Cancer

Décembre 2020

Municipal return to work management in cancer survivors: a controlled intervention study

Purpose Resuming work during or after cancer treatment has become an important target in cancer rehabilitation. The aim was in a controlled trial to study the return to work (RTW) effect of an early, individually tailored vocational rehabilitation intervention targeted to improve readiness for RTW in cancer survivors.Methods Participants diagnosed with breast, cervix, ovary, testicular, colon-rectal, and head-and-neck cancers as well as being employed were allocated to a vocational rehabilitation intervention provided by municipal social workers (n= 83) or to usual municipal RTW management (n = 264). The intervention contained three elements: motivational communication inspired by Acceptance and Commitment Therapy by which RTW barriers were addressed, municipal cancer rehabilitation and finally employer and workplace contact. RTW effect was assessed as relative cumulative incidence proportions (RCIP) in the control and intervention group within 52 weeks of follow-up, estimated from the week where treatment ended at the hospital. RCIP was interpreted and reported as relative risk (RR) with 95% confidence intervals (CI) adjusted for gender, age cancer diagnosis, education, comorbidity, and sick leave weeks. Results Across cancer diagnoses 69 (83.1%) and 215 (81.4%) returned to work in the intervention and control group, respectively. No statistical effect was seen (RR 1.08 (95% CI 0.98-1.19)). Repeating the analyses solely for participants with breast cancer (n = 290) showed a significant effect of the intervention (RR 1.12 (95% CI 1.01-1.23)). Conclusions More than 80% returned to work in both groups. However, no statistical difference in RTW effect was seen across cancer diagnoses within one year from being exposed to an early, individually tailored vocational rehabilitation intervention compared with usual municipal RTW management.

Source: Stapelfeldt CM, Momsen AH, Jensen AB, Andersen NT, Nielsen CV, Acta oncologica, p. 1-8, 2020 Dec. 

The Predictive Value of Return to Work Self-efficacy for Return to Work Among Employees with Cancer Undergoing Chemotherapy

Purpose The aim of the present study was to examine the predictive value of Return to Work Self-efficacy (RTWSE) on Return to Work (RTW) among employees undergoing chemotherapy for cancer and to examine the relative contribution of RTWSE as predictor variable compared to personal, health-related, illness- and treatment-related and work-related factors. Methods A sample of 114 sickness absent employees with various cancers (age 18–62) included in the study on average 33 days after initiating chemotherapy were followed for 15 months. Data sources included patient questionnaires (RTWSE, depression, fatigue, performance status), sociodemographic factors (age, sex, job type, and perceived support from the workplace), patient records (type of cancer, treatment intention, number of treatment modalities, time since diagnosis and time since initiation of chemotherapy), and Danish national registries (RTW and education). Associations between RTWSE at baseline and weeks until full RTW during 15-months follow-up were analyzed using Cox proportional hazards regression. Results In the univariate analysis, high RTWSE was associated with shorter time to RTW (Hazard Ratio (HR) 1.84, 95% confidence interval (CI) 1.12–3.03). In the multivariate model, RTWSE failed to reach statistical significance (HR 1.12, 95% CI 0.62–2.02), whereas female sex (HR 0.30, 95% CI 0.15–0.60) and receiving palliative treatment (HR 0.15, 95% CI 0.05–0.44) were significantly associated with later RTW. Conclusions Compared to other factors of significance, RTWSE was not the strongest predictor of RTW when examined among employees undergoing chemotherapy for cancer. Before using the RTWSE questionnaire to identify employees with cancer at risk of late RTW, it is important to recognize that the predictive value of RTWSE may be different for employees on sick leave due to cancer than for other sickness absence populations.

Source: Rosbjerg R, Hansen D, Gilså Z, Robert H, Inger L, Merete T, Journal of Occupational Rehabilitation, Vol. 30(4), p. 665-678, 2020 Dec. 

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, Vol. 30(4), p.635-645, 2020 Dec.

