Work adjustments and employment among breast cancer survivors: a French prospective study
Purpose The objective of our study was to assess the rate of work adjustments 1 year after the diagnosis in a population of female breast cancer (BC) survivors, in the context of the French system of social protection. We also characterised these adjustments and their influence on the reduction of professional exclusion of patients 1 year after the diagnosis. Methods This observational, prospective study was conducted from February 2015 to April 2016 among female patients with BC. Inclusion criteria were women aged between 18 and 65 years, treated for BC and integrated into the labour market at the time of diagnosis (working or on sick leave). Exclusion criteria were metastatic BC, retired patients and refusal to participate. A 1-year follow-up was scheduled, and data collection was performed with questionnaires. Results In total, 213 patients were included between February 2015 and April 2016. One year after the diagnosis (T1), among 185 BC survivors, 78 (42.2%) patients were working. Among them, 13 patients did not interrupt their occupational activity and 65 returned to work after a period of sick leave. Sixty-four patients returned to work after the end of chemotherapy (after 6 months), and one returned to work before this therapeutic threshold. Sixty-six patients (35.7%) benefited from at least one adjustment of their work conditions to facilitate their return to work (RTW) or maintenance at work: working hours were decreased for 43 patients, and workstation changes were performed for 22 patients. An occupational health physician was involved for some patients; work adjustments were prescribed to 42 patients, 7 patients had medical restrictions for physical reasons and 4 patients had restrictions for psychological reasons. Forty-three patients benefited from part-time work prescribed for therapeutic reasons. Conclusions Referral to occupational health physicians and work adjustments remain limited in the process of RTW or maintenance at work after BC in France, despite their positive impact.
Source: Vayr F, Montastruc M, Savall F, Despas F, Judic E, Basso M, Dunet C, Dalenc F, Laurent G, Soulat JM, Herin F, Supportive Care in Cancer, Vol. 2(1), p.185-192, 2020 Jan.
The challenge of return to work in workers with cancer: employer priorities despite variation in social policies related to work and health
Purpose This study explored employer's perspectives on (1) their experience of good practice related to workers diagnosed with cancer and their return to work (RTW), and (2) their perceived needs necessary to achieve good practice as reported by employers from nine separate countries. Methods Twenty-five semi-structured interviews were held in eight European countries and Israel with two to three employers typically including HR managers or line managers from both profit and non-profit organisations of different sizes and sectors. Interviews were recorded and transcribed verbatim. A grounded theory/thematic analysis approach was completed. Results Employers' experience with RTW assistance for workers with cancer appears to be a dynamic process. Results indicate that good practice includes six phases: (1) reacting to disclosure, (2) collecting information, (3) decision-making related to initial actions, (4) remaining in touch, (5) decision-making on RTW, and (6) follow-up. The exact details of the process are shaped by country, employer type, and worker characteristics; however, there was consistency related to the need for (1) structured procedures, (2) collaboration, (3) communication skills training, (4) information on cancer, and (5) financial resources for realizing RTW support measures. Conclusions Notwithstanding variations at country, employer, and worker levels, the employers from all nine countries reported that good practice regarding RTW assistance in workers with a history of cancer consists of the six phases above. Employers indicate that they would benefit from shared collaboration and resources that support good practice for this human resource matter. Implications for Cancer Survivors Further research and development based on the six phases of employer support as a framework for a tool or strategy to support workers with a history of cancer across countries and organisations is warranted.
Source: de Rijk A, Amir Z, Cohen M, Furlan T, Godderis L, Knezevic B, Miglioretti M, Munir F, Popa AE, Sedlakova M, Torp S, Yagil D, Tamminga S, de Boer A, Journal of Cancer Survivorship: Research And Practice, 2019 Nov.
A meta-review of qualitative research on adult cancer survivors: current strengths and evidence gaps
Purpose The number of qualitative studies exploring cancer survivor experiences has significantly increased in recent years, with a large number of systematic reviews now published. This meta-review (systematic review of systematic reviews) aimed to assess the evidence base-summarising existing qualitative findings and identifying gaps for further research. Methods Systematic reviews published from 1950 to 2018 were identified via database searches (MEDLINE, Embase, CINAHL, PsycINFO). Two authors assessed eligibility and extracted data. Review quality was assessed using the JBI Critical Appraisal Checklist for Systematic Reviews. Results A total of 1465 titles were retrieved, and 60 reviews were included in the final review. All included reviews were conducted between 1998 and 2018. Whilst many reviews included mixed cancer types (21), the majority included only one cancer type (breast (19), gynaecological (10), prostate (5), haematological (2), colorectal (1), bladder (1) and melanoma (1)). Reviews focused on several survivorship topic areas including quality of life, experiences of survivors from ethnic minorities, returning to work and experiences of survivorship healthcare services. Less frequently reviewed topics included fertility, body image, coping strategies and spirituality. Conclusions This meta-review provides insight into the areas of research density and paucity. Breast and gynaecological cancer survivors are strongly represented. Gaps in synthesis include reviews for other common cancers (e.g. lung, colorectal, melanoma, haematological) as well as survivorship topic areas such as side/late effects, psychological issues, financial toxicity and health behaviours. Implications for Cancer Survivors Qualitative research into cancer survivor experiences can guide intervention development, as well as provide survivors with insight into the experiences and challenges faced by others with cancer.
Source: Laidsaar-Powell R, Konings S, Rankin N, Koczwara B, Kemp E, Mazariego C, Butow P, Journal of Cancer Survivorship: Research and Practice, 2019 Nov.
