Barriers to and Facilitators of Implementing Programs for Return to Work (RTW) of Cancer Survivors in Four European Countries: A Qualitative Study

Purpose Implementation of return to work (RTW) programs for cancer survivors has proved to be challenging. The purpose of our study was to gather experiences about barriers to and facilitators of implementing RTW programs for cancer survivors in four European countries. Methods Separate multidisciplinary focus groups were held in Belgium (n = 8), the Netherlands (n = 8), Ireland (n = 6), and UK (n = 4) in 2017 and included among others a physician, and a representative of an employer, a cancer society, and the government. Primary focus of thematic analysis was what could be done to improve the implementation of RTW programs for cancer survivors. Analysis used the 'Arena in work disability prevention model' as the conceptual framework. Results Many barriers to and facilitators of implementing RTW programs for cancer survivors were described including the personal, workplace, healthcare and legislative system as well as the overall societal and political context. That is, for example cooperation between stakeholders, time, money and ability issues at the workplace, and insufficient/inadequate legislation. Insufficient knowledge of cancer and its implications for work was identified as an overarching theme in all countries leading to stigma, misconceptions and lack of communication. This was mentioned in relation to the workplace, personal and healthcare system, and in the overall societal context. Conclusions Results indicate that a prerequisite for implementing RTW programs is raising sufficient knowledge regarding cancer and its implications for work. Greater knowledge could be a first step to better implement RTW programs which may result in better supporting cancer survivors with their RTW.

Source: Tamminga SJ, Braspenning AM, Haste A, Sharp L, Frings-Dresen MHW, de Boer AGEM, Journal of Occupational Rehabilitation, 2018 Nov.

Return to work after breast cancer diagnosis: An observational prospective study in Brazil

Purpose In North America and Europe, return-to-work (RTW) rates vary among breast cancer (BC) survivors, from 24% to 66% and from 53% to 82% at 6 and 36 months after diagnosis, respectively. To date, there is a lack of data on RTW rates after BC diagnosis in Latin America. Therefore, the primary objectives of this study were to define RTW rates at 12 and 24 months after BC diagnosis and to identify the factors associated with RTW in this population. Methods In total, 125 employed women from a single institution with newly diagnosed BC were interviewed by telephone at 6, 12, and 24 months after diagnosis. Those who had inoperable or metastatic disease were excluded. Results Overall, RTW rates were 30.3% and 60.4% at 12 and 24 months after BC diagnosis, respectively. Most women reported that they received support from their employer, but only 29.1% reported having been offered work adjustments. In multivariate analysis, the factors associated with positive RTW outcomes included higher household income (odds ratio [OR], 17.76; 95% confidence interval [CI], 3.33-94.75; P = .001), breast-conserving surgery (OR, 9.77; 95% CI, 2.03-47.05; P = .004), and work adjustments (OR, 37.62; 95% CI, 2.03-47.05; P = .004). The factors associated with negative RTW outcomes included adjuvant endocrine therapy (OR, 0.11; 95% CI, 0.02-0.74; P = .023), and depression diagnosed after BC (OR, 0.07; 95% CI, 0.01-0.63; P = .017). Conclusions RTW rates in the current study were lower than those observed in developed countries but similar to the rates among low-income Americans. Workplace adjustments, higher income, breast-conserving surgery, endocrine therapy, and depression after BC played an important role in the RTW decision.

Source: Landeiro LCG, Gagliato DM, Fêde AB, Fraile NM, Lopez RM, da Fonseca LG, Petry V, Testa L, Hoff PM, Mano MS, Cancer, Vol. 124 (24), p.4700-4710, 2018 Dec.

Returning to work after breast cancer: A systematic review of reviews

Purpose Due to improvements in breast cancer diagnosis and treatment, the healthcare system faces a growing number of cancer survivors. Breast cancer survivors experience many difficulties when returning to work, including discrimination at work and lack of support by employers and colleagues. Objective To point out the knowledge in literature up to date about return to work (RTW) after breast cancer, the factors influencing it and the interventions to facilitate it. Methods A literature search was conducted in January 2017 using the databases Medline (PubMed) and Scopus. Studies were included if they analyzed the problem of RTW in women treated for breast cancer. Results Twenty-six articles met the inclusion criteria. The studies were divided into four themes: factors facilitating or impeding RTW; interventions to enhance RTW; lived experiences of RTW; economic aspects related to cancer survivors and RTW. Conclusions The heterogeneity of the interventions suggests the need for a better definition of the concept of RTW. To compare interventions, studies should use a rigorous approach and better outcome measures should be identified to evaluate RTW.

Source: Cocchiara RA, Sciarra I, D'Egidio V, Sestili C, Mancino M, Backhaus I, Mannocci A, De Luca A, Frusone F, Monti M, La Torre G, Di Bella O, Di Murro F, Palmeri V, Lia L, Aceti V, Libia A, Work, 2018 Oct.

Work-specific cognitive symptoms and the role of work characteristics, fatigue, and depressive symptoms in cancer patients during 18 months post return to work

Purpose Cancer patients can experience work-specific cognitive symptoms post return to work. The study aims to (1) describe the course of work-specific cognitive symptoms in the first 18 months post return to work and (2) examine the associations of work characteristics, fatigue and depressive symptoms with work-specific cognitive symptoms over time. Methods This study used data from the 18-month longitudinal "Work Life after Cancer" cohort. The Cognitive Symptom Checklist-Work Dutch Version (CSC-W DV) was used to measure work-specific cognitive symptoms. Linear mixed models were performed to examine the course of work-specific cognitive symptoms during 18-month follow-up; linear regression analyses with generalized estimating equations were used to examine associations over time. Results Working cancer patients examined with different cancer types were included (n = 378). Work-specific cognitive symptoms were stable over 18 months. At baseline, cancer patients reported more working memory symptoms (M = 32.0; CI, 30.0-34.0) compared with executive function symptoms (M = 19.3; CI, 17.6-20.9). Cancer patients holding a job with both manual and nonmanual tasks reported less work-specific cognitive symptoms (unstandardized regression coefficient b = -4.80; CI, -7.76 to -1.83) over time, compared with cancer patients with a nonmanual job. Over time, higher depressive symptoms were related to experiencing more overall work-specific cognitive symptoms (b = 1.27; CI, 1.00-1.55) and a higher fatigue score was related to more working memory symptoms (b = 0.13; CI, 0.04-0.23). Conclusions Job type should be considered when looking at work-specific cognitive symptoms over time in working cancer patients. To reduce work-specific cognitive symptoms, interventions targeted at fatigue and depressive symptoms might be promising.

