Avril 2020

Employers' Experience on Involvement in Sickness Absence/Return to Work Support for Employees with Cancer in Small Enterprises

Purpose Return to work (RTW) is important for employees who have survived cancer, yet it is challenging for employers. Small enterprises (< 100 employees) might have limited resources to facilitate RTW of cancer survivors. The purpose of this article is to examine how such employers engage in the support of RTW and to uncover their needs. Methods Eleven owners and one HR manager representing 12 small enterprises (various sectors) were interviewed regarding their experience with RTW of employees surviving cancer. We conducted a thematic analysis with aspects of Grounded Theory. Results The characteristics of being a small enterprise (i.e. informal practical arrangements, working as a family, working with limited resources and people) related to four concerns experienced by these employers (concerns about the employer's enterprise; the employee's cancer and recovery; RTW and work adjustments; and about communication). In line with these concerns, employers need information on rights and obligations, RTW arrangements and communication skills during RTW guidance. Conclusions In small enterprises, employers have generally close relationships with their employees, which means that support is gladly provided when employees are diagnosed with cancer. They do however have limited financial means to facilitate RTW and workplace adjustments. They therefore perceive long-term sickness and RTW as a major financial risk for the company.

Source: Tiedtke C, De Rijk A, Van den Broeck A, Godderis L, Journal of occupational rehabilitation, 2020 Apr.

Return to work after a cancer diagnosis: a meta-review of reviews and a meta-synthesis of recent qualitative studies.

Purpose Returning to work (RTW) after cancer treatment can be challenging, but when desired, has many benefits. While there are many qualitative studies (reviews and recent studies) available on cancer survivors' experience of returning to work, synthesis of these qualitative studies is lacking. We aimed to summarise the existing qualitative reviews and recent studies following the last published review, to examine cancer survivors' motivations for and experiences of RTW, and to highlight factors within both the survivors and his or her environment that influence RTW. Methods A set of systematic reviews focusing on RTW were identified. A systematic search for individual papers published on RTW since the last review was also completed. Data extraction and bias assessment were conducted, with 25% double-coded to ensure reliability. A meta-ethnographic approach was utilised to synthesise the findings of each. Results Seven systematic reviews and 12 individual papers between 2017 and 2019 were identified. Quality was variable. Most reviews and studies focused on women with breast cancer. Three major themes were identified: person factors, employment factors and wider contextual factors including family, social and cultural variables. Conclusions We identified gaps in research on the RTW experiences of people with cancers other than breast, men, those with low incomes and more diverse populations. Implications for Cancer Survivors Cancer survivors need to consider personal, employer and wider contextual factors when deciding whether and when to RTW. Future interventions to support survivors should be informed by these findings, addressing the diverse range of potential factors related to RTW in an individual survivor.

Source:  Butow P, Laidsaar-Powell R, Konings S, Lim CYS, Koczwara B, Journal of cancer survivorship : research and practice, Vol. 14 (2), p. 114-134, 2020 Apr.

Workforce Participation of Australian Women with Breast Cancer

Purpose International research suggests that many women do not return to their previous work after breast cancer. This study aimed to identify workforce participation patterns for Australian women with breast cancer and compare these to healthy aged matched women. Methods Using the 1946-1951 birth cohort of the Australian Longitudinal Study on Women's Health, the work status of women was compared three years before and three years after their first reported breast cancer diagnosis. Latent class analysis was used to identify workforce participation patterns of women with breast cancer and healthy aged matched women. Multinomial logistic regression examined associations between work patterns and other risk factors. Results Pre and post breast cancer diagnosis work status data were available for 448 women with breast cancer between 1998 and 2010. Three years after diagnosis, 48% of full-time workers returned to full-time work but 52% returned to part time work or were not in paid work. Latent class analysis identified five classes. Women with breast cancer were more likely to be in the "mostly full-time work" and "mostly not in paid work" classes compared to healthy women. Odds ratios showed that women in remote areas, partnered, with less education or with chronic health condition were more likely to be "not in paid work". Conclusions Breast cancer has a negative impact on the workforce participation of Australian women. Women with breast cancer need support to return to work. This article is protected by copyright.

Source: Lewis J, Mackenzie L, Black D, Psycho-oncology, 2020 Apr.