A Dimension in Recovery: Return to Working Life after Breast Cancer
Purpose Returning to work (RTW) after breast cancer is an important step in psychosocial recovery. Objective To explore experiences of Turkish breast cancer survivors about returning or continuing to work. Methods This study utilized a qualitative descriptive approach. Data were collected through semi-structured interviews conducted with 12 breast cancer survivors with full employment. The data were analyzed using inductive content analysis method. Results Four themes emerged as a result of analysis of obtained data: decision-making process, difficulties in work life, sources of motivation for maintenance of work life, and benefits of RTW. Conclusions The results of the study showed that RTW involves many uncertainties, and women experience difficulties resulting from themselves, work life, and colleagues. Support from family, colleagues, and employers is an important source of motivation in women's coping with these difficulties. In addition, RTW positively influences psychosocial well-being. Implications for practice: Health professionals should provide support as part of follow-up care regarding difficulties in the return to and continuation of work experienced by breast cancer survivors. Future studies could focus on experiences of all stakeholders including physicians, nurses, colleagues, and employers.
Source: Şengün İnan F, Günüşen N, Özkul B, Aktürk N, Cancer Nursing, 2019 Oct.
Physical symptoms and components of labor tasks associated with upper limb disability among working breast cancer survivors
Purpose Each year, the number of breast cancer (BC) cases increases in Brazil and worldwide. In addition, BC affects women of working age who need to resume their jobs after treatments. This is an observational, cross-sectional study that investigated the association of physical symptoms and work tasks with upper limb disability and return to work in BC survivors. Methods Sociodemographic, labor, clinical and surgical aspects, and physical incapacity of the upper limbs of 62 women diagnosed with BC were evaluated through a questionnaire of our own and the disability of the arm, shoulder, and hand (DASH) questionnaire. The data were analyzed by the IBM Statistical Package for Social Sciences SPSS version 20.0 and a significance of p < 0.05 was adopted. Logistic regression and odds ratio were used to verify the level of association between work tasks and pain with return to work, and multiple linear regression verified the association of physical symptoms with upper limb functionality. Results The work tasks associated with non-return to work were raising objects above the head (OR 3.64, 95% CI 1.26-10.51), lifting objects of more than 5 kg (OR 2.88, 95% CI 1.02-8.13), and loading objects of more than 5 kg (OR 3.93; 95% CI 1.14-10.07). The pain in the upper quadrant homologous to the surgery explained 64% of the variance in physical incapacity of the upper limbs. Conclusions There is an association of labor tasks that require upper limb strength and range of motion with non-return to work, and also pain in the upper quadrant homologous to the BC with reduction in the functionality of the upper limbs.
Source: de Souza Cunha N, Zomkowski K, Fernandes BL, Sacomori C, de Azevedo Guimarães AC, Sperandio FF, Breast Cancer, 2019 Aug.
Recurrent sick leave and resignation rates among female cancer survivors after return to work: the Japan sickness absence and return to work (J-SAR) study
Purpose To date, there have not been any workforce-based Japanese cohort studies investigating work sustainability after return to work (RTW). The objective of this study was to investigate the post-RTW cumulative recurrent sick leave rate and cumulative resignation rate among female cancer survivors. Methods Among Japanese employees who were registered in the Japan sickness absence and return to work (J-SAR) study, the subjects were those female employees who returned to work after sick leave due to newly clinically diagnosed cancer (C01-C99; ICD-10), based on a physician's certificate, between 2000 and 2011. The last day of the follow-up period was December 31, 2012. The recurrent sickness leave rate and resignation rate were calculated using competing risk survival analysis. Results Of 223 cancer survivors, 61 took further physician-certified sick leave after their RTW. The median duration of the post-RTW work period among all cancer survivors was 10.6 years. The work continuance rates of the female cancer survivors were 83.2 and 60.4% at 1 and 5 years after they returned to work, respectively. There was a steep reduction in the work continuance rate during the first post-RTW year. There were considerable differences in the work continuance rate according to the primary cancer site. Cumulative recurrent sick leave rates of 11.8 and 28.9% were seen at 1 and 5 years after the subjects returned to work. The cumulative resignation rate was 5.0 and 10.7% at 1 and 5 years after the subjects returned to work. Most recurrent sick leave occurred in the first year after the subjects returned to work, followed by the second year. Conclusions Sixty percent of female cancer survivors were still working at 5 years after returning to work, although the work continuance rates for different types of cancer varied significantly.
Source: Endo M, Haruyama Y, Muto G, Imai Y, Mitsui K, Mizoue T, Wada H, Kobashi G, Tanigawa T, BMC Public Health, Vol. 19 (1).