Source: Dorland HF, Abma FI, Roelen CAM, Stewart RE, Amick BC, Bültmann U, Ranchor AV, Psycho-Oncology, Vol. 27(9), p.2229-2236, 2018 Sept.

The role of the general practitioner in return to work after cancer-a systematic review

Purpose The number of cancer patients and survivors of working age is increasing. General Practitioners (GPs) may have a significant role in psychosocial cancer care, including work-related concerns. Therefore, we performed a systematic literature review to identify the role of the GP in work-related concerns and integration/reintegration into work of cancer patients and/or survivors. Methods We searched PubMed, Embase, Cinahl, PsycINFO and Cochrane Library, irrespective of study design. We found 4863 articles and, after removing duplicates, we screened 3388 articles by title and abstract and reviewed 66 of these in full text. The Critical Appraisal Skills Programme tool was used to assess the methodological quality of included articles. We used narrative synthesis to describe the role of the GP. Results We included four qualitative studies from three countries. Two of these studies focused on the health care professionals' perspectives and two studies focused on patients' perspectives regarding the role of the GP. Lack of communication between health care professionals, lack of knowledge about work-related concerns and limited resources were recurring themes in these papers. Fully establishing the role of the GP is difficult given the small number of studies on work-related concerns in cancer patients in primary care. Conclusions There is little evidence regarding the role of the general practitioner in cancer care and work guidance. Therefore, further research should focus on the role that is desired for GPs and on interventions to study the feasibility of GP involvement in the return to work of cancer patients and/or survivors.

Source: de Jong F, Frings-Dresen M, HDijk N, vanvan Etten-Jamaludin F, Svan Asselt K, de Boer A, Family Practice, Vol. 35(5), p.531-541, 2018 Oct.

Women's experiences of encounters with healthcare professionals' regarding work after breast-cancer surgery and associations with sickness absence: a 2-year follow-up cohort study

Purpose Breast cancer (BC) is the most common cancer among women, and half of those diagnosed are of working age. Positive encounters regarding work from healthcare professionals have been shown to promote return to work among sickness absentees in general. However, the knowledge about encounters possible associations with sickness absence (SA) in women with BC is scarce. Aim To explore if women had experienced encounters regarding work from healthcare professionals during the first year after BC surgery and if this was associated with SA during the second year after surgery, controlled for treatment and sociodemographic effects. Methods A prospective cohort study of 690 Swedish women with primary BC, aged 24-63 years included after surgery. Descriptive statistics and adjusted logistic regression (age, birth country, education, self-rated health, treatment) with 95% confidence intervals (CI) were used. Results Eighty percent of the women had experienced encounters regarding work. Women who got advice and support regarding work (adjusted odds ratio (OR) 0.5; 0.3-0.9) or were encouraged to work (adjusted OR 0.6; 0.3-0.9) had less SA. A larger proportion of those encouraged to work had less advanced cancer, surgery, hormone, or radiotherapy. Consistently, women encouraged to be on SA had more SA, but this was partly explained by disease or treatment factors (crude OR 1.6; 1.1-2.4, adjusted OR 1.2 (0.8-1.9) since a larger proportion of those with more advanced cancer, surgery, or chemotherapy had more SA. Conclusions Most women experienced encounters regarding work, and the nature of these encounters were associated with SA 2 years after BC surgery.

Source: Söderman M, Friberg E, Alexanderson K, Wennman-Larsen A, Supportive Care in Cancer: Official Journal of The Multinational Association Of Supportive Care in Cancer, 2018 Sep.

Cancer survivors' experiences of return to work: A qualitative study

Purpose The study aimed to explore Iranian cancer survivors' experiences of returning to work. Methods Semi-structured interviews were conducted with 20 cancer survivors at their workplace and in a referral cancer center. Data were analyzed using a conventional content analysis technique. Results Three main categories were identified as important in cancer survivors' experiences of returning to work: (1) individual perspectives, (2) nature of disease, and (3) access to support system. Results showed that returning to work contained different meaning for men and women. Also, it was found that cancer survivors had limited information about the disease and return to work that made them doubtful about returning to work. Conclusions Cancer survivors have different individual perspectives that affect their decision about returning to work. Their perspectives should be assessed before returning to work, and necessary support should be provided for them in returning to work process. In this regard, health care systems and rehabilitation specialists should inform cancer survivors about the disease and return to work. Also, employers should prepare work places for cancer survivors' entrance.

Source: Zamanzadeh V, Valizadeh L, Rahmani A, Zirak M, Desiron H, Psycho-Oncology, Vol. 27 (10), p.2398-2404, 2018 Oct.

Return to work after breast cancer diagnosis: An observational prospective study in brazil

Purpose In North America and Europe, return-to-work (RTW) rates vary among breast cancer (BC) survivors, from 24% to 66% and from 53% to 82% at 6 and 36 months after diagnosis, respectively. To date, there is a lack of data on RTW rates after BC diagnosis in Latin America. Therefore, the primary objectives of this study were to define RTW rates at 12 and 24 months after BC diagnosis and to identify the factors associated with RTW in this population. Methods In total, 125 employed women from a single institution with newly diagnosed BC were interviewed by telephone at 6, 12, and 24 months after diagnosis. Those who had inoperable or metastatic disease were excluded. Results Overall, RTW rates were 30.3% and 60.4% at 12 and 24 months after BC diagnosis, respectively. Most women reported that they received support from their employer, but only 29.1% reported having been offered work adjustments. In multivariate analysis, the factors associated with positive RTW outcomes included higher household income (odds ratio [OR], 17.76; 95% confidence interval [CI], 3.33-94.75; P = .001), breast-conserving surgery (OR, 9.77; 95% CI, 2.03-47.05; P = .004), and work adjustments (OR, 37.62; 95% CI, 2.03-47.05; P = .004). The factors associated with negative RTW outcomes included adjuvant endocrine therapy (OR, 0.11; 95% CI, 0.02-0.74; P = .023), and depression diagnosed after BC (OR, 0.07; 95% CI, 0.01-0.63; P = .017). Conclusions RTW rates in the current study were lower than those observed in developed countries but similar to the rates among low-income Americans. Workplace adjustments, higher income, breast-conserving surgery, endocrine therapy, and depression after BC played an important role in the RTW decision.

Source: Landeiro LCG, Gagliato DM, Fêde AB, Fraile NM, Lopez RM, da Fonseca LG, Petry V, Testa L, Hoff PM, Mano MS, Cancer, 2018 Oct.