Novembre 2020

Working after cancer: in-depth perspectives from a setting with limited employment protection policies

Purpose A considerable proportion of individuals who are diagnosed with cancer are at a working age. We aimed to gain an in-depth understanding of the challenges, and arising needs related to working after cancer in a setting with limited employment protection policies. Methods Focus group discussions were conducted with cancer patients who were diagnosed at least 1 year prior to recruitment, and either had paid work, were self-employed, currently unemployed, or currently retired (N = 66). Results Three main themes were identified: (1) loss of income: While some participants were entitled for a 1-year cancer-specific sick leave, many other participants recounted having insufficient paid sick leave, forcing them to take prolonged unpaid leave to complete treatment; (2) dealing with side effects of cancer and its treatment: The need for workplace accommodations was highlighted including flexible working hours, lighter workloads, and dedicated rest areas to enable patients to cope better; (3) Discrimination and stigma at workplace: Some participants mentioned being passed over on a promotion, getting demoted, or being forced to resign once their cancer diagnosis was disclosed, highlighting an urgent need to destigmatize cancer in the workplace. Conclusions In settings with limited employment protection policies, a cancer diagnosis severely impacts the working experiences of patients, leading to financial loss. Urgent interventions and legislative reforms are needed in these settings to address the unmet employment needs of cancer survivors. Implications for Cancer Survivors This study may facilitate planning of local solutions to fulfill the unmet employment needs following cancer, such as return-to-work navigation services.

Source: Kong YC, Rauf N, Subramaniam S, Bustamam RS, Wong LP, Ho GF, Zaharah H, Mellor M, Yip CH, Bhoo-Pathy N, Journal of cancer survivorship : research and practice, 2020 Oct.

Boosting return to work after breast cancer: The mediator role of perceived emotional intelligence

Purpose This study aimed to explore work ability (WA) in breast cancer (BC) survivors and to examine the mechanism by which perceived emotional intelligence (PEI) acts as a covitality factor that preserves WA and promotes the return to work in this clinical population. Methods The sample was composed of 622 women divided into two groups: BC survivors (6.75%) and healthy controls (93.25%). Participants completed the Work Ability Index and Trait-Meta-Mood Scales. Descriptive statistical and serial mediation analyses were conducted to explore the mechanism by which PEI influences the relationship between BC survivors and WA. Results Preliminary descriptive analysis showed that BC survivors displayed lower levels of WA than healthy controls. The overall serial mediation analysis revealed that BC and PEI predicted 35.4% of the variance of WA. The direct effects showed that BC and age decrease WA. Regarding PEI, our results indicated that emotional clarity and mood repair lead to higher WA, while emotional attention decreased the ability to work in both, the BC sample and healthy controls. The mediation analysis revealed that WA could be preserved in BC survivors by an indirect effect through mood repair. Conclusions Our findings support previous research demonstrating that BC patients have lower levels of WA compared to healthy controls. This study highlighted the relevance of PEI as a covitality factor that enhances WA. Our research offers vital support for the need to improve emotional competences in BC patients to increase WA levels and return to work odds.

Source: Gómez‐Molinero R, Guil R, Psycho-Oncology, Vol. 29 (11), p.1936-1942, 2020 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 semistructured 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 İ, Figen G, Neslihan Ö, BurcuAktürk N, Cancer Nursing, Vol. 43 (6), E328-E334, 2020 Dec.

A scoping review of return to work decision-making and experiences of breast cancer survivors in Korea

Purpose Return to work (RTW) is an important component of cancer survivorship for individual rehabilitation and economic development. The focus of prior research on cancer survivor RTW has generally been on Western and general cancer populations. There is a need to examine the existing research on RTW decisions and experiences in Korean breast cancer survivors (BCS). Methods This scoping review followed the framework of Arksey and O'Malley, which consisted of identifying the research question, discovering and selecting studies, charting data, analyzing results, and incorporating expert consultations. Quality assessments and a thematic map were included. Results Out of 863 original articles found in the literature search, 8 articles met the inclusion criteria. Majority were published in the past 5 years. The scope of the field, socio-demographic and clinical associations, and factors associated with RTW decision-making and experiences were reported. In the thematic analysis, 4 main categories were derived. Conclusions Future research needs to be conducted on effective RTW interventions targeting various educational backgrounds, socioeconomic levels, and job types. More institutional and social support would encourage more successful RTW through educational awareness, financial assistance, and workplace accommodations. Future studies should focus on interdisciplinary RTW efforts with multiple stakeholders. Implication for Cancer Survivors BCS need programs that include social support, individual coping strategies, reliable RTW information, physical rehabilitation, vocational counseling, workplace allowances, and psychological support. More support should be provided through extending the work law and engaging employers. If they desire to resume working, BCS should be fully supported with RTW specific resources.

Source : Sohn KJ, Park SY, Kim S, Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 2020 Oct.