Work‐related medical rehabilitation in patients with cancer—Postrehabilitation results from a cluster‐randomized multicenter trial
Purpose Effective multidisciplinary rehabilitation programs supporting the return to work have become increasingly relevant for cancer survivors. In Germany, inpatient work‐related medical rehabilitation programs consider treatment modules of work‐related diagnostics, work‐related functional capacity training, psychosocial groups, and intensified social counseling. The authors tested the effectiveness of a work‐related medical rehabilitation program compared with conventional medical rehabilitation using a cluster‐randomized multicenter trial. Methods In total, 484 patients with cancer were recruited at 4 rehabilitation centers. Patients at a center who started their rehabilitation in the same week represented a cluster. These clusters were randomly assigned using computer‐generated randomization schedules either to an intervention group (IG) or to a control group (CG). The primary outcome was role functioning. Secondary outcomes were other quality‐of‐life domains and the return to work. Results In total, 425 patients (210 in the IG) were included in the analysis at the 3‐month follow‐up. There was no significant difference between the IG and CG in role functioning (b = 3.55; 95% CI, −1.18 to 8.29; P = .142). Participants in the IG reported better physical functioning (b = 5.99; 95% CI, 3.33‐8.65; P < .001), less physical fatigue (b = −5.09; 95% CI, −9.62 to −0.56; P = .028), and less pain (b = −6.24; 95% CI, −11.24 to −1.23; P = .015). Conclusions Work‐related medical rehabilitation had no effect on the primary outcome compared with conventional medical rehabilitation but may enhance physical functioning and reduce physical fatigue and pain. Work‐related medical rehabilitation has no effect on role functioning compared with conventional medical rehabilitation. However, it may enhance physical functioning and reduce physical fatigue and pain.
Source: Fauser D, Wienert J, Beinert T, Schmielau J, Biester I, Krüger HU, Presl A, Bethge M, Cancer, Vol. 125 (15), p.2666-2674, 2019 Aug.
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, Vol. 47 (5), p.519-527, 2019 Jul.
Return to work after breast cancer: The role of treatment‐related side effects and potential impact on quality of life
Purpose For breast cancer survivors return to work (RTW) is important from an economic, societal and personal perspective. Methods Thus, we investigated the impact of side effects and other factors on RTW. Five years post‐diagnosis 135 disease‐free breast cancer survivors below retirement age who were employed pre‐diagnosis recorded their current and previous working status and reasons for impaired RTW. Results Patient‐reported outcomes were prospectively reported over the cancer continuum. One year post‐surgery 57% of survivors worked the same and 22% with reduced working time compared to pre‐diagnosis. Logistic regression revealed significant associations of depressive symptoms, arm morbidity, lower education and younger age with impaired RTW after 1 year, and persisting physical fatigue and living with partner with impaired RTW after 5 years. Major self‐reported reasons included fatigue and cognitive problems. Temporal patterns of general quality of life (QoL), physical, cognitive and role function, and financial problems were significantly worse among women with no RTW compared to those working again. In conclusion, cessation of work after breast cancer seems associated with worse QoL. Fatigue, psychological and cognitive problems as well as arm morbidity seemed to hinder RTW. Conclusions Thus, a better management of these problems might help women to stay in working life.
Source: Schmidt ME, Scherer S, Wiskemann J, Steindorf K, European Journal of Cancer Care, Vol. 28 (4), 2019 Jul.
Return to work after breast cancer treatments: Rebuilding everything despite feeling "in-between"
Purpose The aim of this longitudinal qualitative study is to describe the return-to-work (RTW) journey from the end of breast cancer (BC) treatments to RTW. Methods Nine BC survivors were recruited in the province of Quebec (Canada). The participants, francophones between 30 and 60 years old, had received chemotherapy treatments and planned to RTW in the next six months. Results The interviews were performed at the end of cancer treatments (n = 9), one month before RTW (n = 9), and after RTW (n = 5). A content analysis was performed based on an iterative process. The first six months after the end of treatment was identified as an "in-between" period, during which participants questioned their ability to return to normal life due to the impact of side effects and a sense of withdrawal from health-care services. A three-stage journey similar to a rite of passage process (Van Gennep, 1969) was observed. 1) BC survivors became aware of feeling on the fringes of the workplace as they awaited RTW. 2) During that waiting period, BC survivors were rebuilding a "normal routine" and taking actions on their own in order to re-enter their workplace. 3) After RTW, they needed to make adjustments to maintain a work routine. Support for BC survivors resuming their active lives needs to be optimized. Conclusions BC survivors require support on side effect management, RTW decision-making, and resources for resuming daily activities. Nurses must be aware of the "in-between" period so that they can help BC survivors rebuild their confidence during this rite of passage process. • Participants felt "in between" health-care services and workplace during the first six months after the end of treatment. • Three-stage return to work (RTW) journey similar to a "rite of passage" process was observed. • Survivors are capable of identifying what needs to be set up in order to resume a routine and RTW. • Nurses should recognize that surviving cancer can lead to an experience of feeling "in-between".
Source: Bilodeau K, Tremblay D, Durand MJ, European Journal of Oncology Nursing, Vol. 41, p.165-172, 2019 Aug.
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 MH, de Boer A, Journal of Occupational Rehabilitation, Vol. 29 (3), p. 550-559, 2019 Sep.
Longitudinal Associations Between Fatigue and Perceived Work Ability in Cancer Survivors
Purpose To examine the associations between changes of fatigue and changes of perceived work ability in cancer survivors. Furthermore, to examine the effects of physical job demands on these associations. Methods Data from a feasibility study on a multidisciplinary intervention to enhance return to work in patients with cancer receiving chemotherapy was used. Fatigue (Multidimensional Fatigue Inventory) and perceived work ability (first item of the Work Ability Index) were assessed at baseline, and after 6, 12, and 18 months. Change scores (S1, S2, S3) from each assessment to the next were calculated, thus encompassing three separate time periods of 6 months. Regression analyses were used to quantify associations between change of perceived work ability and (model 1) change of general fatigue, and (model 2) change of mental and physical fatigue for each 6-month period separately. For model 2, interaction effects of perceived physical job demands were studied. Results A total of 89 participants were included for analysis, among which 84% with a diagnosis of breast cancer. On average, in model 1, a reduction of five points on general fatigue was associated with an improvement of one point in perceived work ability in all three 6-month periods. Model 2 showed, similarly, that change of physical fatigue (S1 and S2: B = − 0.225; p <.001 and B = − 0.162; p =.012) and change of mental fatigue (S3: B = − 0.177; p =.027) were significantly inversely associated with change of perceived work ability. Interaction effects were not significant. Conclusions The inverse, longitudinal association between fatigue and perceived work ability supports previous findings from cross-sectional studies and shows potential occupational impact of targeting fatigue in cancer rehabilitation.