Return to Work of Cancer Survivors: Predicting Healthcare Professionals' Assumed Role Responsibility

Purpose Returning to work is highly beneficial for many cancer survivors. While research has documented the significance of healthcare professionals in the process of return to work (RTW), very little is known about those professionals' views regarding their responsibility for RTW. The purpose of the present study was to identify factors that predict the extent to which healthcare professionals view involvement in the RTW of cancer survivors as part of their role. Methods In a cross-sectional design, questionnaires measuring attitudes regarding personal role responsibility for RTW, team role responsibility for RTW and benefits of RTW were administered to 157 healthcare professionals who care for working-age cancer survivors: oncologists, occupational physicians, family physicians, oncology nurses, oncology social workers, and psychologists. Results Both belief in the benefits of RTW, and the view that RTW is the team responsibility of healthcare professionals working with cancer survivors, are positively related to viewing RTW as part of the responsibilities of one's personal professional role. Moderation analysis indicated that perception of team responsibility for RTW moderates the effect of the perceived benefits of RTW, such that the perception of benefits is significantly associated with personal role responsibility only when there is a low level of perceived team responsibility. Conclusions Issues related to RTW should be routinely included in basic and advanced training of healthcare professionals involved in the treatment of working-age cancer survivors, to increase awareness of this aspect of cancer survivors' well-being and position RTW as part of healthcare professionals' role responsibilities.

Source: Yagil D, Eshed-Lavi N, Carel R, Cohen M, Journal of Occupational Rehabilitation, 2018 Aug.

Return to work in European Cancer survivors: a systematic review

Purpose Return to work (RTW) of cancer survivors (CSs) fluctuates in different contexts. This systematic review searched for recent data on the RTW rate of CSs in Europe, investigating associated factors. Methods Bibliographic search covered the period from January 2010 to February 2018, with no language restrictions. European population-based studies assessing RTW rate after cancer diagnosis were included. We excluded studies focusing on a specific cancer diagnosis. Results Twelve observational studies were selected. The cohorts investigated included 280 to 46,720 individuals from Northwestern and Central Europe diagnosed with cancer from 1987 to 2010. The median interval between diagnosis and documented RTW was 2 years (0.2-23.4 years). RTW rates of CSs ranged from 39 to 77%. RTW of individuals employed at the time of diagnosis ranged from 60 to 92%, the latter registered in a sample with good prognosis. Personal factors, work-related factors, and cancer-related factors were all associated with RTW. Healthcare team interventions facilitated reintegration to work. Conclusions Data from Mediterranean and Central European countries are urgently needed to understand whether RTW is an issue for CSs there as well and whether socio-rehabilitative interventions are required to mitigate the potential negative impact of cancer on individuals and society.

Source: Paltrinieri S, Fugazzaro S, Pellegrini M, Costi S, Bertozzi L, Bassi MC, Vicentini M, Mazzini E, Supportive Care in Cancer, Vol. 26 (9), p.2983-2994, 2018 Sep.

Cancer survivors' experiences of return to work: A qualitative study

Purpose The study aimed to explore Iranian cancer survivors' experiences of returning to work. Methods Semistructured interviews were conducted with 20 cancer survivors at their workplace and in a referral cancer center. Data were analyzed using a conventional content analysis technique. Results Three main categories were identified as important in cancer survivors' experiences of returning to work: (1) individual perspectives, (2) nature of disease, and (3) access to support system. Results showed that returning to work contained different meaning for men and women. Also, it was found that cancer survivors had limited information about the disease and return to work that made them doubtful about returning to work. Conclusions Cancer survivors have different individual perspectives that affect their decision about returning to work. Their perspectives should be assessed before returning to work, and necessary support should be provided for them in returning to work process. In this regard, health care systems and rehabilitation specialists should inform cancer survivors about the disease and return to work. Also, employers should prepare work places for cancer survivors' entrance.

Source: Zamanzadeh V, Valizadeh L, Rahmani A, Zirak M, Desiron H, Psycho-Oncology Publisher:

Work-Related Outcomes in Self-Employed Cancer Survivors: A European Multi-country Study

Purpose To describe: (i) patterns of self-employment and social welfare provisions for self-employed and salaried workers in several European countries; (ii) work-related outcomes after cancer in self-employed people and to compare these with the work-related outcomes of salaried survivors within each sample; and (iii) work-related outcomes for self-employed cancer survivors across countries. Methods Data from 11 samples from seven European countries were included. All samples had cross-sectional survey data on work outcomes in self-employed and salaried cancer survivors who were working at time of diagnosis (n = 22-261 self-employed/101-1871 salaried). The samples included different cancers and assessed different outcomes at different times post-diagnosis. Results Fewer self-employed cancer survivors took time off work due to cancer compared to salaried survivors. More self-employed than salaried survivors worked post-diagnosis in almost all countries. Among those working at the time of survey, self-employed survivors had made a larger reduction in working hours compared to pre-diagnosis, but they still worked more hours per week post-diagnosis than salaried survivors. The self-employed had received less financial compensation when absent from work post-cancer, and more self-employed, than salaried, survivors reported a negative financial change due to the cancer. There were differences between self-employed and salaried survivors in physical job demands, work ability and quality-of-life but the direction and magnitude of the differences differed across countries. Conclusions Despite sample differences, self-employed survivors more often continued working during treatment and had, in general, worse financial outcomes than salaried cancer survivors. Other work-related outcomes differed in different directions across countries.

Source: Torp S, Paraponaris A, Van Hoof E, Lindbohm ML, Tamminga SJ, Alleaume C, Van Campenhout N, Sharp L, de Boer AGEM, Journal Of Occupational Rehabilitation, 2018 Jun.