Octobre 2020

From shaky grounds to solid foundations: A salutogenic perspective on return to work after cancer

Purpose Almost a third of employed individuals of working age fall out of work after cancer treatment. Aim: To explore cancer survivors' successful return to work, focusing on assets and resources utilized to resolve cancer- and work-related obstacles to achieve long-term employment. Methods We interviewed eight cancer survivors who had remained at work for at least 3 years after cancer treatment. We performed interpretative phenomenological analysis and applied Antonovsky's salutogenic model of health as a framework. Results The participants experienced uncertainty regarding cancer recurrence, impairments, and long-lasting effects on work ability. They utilized a wide range of resistance resources at personal, interpersonal, and social levels. Their determination to return to work was generally strong, but the time needed to find sustainable work and strategies to return to work varied. All participants prioritized activities that energized them and adapted actively to their new situation. When unsure about outcomes, they focused on the best alternative and controlled fear cognitively. Conclusions Finding meaningful activities, testing actual work ability, and focusing on the best possible outcome seemed important to remain in work after cancer. It may be helpful to identify available resources and utilize them to resolve tensions resulting from cancer and cancer treatment.

Source : Brusletto B, Ihlebæk CM, Mjøsund NH, Torp S, Scandinavian Journal of Occupational Therapy, Vol. 27 (7), p.524-535, 2020 Oct.

Cancer survivorship needs in Brazil: Patient and family perspective

Purpose Cancer Survivorship is a growing public health challenge. Effective responses from health care and social services depend on appropriate identification of survivors and their families´ specific needs. There are few studies on survivorship in low and middle-income countries, therefore, more evidence-based studies are necessary to develop a comprehensive approach to cancer survivorship. Objectives Identify the needs of cancer survivors and their relatives, specifically those of individuals with breast, cervical or prostate cancer, and with acute lymphocytic leukemia (ALL). Methods A qualitative, exploratory study conducted in two referral institutions in Brazil, located in Rio de Janeiro (Southeast region) and Fortaleza (Northeast region). The study included 47 patients of public and private health services and 12 family members. We used script-based semi-structured interviews. The discursive material obtained was categorized and analyzed using the Thematic Analysis approach. Results The analysis identified three central themes: 1) consequences of cancer treatment; 2) Changes in daily life associated with cancer survivorship; and 3) Unmet structural needs in cancer survivorship. Conclusions Social and cancer control policies in Brazil should provide resources, specific care standards and clinical, psychological and social support. Cancer survivors should also receive rehabilitation and work reintegration guidelines. This matter requires broader access to qualified cancer information, development of an integrated patient-centered care and care model, and more research resources for the country's post-treatment cancer period.

Source: Santos, ATC, Silva RP, Almeida LM, Bosi MLM, Menezes MFB, Skaba MMVF, Nigenda G, Arruda CAM, Pinheiro CPO, González-Robledo MC, Knaul FM, PLoS ONE, Vol. 15 (10), p.1-17, 2020 Oct.

Boosting return to work after breast cancer: The mediator role of perceived emotional intelligence

Purpose This study aimed to explore work ability (WA) in breast cancer (BC) survivors and to examine the mechanism by which perceived emotional intelligence (PEI) acts as a covitality factor that preserves WA and promotes the return to work in this clinical population. Methods The sample was composed of 622 women divided into two groups: BC survivors (6.75%) and healthy controls (93.25%). Participants completed the Work Ability Index and Trait‐Meta‐Mood Scales. Descriptive statistical and serial mediation analyses were conducted to explore the mechanism by which PEI influences the relationship between BC survivors and WA. Results Preliminary descriptive analysis showed that BC survivors displayed lower levels of WA than healthy controls. The overall serial mediation analysis revealed that BC and PEI predicted 35.4% of the variance of WA. The direct effects showed that BC and age decrease WA. Regarding PEI, our results indicated that emotional clarity and mood repair lead to higher WA, while emotional attention decreased the ability to work in both, the BC sample and healthy controls. The mediation analysis revealed that WA could be preserved in BC survivors by an indirect effect through mood repair. Conclusions Our findings support previous research demonstrating that BC patients have lower levels of WA compared to healthy controls. This study highlighted the relevance of PEI as a covitality factor that enhances WA. Our research offers vital support for the need to improve emotional competences in BC patients to increase WA levels and return to work odds.

Source: Gómez‐Molinero R, Guil R, Psycho-Oncology, 2020 Oct.