Source: Wolvers MDJ, Leensen MCJ, Groeneveld IF, Frings-Dresen MHW, De Boer AGEM, Journal of Occupational Rehabilitation, Vol. 29 (3), p. 540-549, 2019 Sep.
Employees Diagnosed with Cancer: Current Perspectives and Future Directions from an Employer's Point of View
Purpose and methods Cancer survivors have a higher risk of adverse work outcomes such as not being able to return to work (RTW). The process of returning to work is complex as a result of the diverse stakeholders and numerous factors involved related to the employee diagnosed with cancer, the work environment, health care system, and the legal system. One of the key stakeholders is the employer, as the employer is in the position to facilitate work accommodations. Therefore, the purpose of this brief review is to consider opportunities regarding the role of the employer to enhance the work participation of employees with cancer. Results and conclusions We currently know little about which aspects of employer support have a positive impact on the ability of employees diagnosed with cancer to retain at work or RTW. In addition, there is a lack of interventions and tools which support employers in their management of employees diagnosed with cancer. The inclusion of employer support into the workplace can help employees diagnosed with cancer with their work retention and RTW, which is an important aspect of their quality of life and benefits the society at large.
Source: Tamminga SJ, Wolvers MDJ, Greidanus MA, Zaman AC GNM, Braspenning AM, Frings-Dresen M HW, de Boer A GEM, Journal of Occupational Rehabilitation, Vol. 29(2), p.472-474, 2019 Jun.
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 RC, Journal of Occupational Rehabilitation, Vol. 29(2), p.443-450, 2019 Jun.
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, Vol. 29(2), p.406-422, 2019 Jun.
Return to Work Interventions for Cancer Survivors: A Systematic Review and a Methodological Critique
Purpose Cancer patients are more at risk of being unemployed or having difficulties to return to work (RTW) compared to individuals without health concerns, and is thus a major public health issue. The aim of this systematic review is to identify and describe the interventions developed specifically to help cancer patients to RTW after treatment. Methods Two researchers independently screened the articles for inclusion and Critical Appraisal Skills Program (CASP) checklists were used to assess the methodology of the included studies. Ten manuscripts met the inclusion criteria. Results The type of studies were three quasi-experimental studies, three longitudinal studies, three randomized controlled trials (RCTs) and a qualitative study. RTW interventions were conducted in or outside the hospital (n = 6 and 3 respectively), or both (n = 1). Improvements in RTW were only observed in quasi-experimental studies. No improvement in RTW was noted in RCTs, nor in other measures (e.g., quality of life, fatigue). Conclusions Lack of statistically significant improvement does not necessarily reflect reality, but may be attributed to non-adapted research methods. This systematic review underscores the need for researches in the RTW field to reach a consensus on RTW criteria and their assessment.
Source: Lamore K, Dubois T, Rothe U, Leonardi M, Girard I, Manuwald U, Nazarov S, Silvaggi F, Guastafierro E, Scaratti C, Breton T, Foucaud J, International Journal of Environmental Research and Public Health, Vol. 16 (8), 2019 Apr.
Return to work after breast cancer: The role of treatment-related side effects and potential impact on quality of life
Purpose For breast cancer survivors return to work (RTW) is important from an economic, societal and personal perspective. Thus, we investigated the impact of side effects and other factors on RTW. Methods Five years post-diagnosis 135 disease-free breast cancer survivors below retirement age who were employed pre-diagnosis recorded their current and previous working status and reasons for impaired RTW. Patient-reported outcomes were prospectively reported over the cancer continuum. Results One year post-surgery 57% of survivors worked the same and 22% with reduced working time compared to pre-diagnosis. Logistic regression revealed significant associations of depressive symptoms, arm morbidity, lower education and younger age with impaired RTW after 1 year, and persisting physical fatigue and living with partner with impaired RTW after 5 years. Major self-reported reasons included fatigue and cognitive problems. Temporal patterns of general quality of life (QoL), physical, cognitive and role function, and financial problems were significantly worse among women with no RTW compared to those working again. In conclusion, cessation of work after breast cancer seems associated with worse QoL. Conclusions Fatigue, psychological and cognitive problems as well as arm morbidity seemed to hinder RTW. Thus, a better management of these problems might help women to stay in working life.
Source: Schmidt ME, Scherer S, Wiskemann J, Steindorf K, European Journal of Cancer Care, 2019 Apr.