Workspecific cognitive symptoms and the role of work characteristics, fatigue, and depressive symptoms in cancer patients during 18 months post return to work

Purpose Cancer patients can experience work‐specific cognitive symptoms post return to work. The study aims to (1) describe the course of work‐specific cognitive symptoms in the first 18 months post return to work and (2) examine the associations of work characteristics, fatigue and depressive symptoms with work‐specific cognitive symptoms over time. Methods This study used data from the 18‐month longitudinal 'Work Life after Cancer' cohort. The Cognitive Symptom Checklist‐Work Dutch Version (CSC‐W DV) was used to measure work‐specific cognitive symptoms. Linear mixed models were performed to examine the course of work‐specific cognitive symptoms during 18‐month follow‐up; linear regression analyses with generalized estimating equations were used to examine associations over time. Results Working cancer patients examined with different cancer types were included (n = 378). Work‐specific cognitive symptoms were stable over 18 months. At baseline, cancer patients reported more working memory symptoms (M = 32.0; CI, 30.0‐34.0) compared with executive function symptoms (M = 19.3; CI, 17.6‐20.9). Cancer patients holding a job with both manual and nonmanual tasks reported less work‐specific cognitive symptoms (unstandardized regression coefficient b = −4.80; CI, −7.76 to −1.83) over time, compared with cancer patients with a nonmanual job. Over time, higher depressive symptoms were related to experiencing more overall work‐specific cognitive symptoms (b = 1.27; CI, 1.00‐1.55) and a higher fatigue score was related to more working memory symptoms (b = 0.13; CI, 0.04‐0.23). Conclusions Job type should be considered when looking at work‐specific cognitive symptoms over time in working cancer patients. To reduce work‐specific cognitive symptoms, interventions targeted at fatigue and depressive symptoms might be promising.

Source: Dorland HF, Abma FI, Roelen CAM, Stewart RE, Amick BC, Bültmann U, Ranchor AV, Psycho-Oncology Publisher.

Cancer survivors' experiences of return to work: A qualitative study

Purpose The study aimed to explore Iranian cancer survivors' experiences of returning to work. Methods Semi-structured interviews were conducted with 20 cancer survivors at their workplace and in a referral cancer center. Data were analyzed using a conventional content analysis technique. Results Three main categories were identified as important in cancer survivors' experiences of returning to work: 1) individual perspectives, 2) nature of disease and 3) access to support system. Results showed that returning to work contained different meaning for men and women. Also, it was found that cancer survivors had limited information about the disease and return to work (RTW) that made them doubtful about returning to work. Conclusions Cancer survivors' have different individual perspectives that affect their decision about returning to work. Their perspectives should be assessed before returning to work and necessary support should be provided for them in returning to work process. In this regard, healthcare systems and rehabilitation specialists should inform cancer survivors about the disease and RTW. Also, employers should prepare work places for cancer survivors' entrance.

Source: Zamanzadeh V, Valizadeh L, Rahmani A, Zirak M, Desiron H, Psycho-Oncology, 2018 Jul. 

What Employer Actions Are Considered Most Important for the Return to Work of Employees with Cancer? A Delphi Study Among Employees and Employers

Purpose Employers are important stakeholders in the return to work (RTW) of employees with cancer. However, it is unclear what employer actions are most important to that process. The objective, therefore, was to reach consensus on what employer actions are considered most important for the RTW of employees with cancer, by employers and employees separately. Methods A two-round online Delphi study was conducted with two expert panels: one with 23 employers and one with 29 employees with cancer. The results from each panel were analysed separately. Out of 24 suggested employer actions, participants selected the 10 they considered most important for RTW in each of the following RTW phases: (1) disclosure, (2) treatment, (3) RTW plan, and (4) actual RTW. The consensus threshold was set at ≥ 80% during the second round. Results The employer and employee expert panels both reached consensus on the importance of 'emotional support', 'practical support', 'allow sufficient sick leave', 'plan return to work', 'adjust expectations', 'assess work ability', and 'show appreciation'. Employers also reached consensus on 'communicate' and 'treat normally', and employees on 'handle unpredictability'. All these employer actions were considered to be specific for one to three RTW phases. Conclusions Employers reached consensus on the importance of nine employer actions, employees on eight. Both stakeholder perspectives showed great similarities, but did vary regarding important employer actions during the employee's treatment. We recommend developing interventions targeting the employer, meeting both employer and employee needs in each RTW phase, to enhance RTW support for employees with cancer.

Source: Greidanus MA, Tamminga SJ, de Rijk AE, Frings-Dresen MHW, de Boer AGEM, Journal of Occupational Rehabilitation, 2018 Jul.

Return to work in European Cancer survivors: a systematic review

Purpose Return to work (RTW) of cancer survivors (CSs) fluctuates in different contexts. This systematic review searched for recent data on the RTW rate of CSs in Europe, investigating associated factors. Methods Bibliographic search covered the period from January 2010 to February 2018, with no language restrictions. European population-based studies assessing RTW rate after cancer diagnosis were included. We excluded studies focusing on a specific cancer diagnosis. Results Twelve observational studies were selected. The cohorts investigated included 280 to 46,720 individuals from Northwestern and Central Europe diagnosed with cancer from 1987 to 2010. The median interval between diagnosis and documented RTW was 2 years (0.2-23.4 years). RTW rates of CSs ranged from 39 to 77%. RTW of individuals employed at the time of diagnosis ranged from 60 to 92%, the latter registered in a sample with good prognosis. Personal factors, work-related factors, and cancer-related factors were all associated with RTW. Healthcare team interventions facilitated reintegration to work. Conclusions Data from Mediterranean and Central European countries are urgently needed to understand whether RTW is an issue for CSs there as well and whether socio-rehabilitative interventions are required to mitigate the potential negative impact of cancer on individuals and society.

Source: Paltrinieri S, Fugazzaro S, Bertozzi L, Bassi MC, Pellegrini M, Vicentini M, Mazzini E, Costi S, Official Journal of the Multinational Association of Supportive Care in Cancer, 2018 May.

Work-specific cognitive symptoms and the role of work characteristics, fatigue and depressive symptoms in cancer patients during 18 months post return to work

Purpose Cancer patients can experience work-specific cognitive symptoms post return to work (RTW). The study aims to: 1) describe the course of work-specific cognitive symptoms in the first 18 months post RTW, and 2) examine the associations of work characteristics, fatigue and depressive symptoms with work-specific cognitive symptoms over time. Methods This study used data from the 18-months longitudinal "Work Life after Cancer" cohort. The Cognitive Symptom Checklist-Work, Dutch Version (CSC-W DV) was used to measure work-specific cognitive symptoms. Linear mixed models were performed to examine the course of work-specific cognitive symptoms during 18 months follow-up; linear regression analyses with generalised estimating equations (GEE) were used to examine associations over time. Results Working cancer patients diagnosed with different cancer types were included (n=378). Work-specific cognitive symptoms were stable over 18 months. At baseline, cancer patients reported more working memory symptoms (M=31.9, CI=23.1, 26.4) compared to executive function symptoms (M=19.3; CI=17.6, 20.9). Cancer patients holding a job with both manual and non-manual tasks reported less work-specific cognitive symptoms (unstandardized regression coefficient b=-4.80; CI=-7.76, -1.83) over time, compared to cancer patients with a non-manual job. Over time, higher depressive symptoms were related to experiencing more overall work-specific cognitive symptoms (b=1.27; CI=1.00, 1.55) and a higher fatigue score was related to more working memory symptoms (b=0.13; CI=0.04, 0.23). Conclusions Job type should be considered when looking at work-specific cognitive symptoms over time in working cancer patients. To reduce work-specific cognitive symptoms, interventions targeted at fatigue and depressive symptoms might be promising.