Mars 2020

Breast cancer specialists' perspective on their role in their patients' return to work: A qualitative study

Purpose This study aimed to explore the views of breast cancer (BC) specialists as to their role in the return-to-work (RTW) process of their BC patients. Methods A qualitative study using semi-structured interviews was conducted in a sample of 20 BC specialists selected according to age, gender, medical specialty (medical oncology, radiation oncology, gynecological surgery), and healthcare organization (regional cancer center, university or private hospital). All interviews were audiotaped and transcribed for qualitative thematic content analysis. Results BC specialists had heterogeneous representations and practices regarding their role in their patients` RTW process, ranging from non-involvement to frequent discussion. Most BC specialists had concerns regarding the "right time and right way" to address patient`s RTW. They hardly mentioned workplace and job factors as potential barriers but rather stressed motivation. The main reported barriers to involvement in the RTW process were lack of time, lack of knowledge, lack of skills, and a professional attitude exclusively focused on cancer care issues. Conclusions While our study showed varying representations and practices among BC specialists, participants consistently identified barriers in supporting BC survivors` RTW. The results will guide the development of an intervention to facilitate the role of BC specialists in the RTW process as part of a multicomponent intervention to facilitate BC survivors` RTW.

Source: Lamort-Bouché M, Péron J, Broc G, Kochan A, Jordan C, Letrilliart L, Fervers B, Fassier JB, Scandinavian Journal of Work, Environment & Health, Vol. 46 (2), p. 177-187, 2020 Mar.

Février 2020

Supporting the Return to Work After Cancer in Romania: Exploring Employers' Perspectives

Purpose Evidence shows that employers play a key role in facilitating the return to work of employees with cancer, yet little is known about the employers' experiences in settings where no policies or regulations are available to guide this process. Against this background, we aimed (1) to understand how employers experience and manage the process of having employees with cancer and (2) to explore their reflections regarding their role in returning to work. Methods Twenty employers from various types of organisations and sectors were interviewed. Inductive thematic analysis was performed using NVivo 11. Results Employers experienced having employees with cancer as a process with three distinct phases reflected in three emerging themes: disclosure of the diagnosis and absence from work; returning to work; post-returning to work. A fourth theme emphasizes the employers' reflections on how they conceive their own role. In the absence of a normative framework for dealing with employees with cancer, employers used commonsensical rules of thumb and immediate solutions based on ad-hoc decisions and were often compelled to innovate. They offered accommodations only if requested by the employee after returning to work. The return to work process was neither planned nor phased. Conclusions Employers need information and guidelines for effectively assisting employees with cancer. Better channels of communication and collaboration with health professionals are essential for more adequate support for the long-term consequences of cancer. A detailed return to work policy is required to tackle the inconsistencies in the support offered and this policy must also rethink how diagnosis disclosure takes place in Romanian organisations.

Source: Popa A, Morândău E, Popa F, Radu-Ioan R, Mihai S, Sidor A, Journal of Occupational Rehabilitation, Vol. 30(1), p.59-71, 2020 Mar.

Janvier 2020

Factors influencing return to work of cancer survivors: a population-based study in Italy

Purpose Little is known about return to work (RTW) of cancer survivors (CSs) in Central and Southern Europe. This study investigates the RTW rate of Italian CSs, describes their sick leave (SL) pattern, and explores factors affecting their RTW process. Methods A population-based cross-sectional survey involving CSs registered at the Cancer Registry of Reggio Emilia Province (Italy) was launched in July 2016. Eligibility was restricted to individuals with first diagnosis of cancer in 2012 (stages I-III), aged 20-59, and employed at the time of diagnosis. Results Of the 266 individuals interviewed, 140 (52.6%) were reintegrated without difficulty, 113 (42.5%) returned to work with some difficulty, and 13 did not RTW (4.9%). The majority of CSs (56%) took SL for some periods during treatment. Age > 50 years and higher income seemed to facilitate RTW (RR = 0.65, 95% CI 0.49-0.88 and RR = 0.72, 95% CI 0.54-0.97, respectively), while being divorced acted as a barrier compared to being married (RR = 1.45, 95% CI 1.04-2.01). Individuals uncertain about the type of company they were working for reported greater difficulty in RTW (RR = 1.68, 95% CI 1.03-2.72). Individuals who had undergone chemotherapy and those perceiving physical limitations had a higher risk of difficulty in the RTW process (RR = 1.79, 95% CI 1.42-2.24 and RR = 1.59, 95% CI 1.25-2.02, respectively). Conclusions Most CSs did RTW, with 2/3 combining work and treatment. However, almost half reported difficulty in RTW process. Factors affecting this process should be addressed throughout context-specific social and healthcare pathways aimed at preventing difficulties and potential job loss in this population.

Source: Paltrinieri S, Vicentini M, Mazzini E, Ricchi E, Fugazzaro S, Mancuso P, Giorgi Rossi P, Costi S, Supportive Care in Cancer, Vol. 28 (2), p.701-712, 2020 Feb. 