Cancer survivors' experiences with conversations about work-related issues in the hospital setting

Purpose Early access to work-related psychosocial cancer care can contribute to return to work of cancer survivors. We aimed to explore: 1) the extent to which hospital health care professionals conduct conversations about work-related issues with cancer survivors, 2) whether cancer survivors experience these conversations as helpful, and 3) the possible financial implications for cancer survivors of (not) discussing their work early on. Methods The Dutch Federation of Cancer Patient Organizations developed and conducted a cross-sectional online survey, consisting of 27 items, among cancer survivors in the Netherlands. Results In total, 3500 survivors participated in this study (71% female; mean age (SD) 56 (11) years). Thirty-two percent reported to have had a conversation about work-related issues with a health care professional in the hospital. Fifty-four percent indicated that this conversation had been helpful to them. Conversations about work-related issues took place more frequently with male cancer survivors, those aged 55 years or below, those diagnosed with gynecological, prostate, breast, and hematological or lymphatic cancer, those diagnosed ≤2 years ago, or those who received their last treatment ≤2 years ago. There was no statistically significant association between the occurrence of conversations about work-related issues and experiencing the financial consequences of cancer and/or its treatment as burdensome. Conclusions Although conversations about work-related issues are generally experienced as helpful by cancer survivors, early access to work-related psychosocial cancer care in the hospital setting is not yet systematically offered.

Source: Zegers AD, Coenen P, van Belzen M, Engelen V, Richel C, Dona DJS, van der Beek AJ, Duijts SFA, Psycho-oncology, 2020 Oct.

Changes in employment status, barriers to, and facilitators of (return to) work in breast cancer survivors 5–10 years after diagnosis

Purpose To qualitatively investigate changes in employment status, barriers to and facilitators of (return to) work in breast cancer survivors 5–10 years after diagnosis. Methods Women 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. Results Nineteen 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. Conclusions Breast 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. Even 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 & Rehabilitation, Vol. 42 (21), p.3052-3058, 2020 Oct.

Septembre 2020

The associations between late effects of cancer treatment, work ability and job resources: a systematic review

Purpose The aim of this review is to evaluate associations between possible late effects of cancer treatment (i.e. physical complaints, fatigue, or cognitive complaints) and work ability among workers beyond 2 years after cancer diagnosis who returned to work. The role of job resources (social support, autonomy, leadership style, coaching, and organizational culture) is also evaluated. Methods The search for studies was conducted in PsycINFO, Medline, Business Source Premier, ABI/Inform, CINAHL, Cochrane Library and Web of Science. A quality assessment was used to clarify the quality across studies. Results The searches included 2303 records. Finally, 36 studies were included. Work ability seemed to decline shortly after cancer treatment and recover in the first 2 years after diagnosis, although it might still be lower than among healthy workers. No data were available on the course of work ability beyond the first 2 years. Late physical complaints, fatigue and cognitive complaints were negatively related with work ability across all relevant studies. Furthermore, social support and autonomy were associated with higher work ability, but no data were available on a possible buffering effect of these job resources on the relationship between late effects and work ability. As far as reported, most research was carried out among salaried workers. Conclusions It is unknown if late effects of cancer treatment diminish work ability beyond two years after being diagnosed with cancer. Therefore, more longitudinal research into the associations between possible late effects of cancer treatment and work ability needs to be carried out. Moreover, research is needed on the buffering effect of job resources, both for salaried and self-employed workers.

Source: Boelhouwer IG, Vermeer W, van Vuuren T, International archives of occupational and environmental health, 2020 Sep.

Juillet 2020

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.

Source: Lewis J, Mackenzie L, Black D, Psycho-Oncology, Vol. 29 (7), p.1156-1164, 2020 Jul.

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 nonreturn 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, Supportive Care in Cancer, Vol. 28 (9), p.4445-4458, 2020 Sept.

Cancer survivors’ efforts to facilitate return to work

Purpose This study assesses individual factors that influence return to work (RTW) and in particular on the cancer survivors’ ability to prepare his/her job resumption. Methods A self-administered questionnaire was completed by 105 cancer survivors after at least 4 weeks after the time of their RTW. Various methods of returning to work were compared between occupational and medical characteristics with multivariate statistical tests. Results Regular contact by a cancer survivor with the company during sick leave is associated with RTW within 1 year of diagnosis (ORaj = 5.78). Optional pre-reinstatement visit with the occupational physician is associated with the absence of employee activity’s change (ORaj = 2.30). The cancer survivors who during treatment period ask for an adaption of treatment are more likely to have a change in working conditions (ORaj = 14.5). Conclusions The adaptation to recovery conditions appears to be associated with survivors’ effort to RTW. It should be confirmed with new studies.