Source: Dorland HF, Abma FI, Roelen CAM, Stewart R, Amick BC, Bültmann U, Ranchor AV, Psycho-Oncology, 2018 Jun.

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

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

Source: Wang LH, Kennedy BY, Chang SA, Hong Y, Craigie CJ, Kwon S, Romerosa HY, Couban B, Reid RJ, Khan S, McGillion JS, Blinder M, Busse V, Journal of Clinical Oncology, Vol. 36(18), p.1868-1879, 2018 Jun.

Fatigue and depressive symptoms improve but remain negatively related to work functioning over 18 months after return to work in cancer patients

Purpose The aims of this study are to investigate the course of work functioning, health status, and work-related factors among cancer patients during 18 months after return to work (RTW) and to examine the associations between these variables and work functioning over time. Methods Data were used from the 18-month longitudinal "Work Life after Cancer" (WOLICA) cohort, among 384 cancer patients who resumed work. Linear mixed models were performed to examine the different courses during 18-month follow-up. Linear regression analyses with generalized estimating equations (GEE) were used to examine the associations and interactions. Results Cancer patients reported an increase of work functioning and a decrease of fatigue and depressive symptoms in the first 12 months, followed by a stable course between 12 and 18 months. Cognitive symptoms were stable during the first 18 months. Working hours increased and social support decreased during the first 6 months; both remained stable between 6 and 18 months. Fatigue, depressive, and cognitive symptoms were negatively associated with work functioning over time; working hours and supervisor social support were positively associated. Conclusions Interventions to improve cancer patients' work functioning over time might be promising if they are aimed at reducing fatigue, depressive symptoms, cognitive symptoms, and encouraging supervisor social support.Implications For Cancer Survivors: It is important to monitor cancer patients not only in the period directly after RTW but up to 18 months after RTW, allowing for timely interventions when needed.

Source: Dorland HF, Abma FI, Van Zon SKR, Stewart RE, Amick BC, Ranchor AV, Roelen CAM, Bültmann U, Journal of Cancer Survivorship, Vol. 12 (3), p.371-378, 2018 Jun.

A five-phase process model describing the return to sustainable work of persons who survived cancer: A qualitative study.(includes abstract)

Purpose We investigated persons who survived cancer (PSC) and their experiences in returning to sustainable work. Methods Videotaped, qualitative, in-depth interviews with previous cancer patients were analyzed directly using “Interpretative Phenomenological Analysis” (IPA). Four men and four women aged 42–59 years participated. Mean time since last treatment was nine years. All participants had worked for more than 3 years when interviewed. An advisory team of seven members with diverse cancer experiences contributed as co-researchers. Results The entire trajectory from cancer diagnosis until achievement of sustainable work was analog to a journey, and a process model comprising five phases was developed, including personal situations, treatments, and work issues. The theme “return-to-work” (RTW) turned out to be difficult to separate from the entire journey that started at the time of diagnosis. PSCs were mainly concerned about fighting for life in phases 1 and 2. In phase 3 and 4, some participants had to adjust and make changes at work more than once over a period of 1–10 years before reaching sustainable work in phase 5. Overall, the ability to adapt to new circumstances, take advantage of emerging opportunities, and finding meaningful occupational activities were crucial. Conclusions Our process model may be useful as a tool when discussing the future working life of PSCs. Every individual's journey towards sustainable work was unique, and contained distinct and long-lasting efforts and difficulties. The first attempt to RTW after cancer may not be persistent.

Source: Brusletto B, Torp S, Ihlebæk CM, Vinje HF, European Journal of Oncology Nursing, Vol. 34, p.21-27, 2018 Jun.

Early-stage breast cancer and employment participation after 2 years of follow-up: A comparison with age-matched controls

Purpose Although cancer survivors are more likely to be unemployed than individuals without a cancer history, employment participation after treatment of early-stage breast cancer has not been widely studied to date. The objectives of the current study were to evaluate employment trajectories in a cohort of patients with early-stage breast cancer and age-matched controls from the time of diagnosis to the 2-year follow-up, and identify factors associated with diminished and emerging employment participation. Methods As part of a larger cohort study of 1096 patients with early-stage breast cancer and same-aged women without breast cancer, data from 723 working-age (aged 40-64 years) women (347 patients and 376 controls) were analyzed to evaluate 4 employment trajectories (sustained unemployment, diminished employment, emerging employment, and sustained employment). Multivariable logistic regression models were used to identify factors associated with diminished employment versus sustained employment, and emerging employment versus sustained unemployment. Results Lower percentages of patients (71%) compared with controls (79%) reported full-time or part-time employment at enrollment (P<.01). Fatigue was a significant predictor of diminished employment for both patients (odds ratio [OR], 5.71; 95% confidence interval [95% CI], 2.48-13.15) and controls (OR, 2.38; 95% CI, 1.21-4.68). Among patients, African American race (OR, 4.02; 95% CI, 1.57-10.28) and public/uninsured insurance status (OR, 4.76; 95% CI, 1.34-12.38) were found to be associated with diminished employment. Among controls, high social support was associated with emerging employment (OR, 3.12; 95% CI, 1.25-7.79). Conclusions Fatigued patients, African American patients, and publicly insured/uninsured patients with cancer were more likely to experience diminished employment after 2 years of follow-up. Further investigation with longer follow-up is warranted to identify factors associated with these disparities in employment participation after treatment of early-stage breast cancer.

Source: Ekenga CC, Pérez M, Margenthaler JA, Jeffe DB, Cancer, Vol. 124 (9), p.2026-2035, 2018 May.

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, Vol. 26 (5), p.1617-1624, 2018 May.