Experiences of positive encounters with healthcare professionals among women on long-term sickness absence due to breast cancer or due to other diagnoses: a nationwide survey
PurposeExperiences of encounters with professionals have been shown to influence return to work (RTW) among sickness absentees in general. The aim was to gain knowledge on experiences of encounters with healthcare professionals and the ability to RTW among women on long-term sickness absence (SA) due to breast cancer (BC) compared to among women on long-term SA due to other diagnoses. MethodsAnalyses of questionnaire data about experiences of encounters with healthcare professionals among 6197 women aged 19–65 years and on a SA spell lasting 4–8 months. Of those, 187 were on SA due to BC. Descriptive statistics and adjusted (for age, birth country, educational level, depressive symptoms) logistic regression analyses with 95% confidence intervals (CI) were conducted. ResultsAbout 95% in both groups of women stated that they had experienced positive encounters with healthcare, and a minority, about 20%, had experienced negative encounters. Four specific types of positive encounters had been experienced to a lesser extent by women with BC: "allowed me to take own responsibility" (odds ratio (OR) 0.6; 95% CI 0.4–0.8), "encouraged me to carry through my own solutions" (OR 0.5; 95% CI 0.4–0.7), "made reasonably high demands" (OR 0.6; 95% CI 0.4–0.9), and "sided with me/stood on my side" (OR 0.6; 95% CI 0.4–0.8). Among the women with BC, 46% stated that positive encounters promoted their ability to RTW compared to 56% among the others. ConclusionsMost of the women had experienced positive encounters and about half stated that positive encounters promoted their ability to RTW, although a slightly smaller proportion of the women with BC stated that. This study emphasizes that not only medical treatment but also encounters may influence the ability to RTW, something that is of clinical importance.
Source: Söderman M, Wennman-Larsen A, Alexanderson K, Friberg E, BMC Public Health, Vol. 19 (1), 2019 Mar.
Returning to work after cancer: Survivors', caregivers', and employers' perspectives
PurposeThe Return to Work Initiative was launched to build a comprehensive understanding of issues, needs, current resources, and available supports for Canadian cancer survivors returning to work as the basis for developing a national action plan.MethodsThis Initiative drew on perspectives of stakeholders through a survey and consultations with cancer survivors and caregivers to learn about challenges regarding return to work and interviews and focus groups with workplace representatives and employers to determine issues encountered in the workplace. Common perspectives across stakeholder groups were identified. ResultsCancer survivors (n = 410) described reduction in income, positive and negative experiences returning to work, and work-related issues regarding side effects. Caregivers (n = 60) described loss of concentration and productivity, stress, and lack of support from coworkers. Employer representatives (n = 68) revealed challenges for managers knowing how best to support cancer survivors as there are few of them of which they are aware. All stakeholders agreed that returning to work for cancer survivors is challenging. Multiple strategies are needed to achieve success: in-depth understanding of the issues, consideration of accommodation, communication among stakeholders, education, resources, and financial support. ConclusionsThe work provided a foundation for making decisions about how to proceed to improve return to work for Canadian cancer survivors.
Source: Fitch M, I.Nicoll I, Psycho-Oncology, Vol. 28(4), p.792-798, 2019 Apr.
Changes in employment status, barriers to, and facilitators of (return to) work in breast cancer survivors 5-10 years after diagnosis
PurposeTo qualitatively investigate changes in employment status, barriers to and facilitators of (return to) work in breast cancer survivors 5-10 years after diagnosis. MethodsWomen were eligible to participate in the focus groups if they were younger than 55 years and were employed at time of diagnosis. Data were analysed by two independent researchers using thematic content analysis. ResultsNineteen women participated in three semi-structured focus groups, of whom 18 reported a change in employment status 5-10 years after diagnosis. Perceived barriers to (return to) work shortly after breast cancer diagnosis tended to be disease- and treatment-related, while 5-10 years later, they were personal- and work-related. Participants recommended open communication and support at the workplace, and comprehensive information from (occupational) health care professionals to facilitate dealing with breast cancer at work. ConclusionsBreast cancer survivors still experience changes in employment status 5-10 years after diagnosis. (Occupational) health care professionals should be alert that perceived barriers for returning to work change over time. Future research should focus on increasing awareness (at work) of breast cancer survivors' needs, providing adequate information and support to all involved, and developing interventions to sustain survivors' work ability at the long term. Implications for rehabilitationEven long after diagnosis and treatment, a sizeable number of breast cancer survivors report a change in employment status, such as job loss. (Occupational) health care professionals should be alert that barriers for returning to work and retaining work change over time. There is a lack of awareness and a shortage of interventions regarding work-related issues for breast cancer survivors at long-term follow-up.
Source: van Maarschalkerweerd PEA, Schaapveld M, Paalman CH, Aaronson NK, Duijts SFA, Disability and Rehabilitation,p. 1-7, 2019 Mar.
Qualitative study of return to work following breast cancer treatment
PurposeAfter 5 years' sick leave in Brazil, employees must retire due to disability. The duration from breast cancer surgery to the end of treatment should be ~9 months. However, diagnosis alone can take 6 months. Surveys administered soon after returning to work have highlighted problems regarding the slow speed of the treatment process and lack of protective legislation. AimsTo assess the barriers and facilitators experienced and the coping strategies adopted by Brazilian women 30 days after return to work following breast cancer treatment. MethodsA qualitative study of 12 women treated for breast cancer. The interviews were recorded, transcribed verbatim and independently analysed by two researchers using a standardized method of analysis. ResultsWomen took an average of 583 days to return to work following breast cancer treatment. The return-to-work experience was considered good, with the physical barriers being fatigue and problems with the arms, and the work environmental barriers being related to discrimination from employers and overprotection from colleagues. Facilitators included social and emotional support given by colleagues/relatives/employers and jobs requiring more cognitive effort than physical exertion. Coping strategies were related to job role adjustments and reduction in tasks and working hours. ConclusionsResults were similar to those reported by previous studies, with the exception of the facilitators. Cognitive effort is commonly considered a barrier. However, the present study had an unusually long duration before return to work, possibly reducing the acute effects of chemotherapy on cognition.
