriers and facilitators related to support, communication, RTW policies, knowledge about cancer, balancing interests and roles, and attitude. Survivors perceived barriers and facilitators related to support, communication, work environment, discrimination, and perception of work ability. The synthesis found that the employers' willingness to support can be understood by perceptions they have of the survivor, goals of the employer, and national or organisational policies. Employers require knowledge about cancer and RTW policies to be able to support survivors. Conclusions This review identified a plurality of and a large variety in perceived employer‐related barriers and facilitators for work participation of cancer survivors, which can be understood to be related to both employers' willingness and ability to support. There is a need for interventions targeting employers, with the aim of enhancing the sustainable work participation of cancer survivors.

Source: Greidanus MA, Boer AGEM, Rijk AE, Tiedtke CM, Dierckx de Casterlé B, Frings‐Dresen, MHW, Tamminga SJ, Psycho-Oncology, 2017 Sep.

AOÛT 2017

The impact of prior psychiatric medical treatment on return to work after a diagnosis of breast cancer: A registry based study

Purpose Breast cancer and psychiatric disorders negatively impact work life, both positively associated with unemployment and early retirement. Our purpose was to assess whether being prescribed psychiatric medication, 2-4 yrs prior to a diagnosis of breast cancer, could impact the likelihood of returning to work after cancer therapy. Methods 16,868 self-supporting women, diagnosed with breast cancer in Denmark from 2000 to 2012, were identified from a population-based clinical database, then cross-referenced to data held for psychiatric medication usage, sociodemographics, and labour-market participation. The association between historic psychiatric medication and return to work was estimated using a modified Poisson regression model. 'Return to work' was defined as being self-supporting one year after diagnosis of breast cancer. Results 16% of our cohort had used psychiatric medical treatment 2-4 years before their diagnosis. Sixty-three per cent of these individuals had returned to work one year later, compared to 69% of the patient group with no prior history of using psychiatric medication treatments. In the fully adjusted model, prior use of psychiatric medication diminished the likelihood of returning to work one year after cancer diagnosis (RR = 0.91 (0.87-0.94)). High income and older age were positively associated with returning to work; negative correlates included those related to disease severity. Conclusions Historic use of psychiatric medication provoked a minor, although statistically significant reduction in the resumption of working life one year after a diagnosis of breast cancer. Implications for cancer survivors Although historic use of psychiatric medication may incur a minor effect on working life, further research is needed on the long-term social consequences for sub-groups.

Source: Jensen LS, Overgaard C, Garne JP, Bøggild H, Fonager K, Scandinavian Journal of Public Health, 2017 Aug. 


Work functioning trajectories in cancer patients: Results from the longitudinal Work Life after Cancer (WOLICA) study

Purpose More than 60% of cancer patients are able to work after cancer diagnosis. However, little is known about their functioning at work. Therefore, the aims of this study were to: 1) identify work functioning trajectories in the year following return to work (RTW) in cancer patients, and 2) examine baseline socio-demographic, health-related and work-related variables associated with work functioning trajectories. Methods Longitudinal cohort study including 384 cancer patients who have returned to work after cancer diagnosis. Work functioning was measured at baseline, 3, 6, 9 and 12 months follow-up. Latent class growth modeling (LCGM) was used to identify work functioning trajectories. Associations of baseline variables with work functioning trajectories were examined using univariate and multivariate analyses. Results LCGM analyses with cancer patients who completed on at least three time points the Work Role Functioning Questionnaire (n=324) identified three work functioning trajectories: 'persistently high' (16% of the sample), 'moderate to high' (54%) and 'persistently low' work functioning (32%). Cancer patients with persistently high work functioning had less time between diagnosis and RTW and had less often a changed meaning of work, while cancer patients with persistently low work functioning reported more baseline cognitive symptoms compared to cancer patients in the other trajectories. Three distinct work functioning trajectories in the year following RTW were identified. One-third of the cancer patients reported persistently low work functioning over time, particularly those experiencing cognitive symptoms. Conclusions This knowledge has implications for cancer care and guidance of cancer patients at work.

Source: Dorland HF, Abma FI, Roelen C, Stewart RE, Amick BC, Ranchor AV, Bültmann U, International Journal of Cancer, 2017 July.