Source: Bellagamba G, Descamps A, Cypowyj C, Eisinger F, Villa A, Lehucher-Michel MP, Psychology, Health & Medicine Publisher: Taylor & Francis.

Juin 2020

Trajectories of sickness absence and disability pension in the 2 years before and 3 years after breast cancer diagnosis: A Swedish longitudinal population-based cohort study

Purpose After breast cancer (BC) diagnosis, work incapacity often occurs among working-age women. We investigated the trajectories of previous and subsequent sickness absence and/or disability pension (SA/DP) days, and risk factors for consistently high levels of future SA/DP among these women. Methods This longitudinal cohort study included all 3536 women in Sweden aged 19-64 years who received a first BC diagnosis in 2010. Their annual SA/DP net days from 2 years before to 3 years after diagnosis were calculated. SA/DP patterns were depicted by a group-based trajectory model. Logistic regressions were used to calculate odds ratios (ORs) with 95% CIs of >90 or >180 SA/DP days/year. Results Three trajectories of SA/DP days/year were identified: increasing only in year+1 (61% of all), increasing then decreasing in year+3 (30%), and constantly very high (9%). The risk factors associated with annual SA/DP days >90 (long) and >180 days (extreme long) were similar. Factors associated with having >90 SA/DP days for years 1-3 were: stage II (OR, 4.59; 95% CI, 2.98-7.07), stage III+IV (OR, 26.57; 95% CI, 13.52-52.22), prediagnosis SA 1-30 days (OR, 2.73; 95% CI, 1.30-5.70), prediagnosis SA >90 days (OR, 24.52; 95% CI, 12.25-49.08), and prediagnosis DP (OR, 659.97; 95% CI, 292.52->999.99). Conversely, adjusting for prediagnosis SA/DP and stage, sociodemographic factors were not associated with high levels of SA/DP. Conclusions After BC diagnosis, SA/DP increased significantly but then decreased. The absolute majority had no SA/DP during year 3. Advanced cancer stage and previous high SA/DP rendered the greatest risk for future high SA/DP. More knowledge is needed for applying the information in rehabilitation and return-to-work planning. 

Source: Chen L, Alexanderson KAE, Cancer, Vol. 126 (12), p.2883-2891, 2020 Jun.

The Successful Return-To-Work Questionnaire for Cancer Survivors (I-RTW_CS): Development, Validity and Reproducibility

Purpose Cancer survivors' perspectives on a successful return to work (RTW) may not be captured in the common measure of RTW, namely time until RTW. The purpose of this study was therefore to develop an RTW outcome measure that reflects employed cancer survivors' perspectives, with items that could be influenced by an employer, i.e. the Successful Return-To-Work questionnaire for Cancer Survivors (I-RTW_CS), and to assess its construct validity and reproducibility. Methods First, three focus groups with cancer survivors (n = 14) were organized to generate issues that may constitute successful RTW. Second, a two-round Delphi study among 108 cancer survivors was conducted to select the most important issues. Construct validity of the I-RTW_CS was assessed using correlations with a single-item measure of successful RTW and the Quality of Working Life Questionnaire for Cancer Survivors (QWLQ-CS; n = 57). Reproducibility (test-retest reliability) was assessed using the intraclass correlation coefficient (ICC; n = 50). Results Forty-eight issues were generated, of which seven were included: 'enjoyment in work'; 'work without affecting health'; 'confidence of employer without assumptions about work ability'; 'open communication with employer'; 'feeling welcome at work'; 'good work-life balance'; and 'joint satisfaction with the situation (employer and cancer survivor)'. Correlations with single-item successful RTW and QWLQ-CS were 0.58 and 0.85, respectively. The reproducibility showed an ICC of 0.72. Conclusions The I-RTW_CS provides an RTW outcome measure that includes cancer survivors' perspectives and weights its items on an individual basis, allowing a more meaningful evaluation of cancer survivors' RTW. This study provides preliminary evidence for its construct validity and reproducibility.

Source: Greidanus MA, de Boer AGEM, de Rijk AE, Brouwers S, de Reijke TM, Kersten MJ, Klinkenbijl JHG, Lalisang RI, Lindeboom R, Zondervan PJ, Frings-Dresen MHW, Tamminga SJ, The patient, 2020 Jun.

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.