Determinants of return at work of breast cancer patients: results from the OPTISOINS01 French prospective study

Purpose Return to work (RTW) after breast cancer (BC) is still a new field of research. The factors determining shorter sick leave duration of patients with BC have not been clearly identified. The aim of this study was to describe work during BC treatment and to identify factors associated with sick leave duration. Methods An observational, prospective, multicentre study was conducted among women with operable BC. A logbook was given to all working patients to record sociodemographic and work-related data over a 1-year period. Results Work-related data after BC were available for 178 patients (60%). The median age at diagnosis was 50 years (27-77), 87.9% of patients had an invasive form of BC and 25.3% a lymph node involvement. 25.9% had a radical surgery and 24.2% had an axillary dissection. Radiotherapy was performed in 90.9% of patients and chemotherapy in 48.1%. Sick leave was prescribed for 165 patients (92.7%) for a median of 155 days. On univariate analysis, invasive BC (p=0.025), lymph node involvement (p=0.005), radical surgery (p=0.025), axillary dissection (p=0.004), chemotherapy (p<0.001), personal income <€1900/month (p=0.03) and not having received the patient information booklet on RTW (p=0.047) were found to be associated with a longer duration of sick leave. On multivariate analysis, chemotherapy was found to be associated with longer sick leave (OR: 3.5; 95% CI 1.6 to 7.9; p=0.002). The cost of sick leave to French National Health Insurance was fourfold higher in the case of chemotherapy (p<0.001). Conclusions Advanced disease and chemotherapy are major factors that influence sick leave duration during the management of BC.

Source: Arfi A, Baffert S, Soilly AL, Huchon C, Reyal F, Asselain B, Neffati S, Rouzier R, Héquet D, BMJ Open, Vol. 8 (5), 2018 May.

Labour force participation and the cost of lost productivity due to cancer in Australia

Purpose In Australia, 40% of people diagnosed with cancer will be of working age (25–64 years). A cancer diagnosis may lead to temporary or permanent changes in a person’s labour force participation, which has an economic impact on both the individual and the economy. However, little is known about this economic impact of cancer due to lost productivity in Australia. This paper aims to determine the labour force participation characteristics of people with cancer, to estimate the indirect cost due to lost productivity, and to identify any inequality in the distribution of labour force absence in Australia. Methods This study used national cross-sectional data from the 2015 Survey of Disability, Ageing and Carers, conducted by the Australian Bureau of Statistics (ABS). The ABS weighted each component of the survey to ensure the sample represented the population distribution of Australia. The analysis was limited to people aged 25–64 years. Participants were assigned to one of three health condition groups: ‘no health condition’, ‘cancer’, and ‘any other long-term health condition’. A series of logistic regression models were constructed to determine the association between health condition and labour force participation. Results A total of 34,393 participants surveyed were aged 25–64 years, representing approximately 12,387,800 Australians. Almost half (46%) of people with cancer were not in the labour force, resulting in a reduction of $1.7 billion to the Australian gross domestic product (GDP). Amongst those in the labour force, people with no health condition were 3.00 times more likely to be employed full-time compared to people with cancer (95% CI 1.96–4.57), after adjusting for age, sex, educational attainment and rurality. Amongst those with cancer, people without a tertiary qualification were 3.73 times more likely to be out of the labour force (95% CI 1.97–7.07). Conclusions This paper is the first in Australia to estimate the national labour force participation rates of people with cancer. People with cancer were less likely to be in the labour force, resulting in a reduction in Australia’s GDP. Cancer survivors, especially those without a tertiary qualification may benefit from support to return to work after a diagnosis.

Source: Bates N, Callander E, Lindsay D, Watt K, BMC Public Health, Vol. 18 (1), p.1-1, 2018 Apr.

Health care professionals' perspective on return to work in cancer survivors

Purpose Health care professionals play a significant role in cancer survivors' decisions regarding return to work (RTW). While there is ample research about cancer survivors' views on RTW, little is known about the views of the professionals who accompany them from diagnosis to recovery. The study explores professionals' perceptions of cancer survivors in the RTW context, as well as their views about their own role in the process. Methods In-depth interviews (N = 26) with professionals specializing in physical or mental health working with working-age cancer survivors: occupational physicians, oncologists, oncology nurses, social workers, and psychologists specializing in oncology. Results An analysis of the interviews revealed 2 prominent perceptual dimensions among professionals: the cancer survivor's motivation to RTW and understanding illness-related implications upon returning to work. The 2 dimensions imply the following 4 groups of cancer survivors in the RTW context, as viewed by health professionals: the "realist," the "enthusiast," the "switcher," and the "worrier." The results also indicate that social workers and psychologists view their role in terms of jointly discussing options and implications with the cancer survivor, while physicians and nurses view their role more in terms of providing information and suggestions. Conclusions The training of professionals should increase awareness of the assumptions they make about cancer survivors in regard to RTW. Additionally, training might elaborate professionals' view of their role in the interaction with cancer survivors regarding RTW.

Source: Yagil D, Eshed‐Lavi N, Carel R, Cohen M, Eshed-Lavi N, Psycho-Oncology, Vol. 27 (4), p.1206-1212, 2018 Apr.

Dyadic resources in the return to work of cancer survivors: exploring supervisor-employee perspectives

Purpose The number of working-age people recovering from cancer is gradually on the rise; yet, cancer survivors have higher rates of unemployment compared to other employees. Cancer survivors returning to work cope with symptoms of fatigue, distress, cognitive difficulties and physical limitations. The present article addresses the supervisor-cancer survivor dyad as the unit of analysis, in an attempt to identify the dyadic resources that underlie the coping of the supervisor-employee unit with return to work. Methods In-depth, semi-structured individual interviews were conducted with 12 dyads of cancer survivors and their supervisors, representing successful return to work, followed by comparative content analysis of the data. Results Four themes were revealed: (1) Congruent supervisor-cancer survivor views regarding personalized/standard management of cancer survivors' returning to work; (2) Return to work as a team work approach; (3) Commitment and persistence in the face of obstacles, and (4) Supervisor and cancer survivor mutual appreciation. Conclusions Joint coping of supervisors and cancer survivors with the difficulties of the return to work process is perceived to contribute significantly to the success of return to work. Training of cancer survivors and supervisors conducted by rehabilitation professionals regarding aspects of the orientation toward return to work is suggested. Implication for rehabilitation Cancer survivors have different preferences regarding standard versus exceptional organizational treatment following return to work. Organizational acknowledgment of the cancer survivor's value for the organizations supports cancer survivors' return to work. Cancer survivors can benefit from a sense of responsibility and involvement in decision making regarding the process of return to work.

Source: Yagil D, Goldblatt H, Cohen M, Disability and Rehabilitation, 2018 Apr.

Perceived employer-related 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, de Boer AGEM, de Rijk AE, Tiedtke CM, Dierckx de Casterlé B, Frings‐Dresen MHW, Tamminga SJ, Frings-Dresen MHW, Psycho-Oncology, Vol. 27 (3), p.725-733, 2018 Mar.