Source: Zomkowski K, Cruz de Souza B, Moreira GM, Volkmer C, Da Silva Honório GJ, Moraes Santos G, Flores Sperandio F, Occupational Medicine, 2019 Mar.
Concerns and Returns to Work in Patients with Breast Cancer Receiving Outpatient Chemotherapy: a Pilot Study
PurposeBreast cancer survivors are increasing in number among survivors of all types of cancer, and survivors returning to work are extremely important. The development of outpatient chemotherapy has increased the working population of patients undergoing cancer therapy. Consequently, a significant number of breast cancer survivors experience physical, psychological, and social problems. This study aimed to clarify differences in concerns among patients with breast cancer receiving outpatient chemotherapy according to their employment status. MethodsTwenty-eight patients with breast cancer undergoing outpatient chemotherapy were recruited. A questionnaire was used to survey the attributes, employment status, and levels of concern in these patients based on the Cancer-chemotherapy Concerns Rating Scale (CCRS). Data from three groups (employed full time, employed part-time, and unemployed) were analyzed using multiple comparison tests. ResultsThe patients' mean age was (55.1 ± 9.9) years. According to the CCRS findings, the following three parameters differed between the three groups: scores for the items "I always think about my disease" (employed vs. unemployed, P = 0.005) and "I can't work (housework/schoolwork)" (employed full time vs. part time, P = 0.045), and scores for the "self-existence" subscale (employed vs. unemployed, P = 0.024). ConclusionsThis study revealed the characteristics of concerns in patients with breast cancer according to their employment status. Being able to continue working is considered to enhance the social health of these patients. Predicting concerns in employed patients will help gain perspective in early nursing interventions.
Source: Tamura S, Sakaguchi K, Yamanaka R, Asia-Pacific Journal of Oncology Nursing, Vol. 6 (2), p. 187-192, 2019 Apr.
Work-related medical rehabilitation in patients with cancer-Postrehabilitation results from a cluster-randomized multicenter trial
Purpose Effective multidisciplinary rehabilitation programs supporting the return to work have become increasingly relevant for cancer survivors. In Germany, inpatient work-related medical rehabilitation programs consider treatment modules of work-related diagnostics, work-related functional capacity training, psychosocial groups, and intensified social counseling. The authors tested the effectiveness of a work-related medical rehabilitation program compared with conventional medical rehabilitation using a cluster-randomized multicenter trial. MethodsIn total, 484 patients with cancer were recruited at 4 rehabilitation centers. Patients at a center who started their rehabilitation in the same week represented a cluster. These clusters were randomly assigned using computer-generated randomization schedules either to an intervention group (IG) or to a control group (CG). The primary outcome was role functioning. Secondary outcomes were other quality-of-life domains and the return to work. ResultsIn total, 425 patients (210 in the IG) were included in the analysis at the 3-month follow-up. There was no significant difference between the IG and CG in role functioning (b=3.55; 95% CI, -1.18 to 8.29; P=.142). Participants in the IG reported better physical functioning (b=5.99; 95% CI, 3.33-8.65; P<.001), less physical fatigue (b=-5.09; 95% CI, -9.62 to -0.56; P=.028), and less pain (b=-6.24; 95% CI, -11.24 to -1.23; P=.015). ConclusionsWork-related medical rehabilitation had no effect on the primary outcome compared with conventional medical rehabilitation but may enhance physical functioning and reduce physical fatigue and pain.
Source: Fauser D, Wienert J, Beinert T, Schmielau J, Biester I, Krüger HU, Presl A, Bethge M, Cancer, 2019 Apr.
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, Vol. 27 (4), p.1197-1206, 2019 Apr.
Respectful encounters from healthcare professionals and return to work among 9032 long-term sick-listed due to cancer or due to other diagnoses: results from a Swedish population-based survey
Purpose To examine whether experiences of positive respectful encounters and negative disrespectful encounters differ between sickness absentees with a cancer diagnosis and sickness absentees with other diagnoses, especially in relation to their ability to return to work (RTW). Methods A total of 9032 long-term sickness absentees in Sweden responded to a questionnaire (response rate 52%) about experiences of positive and negative encounters with healthcare professionals. The association between different types of such encounters and participants feeling respected or disrespected were calculated with population attributable risk with 95% confidence intervals (CI). The perceived impact on ability to RTW was also examined. Results Significantly, larger proportions among those who experienced a positive encounter and also felt respected stated that those encounters facilitated their ability to RTW, compared to those who experienced a positive encounter without feeling respected: among cancer absentees the difference in proportions were 21% (CI, 7-34) versus 50% (CI, 45-55); among absentees with other diagnoses 42% (CI, 37-47) versus 63% (CI, 61-64). Similar comparisons among sick-listed who experienced negative encounters indicated that also feeling disrespected impeded ability to RTW among a significantly larger proportion of those with other diagnoses [51% (CI, 48-54) versus 35% (CI, 31-39) of those not feeling disrespected]. Among cancer absentees, the corresponding proportions were 20% (CI, 9-30) versus 25% (CI, 9-41). Conclusions Compared to sickness absentees with other diagnoses, a larger proportion of cancer sickness absentees stated that they were facilitated by respectful encounters and not impeded by disrespectful encounters, regarding self-estimated ability to RTW. More research is needed to examine whether these differences can be associated with use of a patient-centered encountering approach.