Factors associated with return to work in breast cancer survivors treated at the Public Cancer Hospital in Brazil

Purpose To evaluate the impact of return to work on the quality of life of breast cancer patients and to identify factors related to nonreturn to work. Methods An observational, cross-sectional study was performed in breast cancer survivors who had worked before their breast cancer diagnosis. We evaluated factors related to return to work (patient perspective, disease, and work), EORTC quality of life questionnaires (general: EORTC QLQ-C30; and breast cancer-specific: EORTC QLQ-BR23), the Shoulder Pain and Disability Index (SPADI), and the Anxiety and Depression Scale (HADS). Half of the patients underwent a physical therapy examination (shoulder goniometry, hand dynamometry, and limb volume). Univariate and multivariate analysis were performed. Results We included 304 patients, 163 of whom underwent physiotherapy evaluation. Approximately 54.0% (164) of the patients returned to work after treatment. The women who returned to work presented lower age, higher education levels, higher incomes, and smaller initial tumor size. The women who returned to work had higher scores related to body image and sexual function, lower scores in relation to disability and pain, and lower scores related to anxiety and depression. In the multivariate model to evaluate nonreturn to work, pretreatment variables were age, education level, and clinical staging. Sequelae related to loss of strength increased the risk of non return to work. Conclusions Return to work was influenced by age, education level, previous activity types, axillary treatment, and physical sequelae related to loss of hand strength. Breast cancer treatment decreased the women's work capacity. Return to work improved the patients' quality of life.

Source: Colombino ICF, Sarri AJ, Castro IQ, Paiva CE, da Costa Vieira RA, Official Journal of the Multinational Association of Supportive Care in Cancer, 2020 Jan.  

Supporting employers to enhance the return to work of cancer survivors: development of a web-based intervention (MiLES intervention)

Purpose The purpose of this study was to develop an intervention targeting employers, with the aim of enhancing cancer survivors' return to work (RTW). Methods Intervention Mapping was used to combine information gathered from several procedures involving numerous stakeholders, for example, employers, cancer survivors, oncological occupational physicians, and e-health experts. Results Employers indicated that they require tailored support during four RTW phases: (1) disclosure, (2) treatment, (3) RTW planning, and (4) actual RTW. The most important employer actions were identified for each RTW phase, for instance, "communicate," "support practically," and "assess work ability," and thereafter formulated as the performance objectives of the intervention. The trans-theoretical model of change was used as a theoretical framework, and several methodologies were employed to induce the desired behavior change, for example modeling, tailoring, and active learning. Subsequently, a web-based intervention with interactive videos, conversation checklists, links to reliable external sources, and succinct, tailored tips and information was developed and adjusted on the basis of pre-tests with different stakeholders. Conclusions The intervention was developed with input from employers and all relevant stakeholders in the RTW of cancer survivors. The systematic, step-wise development resulted in a succinct and easily accessible intervention targeting the most important employer actions during all RTW phases. As such, the intervention corresponds with employers' needs and preferences in practice. Implications for Cancer Survivors By providing employers with support, the intervention could well be the missing link in efforts to optimize the work participation of cancer survivors.

Source: Greidanus MA, de Boer AGEM, Tiedtke CM, Frings-Dresen MHW, de Rijk AE, Tamminga SJ, Journal of Cancer Survivorship: Research and Practice, 2020 Jan. 

Type of cancer treatment and cognitive symptoms in working cancer survivors: an 18-month follow-up study

Purpose Cognitive symptoms are reported to affect cancer survivors' functioning at work. However, little is known about the type of cancer treatment and cognitive symptoms in working cancer survivors. We examined the longitudinal association between type of cancer treatment and cognitive symptoms in cancer survivors post return to work, and whether the course of cognitive symptoms over 18 months differed per type of cancer treatment. Methods Data from the Dutch longitudinal "Work-Life after Cancer" study were used. The study population consisted of 330 working cancer survivors who completed questionnaires at baseline, and 6, 12, and 18 months follow-up. Cognitive symptoms were assessed with the cognitive symptom checklist-work and linked with cancer treatment data from the Netherlands Cancer Registry. Data were analyzed using generalized estimating equations. Results Cancer survivors who received chemotherapy reported comparable memory symptom levels (b: - 2.3; 95% CI = - 7.1, 2.5) to those receiving locoregional treatment. Executive function symptom levels (b: - 4.1; 95% CI = - 7.8, - 0.4) were significantly lower for cancer survivors who received chemotherapy, compared with those receiving locoregional treatment. In cancer survivors who received other systemic therapy, memory (b: 0.4; 95% CI = 0.1, 0.7) and executive function symptom levels (b: 0.4; 95% CI = 0.0, 0.7) increased over time. In cancer survivors who received chemotherapy and locoregional treatment, memory and executive function symptom scores were persistent during the first 18 months after return to work. Conclusions The contradictory finding that cancer patients receiving chemotherapy report fewer cognitive symptoms warrants further research. Implications for Cancer Survivors Working cancer survivors may have cognitive symptom management needs irrespective of the type of cancer treatment they received.

Source: Ehrenstein JK, van Zon SKR, Duijts SFA, van Dijk BAC, Dorland HF, Schagen SB, Bültmann U, Journal of Cancer Survivorship: Research and Practice, 2020 Jan.