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

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

Source: Caron M, Durand MJ, Tremblay D, Journal of Occupational Rehabilitation, Vol. 28 (1), p.89-96, 2018 Mar.

Developing a Return to Work Intervention for Breast Cancer Survivors with the Intervention Mapping Protocol: Challenges and Opportunities of the Needs Assessment

Purpose Return to work (RTW) is an important step for breast cancer survivors (BCSs). However, they face many barriers that affect particularly women with low socioeconomic status (SES). Health care, workplace, and insurance actors lack knowledge and collaborate poorly. No intervention to date has proven effective to reduce social disparities in employment after breast cancer. The intervention mapping (IM) protocol is being used in France to develop, implement, and evaluate an intervention to facilitate and sustain RTW after breast cancer [FAciliter et Soutenir le retour au TRAvail après un Cancer du Sein (FASTRACS) project]. The research question of this study was to elicit the needs for RTW after breast cancer from various stakeholders' point of view. The aim of this study was to describe the process and the preliminary results of the needs assessment of the FASTRACS project. Methods Different methods were followed to (a) establish and work with a planning group and (b) conduct a needs assessment to create a logic model of the problem. A planning group was organized to gather the stakeholders with the research team. A review of the literature and indicators was conducted to identify the magnitude of the problem and the factors influencing RTW. A qualitative inquiry was conducted with 12 focus groups and 48 individual semi-structured interviews to explore the needs and experience of the stakeholders. Results The results of these tasks were the proposition of a charter of partnership to structure the participative process, a review of the scientific evidence and indicators, and the description by the stakeholders of their needs and experience. Many stakeholders disagreed with the concept of "early intervention." They advocated for a better support of BCSs during their RTW, emphasized as a process. Anticipation, intersectoral collaboration, and workplace accommodation were mentioned to fit the needs of the BCS and their environment. A logic model of the problem was elaborated from these data. Conclusions The ability of the model to consider specific characteristics of women with low SES is discussed, with a view to developing the FASTRACS intervention through the next steps of the IM protocol.

Source: Fassier JB, Lamort-Bouché M, Broc G, Guittard L, Péron J, Rouat S, Carretier J, Fervers B, Letrilliart L, Sarnin P, Frontiers in Public Health, Vol. 6, p. 35, 2018 Feb.

Fatigue and depressive symptoms improve but remain negatively related to work functioning over 18 months after return to work in cancer patients

Purpose The aims of this study are to investigate the course of work functioning, health status, and work-related factors among cancer patients during 18 months after return to work (RTW) and to examine the associations between these variables and work functioning over time. Methods Data were used from the 18-month longitudinal "Work Life after Cancer" (WOLICA) cohort, among 384 cancer patients who resumed work. Linear mixed models were performed to examine the different courses during 18-month follow-up. Linear regression analyses with generalized estimating equations (GEE) were used to examine the associations and interactions. Results Cancer patients reported an increase of work functioning and a decrease of fatigue and depressive symptoms in the first 12 months, followed by a stable course between 12 and 18 months. Cognitive symptoms were stable during the first 18 months. Working hours increased and social support decreased during the first 6 months; both remained stable between 6 and 18 months. Fatigue, depressive, and cognitive symptoms were negatively associated with work functioning over time; working hours and supervisor social support were positively associated. Conclusions Interventions to improve cancer patients' work functioning over time might be promising if they are aimed at reducing fatigue, depressive symptoms, cognitive symptoms, and encouraging supervisor social support. Implications for Cancer Survivors It is important to monitor cancer patients not only in the period directly after RTW but up to 18 months after RTW, allowing for timely interventions when needed.

Source: Dorland HF, Abma FI, Van Zon SKR, Stewart RE, Amick BC, Ranchor AV, Roelen CAM, Bültmann U, Journal of Cancer Survivorship: Research and Practice, 2018 Feb.

The role of the general practitioner in return to work after cancer-a systematic review

Purpose The number of cancer patients and survivors of working age is increasing. General Practitioners (GPs) may have a significant role in psychosocial cancer care, including work-related concerns. Therefore, we performed a systematic literature review to identify the role of the GP in work-related concerns and integration/reintegration into work of cancer patients and/or survivors. Methods We searched PubMed, Embase, Cinahl, PsycINFO and Cochrane Library, irrespective of study design. We found 4863 articles and, after removing duplicates, we screened 3388 articles by title and abstract and reviewed 66 of these in full text. The Critical Appraisal Skills Programme tool was used to assess the methodological quality of included articles. We used narrative synthesis to describe the role of the GP. Results We included four qualitative studies from three countries. Two of these studies focused on the health care professionals' perspectives and two studies focused on patients' perspectives regarding the role of the GP. Lack of communication between health care professionals, lack of knowledge about work-related concerns and limited resources were recurring themes in these papers. Fully establishing the role of the GP is difficult given the small number of studies on work-related concerns in cancer patients in primary care. Conclusions There is little evidence regarding the role of the general practitioner in cancer care and work guidance. Therefore, further research should focus on the role that is desired for GPs and on interventions to study the feasibility of GP involvement in the return to work of cancer patients and/or survivors.

Source: de Jong F, Frings-Dresen MH, Dijk NV, van Etten-Jamaludin FS, van Asselt KM, de Boer AGEM, Family Practice, 2018 Feb.

Early-stage breast cancer and employment participation after 2 years of follow-up: A comparison with age-matched controls

Purpose Although cancer survivors are more likely to be unemployed than individuals without a cancer history, employment participation after treatment of early-stage breast cancer has not been widely studied to date. The objectives of the current study were to evaluate employment trajectories in a cohort of patients with early-stage breast cancer and age-matched controls from the time of diagnosis to the 2-year follow-up, and identify factors associated with diminished and emerging employment participation. Methods As part of a larger cohort study of 1096 patients with early-stage breast cancer and same-aged women without breast cancer, data from 723 working-age (aged 40-64 years) women (347 patients and 376 controls) were analyzed to evaluate 4 employment trajectories (sustained unemployment, diminished employment, emerging employment, and sustained employment). Multivariable logistic regression models were used to identify factors associated with diminished employment versus sustained employment, and emerging employment versus sustained unemployment. Results Lower percentages of patients (71%) compared with controls (79%) reported full-time or part-time employment at enrollment (P<.01). Fatigue was a significant predictor of diminished employment for both patients (odds ratio [OR], 5.71; 95% confidence interval [95% CI], 2.48-13.15) and controls (OR, 2.38; 95% CI, 1.21-4.68). Among patients, African American race (OR, 4.02; 95% CI, 1.57-10.28) and public/uninsured insurance status (OR, 4.76; 95% CI, 1.34-12.38) were found to be associated with diminished employment. Among controls, high social support was associated with emerging employment (OR, 3.12; 95% CI, 1.25-7.79). Conclusions Fatigued patients, African American patients, and publicly insured/uninsured patients with cancer were more likely to experience diminished employment after 2 years of follow-up. Further investigation with longer follow-up is warranted to identify factors associated with these disparities in employment participation after treatment of early-stage breast cancer.