Source: Månsson T, Lynøe N, Alexanderson K, Hinas E, Helgesson G, Friberg E, Official Journal of The Multinational Association of Supportive Care In Cancer, 2019 Jan.
Concerns and Returns to Work in Patients with Breast Cancer Receiving Outpatient Chemotherapy: a Pilot Study
Purpose Breast cancer survivors are increasing in number among survivors of all types of cancer, and survivors returning to work are extremely important. The development of outpatient chemotherapy has increased the working population of patients undergoing cancer therapy. Consequently, a significant number of breast cancer survivors experience physical, psychological, and social problems. This study aimed to clarify differences in concerns among patients with breast cancer receiving outpatient chemotherapy according to their employment status. Methods Twenty-eight patients with breast cancer undergoing outpatient chemotherapy were recruited. A questionnaire was used to survey the attributes, employment status, and levels of concern in these patients based on the Cancer-chemotherapy Concerns Rating Scale (CCRS). Data from three groups (employed full time, employed part-time, and unemployed) were analyzed using multiple comparison tests. Results The patients' mean age was (55.1 ± 9.9) years. According to the CCRS findings, the following three parameters differed between the three groups: scores for the items "I always think about my disease" (employed vs. unemployed, P = 0.005) and "I can't work (housework/schoolwork)" (employed full time vs. part time, P = 0.045), and scores for the "self-existence" subscale (employed vs. unemployed, P = 0.024). Conclusions This study revealed the characteristics of concerns in patients with breast cancer according to their employment status. Being able to continue working is considered to enhance the social health of these patients. Predicting concerns in employed patients will help gain perspective in early nursing interventions.
Source: Asia-Pacific, Journal of Oncology Nursing, Vol. 6(2), p.187-192, Apr-Jun2019.
Returning to work after cancer: Survivors', caregivers' and employers' perspectives
Purpose The Return to Work Initiative was launched to build a comprehensive understanding of issues, needs, current resources, and available supports for Canadian cancer survivors returning to work as the basis for developing a national action plan. Methods This Initiative drew on perspectives of stakeholders through a survey and consultations with cancer survivors and caregivers to learn about challenges regarding return to work; and interviews and focus groups with workplace representatives and employers to determine issues encountered in the workplace. Common perspectives across stakeholder groups were identified. Results Cancer survivors (n=410) described reduction in income, positive and negative experiences returning to work, and work-related issues regarding side effects. Caregivers (n=60) described loss of concentration and productivity, stress, and lack of support from co-workers. Employer representatives (n=68) revealed challenges for managers knowing how best to support cancer survivors as there are few of them of which they are aware. All stakeholders agreed that returning to work for cancer survivors is challenging. Multiple strategies are needed to achieve success: in-depth understanding of the issues, consideration of accommodation, communication among stakeholders, education, resources and financial support. Conclusions The work provided a foundation for making decisions about how to proceed to improve return to work for Canadian cancer survivors.This article is protected by copyright. All rights reserved.
Source: Fitch MI, Nicoll I, Psycho-Oncology, 2019 Feb.
Sociodemographic and disease-related determinants of return to work among women with breast cancer: a German longitudinal cohort study
Purpose Return to work (RTW) is a key parameter of outcome quality that ensures social participation. Therefore, this study analyses the sociodemographic and disease-related determinants of RTW among newly diagnosed breast cancer patients. Methods In a prospective, multicentre cohort study, breast cancer patients were surveyed three times: directly after surgery, after 10 weeks, and after 40 weeks. Logistic regression analysis was applied to estimate the association of RTW at 40 weeks following discharge with sociodemographic and disease-related characteristics (n = 577). Results The sociodemographic variables "entrance certificate at a university of applied science" compared to "university entrance certificate" (OR = 3.1, 95%-CI = 1.2-8.1), age group "55-59 years" compared to "18-44 years" (OR = 3.2, 95%-CI = 1.2-8.4) and "having children" (OR = 2.8, 95%-CI = 1.2-6.2) as well as the disease-related variables "rehabilitation" (OR = 0.5, 95%-CI = 0.3-0.9), self-rated health "good" and "excellent" compared to "bad" (OR = 2.7, 95%-CI = 1.4-5.5; OR = 11.6, 95%-CI = 4.2-31.8) and the UICC-classification "stage II" and "stage III/IV" in comparison to "stage 0/I" (OR = 0.5, 95%-CI = 0.3-0.8; OR = 0.2, 95%-CI = 0.1-0.5) significantly affect RTW among breast cancer patients (Nagelkerke's Pseudo-R2 = 0.275). Conclusions The findings show that significant differences in RTW exist between patient groups and suggest that RTW issues must be addressed more effectively before, during and after treatment. For future research on RTW in Germany, longitudinal studies with a follow-up of several years are necessary. Information and support deficits should be tackled by social services or breast care nurses.
Source:Heuser C, Halbach S, Kowalski C, Enders A, Pfaff H, Ernstmann N, BMC Health Services Research, Vol. 18 (1), 2018 Dec.
Perceived work ability at return to work in women treated for breast cancer: a questionnaire-based study.