Source: Ekenga CC, Pérez ,Margenthaler JA, Jeffe DB, Cancer, 2018 Feb.

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

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

Source: Luo SX, Liu JE, Cheng ASK, Xiao SQ, Su YL, Feuerstein M, Journal of Occupational Rehabilitation, 2018 Feb.

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

Purpose Many recommendations have been made regarding survivorship care provided by teams of primary care professionals. However, the nature of that follow-up, including support for return-to-work (RTW) after cancer, remains largely undefined. As implementation problems are frequently context-related, a pilot study was conducted to describe the contexts, according to Grol and Wensing, in which a new intervention is to be implemented. This pilot study is the first of three steps in intervention development planning. Methods In-depth semi-structured interviews (n=6) were carried out with stakeholders selected for their knowledgeable perspective of various settings, such as hospitals, primary care, employers, and community-based organizations. Interviews focused on participants' perceptions of key contextual facilitators and barriers to consider for the deployment of an RTW intervention in a primary care setting. Data from interviews were transcribed and analyzed. A content analysis was performed based on an iterative process. Results An intervention supporting the process of RTW in primary care makes sense for participants. Results suggest that important levers are present in organizational, professional, and social settings. However, many barriers, mainly related to organizational settings, have been identified, eg, distribution of tasks for survivor follow-up, continuity of information, and coordination of care between specialized oncology care and general primary care. Conclusions To develop and deploy the intervention, recommendations that emerged from this pilot study for overcoming barriers were identified, eg, training (professionals, survivors, and employers), the use of communication tools, and adopting a practice guide for survivor care. The results were also helpful in focusing on the relevance of an intervention supporting the RTW process as a component of primary care for survivors.

Source: Bilodeau K, Tremblay D, Durand MJ, Journal of Multidisciplinary Healthcare, Vol. 11, p.75-83, 2018 Feb.

Assessing factors associated with long-term work disability after cancer in Belgium: a population-based cohort study using competing risks analysis with a 7-year follow-up

Purpose The number of workers with cancer has dramatically increasing worldwide. One of the main priorities is to preserve their quality of life and the sustainability of social security systems. We have carried out this study to assess factors associated with the ability to work after cancer. Such insight should help with the planning of rehabilitation needs and tailored programmes.Methods We conducted this register-based cohort study using individual data from the Belgian Disability Insurance. Data on 15 543 socially insured Belgian people who entered into the long-term work disability between 2007 and 2011 due to cancer were used. We estimated the duration of work disability using Kaplan-Meier and the cause-specific cumulative incidence of ability to work stratified by age, gender, occupational class and year of entering the work disability system for 11 cancer sites using the Fine and Gray model allowing for competing risks. Results The overall median time of work disability was 1.59 years (95% CI 1.52 to 1.66), ranging from 0.75 to 4.98 years. By the end of follow-up, more than one-third of the disabled cancer survivors were able to work (35%). While a large proportion of the women were able to work at the end of follow-up, the men who were able to work could do so sooner. Being women, white collar, young and having haematological, male genital or breast cancers were factors with the bestlikelihood to be able to return to work. Conclusions Good prognostic factors for the ability to work were youth, woman, white collar and having breast, male genital or haematological cancers. Reviewing our results together with the cancer incidence predictions up to 2025 offers a high value for social security and rehabilitation planning and for ascertaining patients' perspectives.

Source: Kiasuwa Mbengi RL, Nicolaie AM, Goetghebeur E, Otter R, Mortelmans K, Missinnne S, Arbyn M, Bouland C, de Brouwer C, BMJ Open, Vol. 8 (2), p.e014094, 2018 Feb.

Healthcare professionals' perspective on return to work in cancer survivors

PurposeHealthcare professionals play a significant role in cancer survivors' decisions regarding return to work. While there is ample research about cancer survivors' views on return to work, little is known about the views of the professionals who accompany them from diagnosis to recovery. The study explores professionals' perceptions of cancer survivors in the return to work context, as well as their views about their own role in the process. Methods In-depth interviews (N=26) with professionals specializing in physical or mental health working with working-age cancer survivors: occupational physicians, oncologists, oncology nurses, social workers and psychologists specializing in oncology. Results An analysis of the interviews revealed two prominent perceptual dimensions among professionals: the cancer survivor's motivation to return to work and understanding illness-related implications upon returning to work. The two dimensions imply the following four groups of cancer survivors in the RTW context, as viewed by health professionals: the "realist"; the "enthusiast"; the "switcher"; and the "worrier". The results also indicate that social workers and psychologists view their role in terms of jointly discussing options and implications with the cancer survivor, while physicians and nurses view their role more in terms of providing information and suggestions. Conclusions The training of professionals should increase awareness of the assumptions they make about cancer survivors in regard to RTW. Additionally, training might elaborate professionals' view of their role in the interaction with cancer survivors regarding return to work.

Source: Yagil D, Eshed-Lavi N, Carel R, Cohen M, Psycho-Oncology, 2018 Jan.

Psychological Interventions to Facilitate Employment Outcomes for Cancer Survivors

Purpose The objective was to examine experimental and quasi-experimental studies about interventions that (i) included behavioral, psychological, educational, or vocational components; (ii) involved cancer survivors aged 18 years or older; and (iii) assessed employment outcomes. Methods The aims were both to describe the variety of interventions that have been studied using rigorous methods and to estimate intervention effects using systematic review and meta-analysis methodologies. Results We found 12 studies evaluating the effects of psychosocial interventions on the employment of cancer survivors (N = 2,151). Overall, there were positive effects on employment status but no evidence of an effect on hours worked and sick leave. Conclusions Despite the positive effect of psychosocial interventions, methodological shortcomings of the included studies overall make it likely that there was bias in the results and too few studies to provide sufficient evidence to recommend particular practices. This review brings attention to the need for additional rigorous studies.

Source: Fong CJ, Murphy KM, Westbrook JD, Markle MM, Research on Social Work Practice, Vol. 28 (1), p.84-98, 2018 Jan.