Purpose Breast cancer survivors often perceive reduced work ability upon returning to work. Objectives To identify predictors of perceived reduced work ability following return to work among women treated for breast cancer and to describe workplace interventions and support after returning to work. Methods A questionnaire was sent to 18-65 years-old women (no. 1578) treated for breast cancer and residing in the catchment area of the Bologna Local Health Authority between 2010 and 2012. The study population was identified through a Hospital Discharge Database. The questionnaires included items about personal characteristics, cancer and work-related factors, perceived work ability and the return to work process. A multivariable logistic regression analysis was performed to identify predictors of reduced work ability upon returning to work. Results Among the 841 respondents, 503 questionnaires were evaluable. In the study, 43.5% of the respondents reported reduced work ability with respect to the pre-diagnosis period. Reduced work ability was more common in non-cohabiting (OR=1.81, 95%CI 1.10-2.98) than in cohabiting/married women, and after mastectomy (OR=2.77, 95%CI 1.26-6.11) than after breast-conserving surgery. Office staff/sales assistants and managers were less likely to report reduced work ability (OR=0.51, 95%CI 0.30-0.88 and OR=0.21, 95%CI 0.06-0.76, respectively) than labourers. Women who perceived reduced work ability reported more frequently adjustment of work assignments, consultation of an occupational physician, insufficient support from employers and colleagues and discrimination. Conclusions Reduced work ability is commonly perceived among women who return to work after treatment for breast cancer. Occupational physicians and general practitioners should be aware of a wide range of factors influencing this perception in order to facilitate a successful return to work.
Source: Musti MA, Collina N, Stivanello E, Bonfiglioli R, Giordani S, Morelli C, Pandolfi P, Med Lav, Vol. 109 (6), p. 407-419, 2018 Dec.
Cancer survivors on the process of returning to work: a Danish focus group study
Purpose The aim of this study was to explore Danish cancer survivors perspectives on the process of returning to work. Methods Six focus-group interviews (N=32) were held with cancer survivors attending a five-day rehabilitation stay. Data were analyzed by applying meaning condensation then organized into themes. Results Most cancer survivors do not imagine themselves resuming work in the same way as before they had cancer. Many cancer survivors are missing support when navigating the bureaucracy involved with the process of returning to work and do not know how to become, or when they will be, ready for work. Conclusions Practice guidelines that support Danish cancer survivors in returning to work are currently based on knowledge from international reviews but should be supplemented with elements addressing how and when to become ready for work.
Source: Nielsen AF, Zinckernage L, Tofte JB, Timm H, Scandinavian Journal of Work, Environment & Health, 2019 Jan.
Understanding the Workplace Interactions of Young Adult Cancer Survivors With Occupational and Environmental Health Professionals
Purpose Work provides satisfaction and stability to young adult cancer survivors. However, progressive health changes because of cancer may compromise safety and diminish functional ability. The purpose of this study was to describe long-term young adult cancer survivors' work experiences and describe their interactions with occupational and environmental health professionals (OEHPs) within the workplace. Methods Cancer survivors were recruited from the Los Angeles County Cancer Surveillance Program. Professional organizations provided access to OEHPs. Constructivist grounded theory guided individual semi-structured interviews during data collection and analysis. Results Processes of interaction between cancer survivors and OEHPs found to influence work included revealing the survivor-self, sustaining work ability, gatekeeping (employment opportunities, return to work), and accessing support. OEHPs appeared to facilitate survivors' work ability in the long term if services were available, services were known to survivors, and survivors revealed needs. Conclusions Educating workers about OEHP services throughout cancer experiences and survivorship could ultimately improve interactivity and provide supportive work environments.
Source: Stone DS, Pavlish CL, Ganz PA, Thomas EA, Casillas JN, Robbins WA, Workplace Health & Safety, 2019 Jan.
Quality of life, fatigue and changes therein as predictors of return to work during breast cancer treatment
Purpose To our knowledge, only one study has assessed Quality of Life (QOL) as a predictor of return to work (RTW) during breast cancer treatment and one has evaluated multidimensional cancer-related fatigue (CRF) as a determinant of RTW. However, no study has assessed the impact of changes in these variables on RTW. The objective of this study was to evaluate QOL, multidimensional CRF and changes in these variables as determinants of RTW during breast cancer treatment. Methods We performed a longitudinal study of 68 patients with a mean age of 46.97 years (SD = 6.92), who were employed at the time of diagnosis. Women were assessed at the beginning of adjuvant treatments (T0) and followed up with by telephone at three (T1) and 6 months later (T2), using questionnaires (QLQ-C30; MFI-20). Results Global QOL, OR = 1.12 [1.01-1.25], sleep disturbance, OR = 1.04 [1.002-1.08], fatigue (QLQ-C30), OR = 0.93 [0.88-0.99], nausea-vomiting, OR = 0.84 [0.73-0.97], reduced motivation, OR = 1.49 [1.05-2.11] and general fatigue, OR = 0.79 [0.63-0.99] at T0 were associated with RTW at T1. At T2 global QOL, OR = 1.09 [1.01-1.17], cognitive functioning, OR = 1.10 [1.03-1.17], general fatigue, OR = 1.82 [1.04-3.17] and mental fatigue, OR = 0.29 [0.11-0.81] were associated with RTW. Furthermore, changes in mental fatigue were associated with RTW at T2, OR = 0.02 [0.001-0.29]. Conclusions Quality of life, fatigue and their changes in them, especially cognitive functioning and mental fatigue, can play an important role in predicting the RTW of women with breast cancer. This confirms the importance of multidisciplinary care for cancer and the emergence of a theoretical psychological model of RTW.
Source: Porro B, Michel A, Zinzindohoué C, Bertrand P, Monrigal E, Trentini F, Baussard L, Cousson-Gélie F, Scandinavian Journal of Caring Sciences, 2019 Jan.