Cancer

Janvier 2021

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

Introduction Resuming work during or after cancer treatment has become an important target in cancer rehabilitation. Purpose 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.Material and 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)). Conclusion 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, 2020 Dec 07, pp. 1-8

An integrative review: Women's psychosocial vulnerability in relation to paid work after a breast cancer diagnosis

Purpose The aim of this integrative review was to explore psychosocial vulnerabilities in women after a breast cancer diagnosis that are related to their paid work. Methods The review methodology was guided by Whittemore and Knafl. The Mehnert Cancer Survivorship and Work Model provided a lens through which to view vulnerability in working women with a focus on facilitating interventions to improve both recovery and work outcomes. PUBMED, CINAHL, Web of Science, and PsycNET databases were searched for English language papers published between January 2014-June 2020.Titles and abstracts were screened. Inclusion/exclusion criteria were then applied to full text screen of the remaining articles following PRISMA guidelines. Thirteen studies meeting the inclusion criteria were critically appraised using the Critical Appraisal Skills Programme (CASP) checklist. A constant comparison approach was used to systematically distil findings into categories and assess their fit within the Mehnert Model subdomains. Results Vulnerabilities coalesced predominantly within the following subdomains: (a) changes in identity and role functioning; (b) social reintegration; (c) coping strategies; and () social supports. Patterns and themes within these subdomains were related both positively and negatively to form the contours of a survivor's satisfaction/dissatisfaction with quality of life related to work and breast cancer recovery. Conclusion Overall, findings highlight the importance of employment and work environments in bolstering women's psychosocial health after a breast cancer diagnosis. Findings from this review support adapting psychosocial distress screening to include vulnerabilities relating to work life. Nurses are ideally positioned to facilitate this screening and engage clinicians in a dialogue surrounding patient's support needs due to nursing's central role on the interdisciplinary team. Nurses may also foster collective accountability for implementing ongoing multidisciplinary survivorship care plans that include a return to work component.

Source: Melnyk H, Djukic M, Merriman J, Vaughan Dickson V, Journal of advanced nursing, 2020 Dec 26.

Factors Affecting Quality of Work Life in a Sample of Cancer Survivor Female Nurses

Purpose Identifying the factors affecting the Quality of Work Life (QWL) of cancer survivor female nurses is important and necessary to overcome the various challenges experienced by these professionals upon returning to work following recovery from the disease. Therefore, this study aimed to identify the factors affecting the level of nurses' QWL. Methods A cross-sectional survey was conducted among 115 registered female nurses who had survived cancer, in general hospitals and clinics in South Korea. SPSS statistics version 21 was used for ordinary least squares, and Stata version 12.0 was used for quantile regression analysis. Results Workplace spirituality affected all quantiles of QWL except the 90% quantile; fatigue was an affecting factor in the 20%, 30%, and 70% quantiles; and job stress in the 20%, 30%, 40%, and 60%, 70%, 80% quantiles. For workplace spirituality, the effect size was 0.33 ( p < 0.001) in the 10% quantile, increasing to 0.45 ( p < 0.001) in the 80% quantile. Conclusions Based on the results of this study, suggestions for clinical practice include providing the mediating strategies and programs to manage fatigue and job stress as well as workplace spirituality. Job-related factors such as shift work should also be considered.

Source: Jin JH, Lee EJ, Medicina, 2020 Dec 21; Vol. 56 (12).

Employment After Breast Cancer Diagnosis and Treatment Among Women in the Sister and the Two Sister Studies

Purpose Women undergoing diagnosis and treatment for breast cancer may face challenges in employment. We investigated the impact of demographic, clinical, workplace, and psychosocial characteristics on loss of employment after a breast cancer diagnosis and treatment. We further describe changes in work status and work environment for cancer survivors who sustain employment. Methods We analyzed responses from a survey of breast cancer survivors from the Sister Study and the Two Sister Study cohorts who reported being employed at the time of their breast cancer diagnosis and who reported employment status (lost vs. sustained employment) at the time of survey administration. Multivariate logistic regression was used to identify the effects of lymphedema, neuropathy, problems with memory or attention, social support, health insurance, and sick leave on lost employment, adjusting for demographic characteristics, cancer stage, treatment, and general health. Results Of the 1675 respondents who reported being employed at the time of diagnosis, 83.5% reported being 'currently' employed at the time of the survey. Older age, peripheral neuropathy, lack of sick leave, late stage at diagnosis, a recurrence or a new cancer, problems with memory or attention, and poor general health were significantly associated with lost employment. Conclusions The long-term effects of breast cancer treatment and workplace provisions for leave and accommodation may have a substantial effect on women's ability to sustain employment. The findings from this study highlight challenges reported by cancer survivors that may inform clinical and occupational interventions to support survivors' return to work.

Source: Peipins LA, Dasari S, Rodriguez JL, White MC, Hodgson ME, Sandler DP, Journal of occupational rehabilitation, 2021 Jan 02

Return to Work and Quality of Life in Disease-Free Adult Patients with Soft-Tissue and Bone Sarcoma of the Extremity

Purpose & methods Treatment of extremital sarcoma patients may be associated with significant functional disabilities and psychosocial distress affecting return to work (RtW) and quality of life (QoL). In this exploratory study we prospectively investigated the RtW rate, explored biomedical and psychosocial predictors of RtW, and compared generic QoL with Swiss population norms. Results Forty people (89 %) returned to work. Full-time employment before sarcoma diagnosis, high educational level, and low tumor grade showed an increased probability of RtW. The median age was lower in patients who returned to work, and they reported less fear of progression. Generic QoL (SF-36) was reduced in almost all dimensions when compared to a normative Swiss population. Conclusion Physical functioning and fear of progression have to be addressed in the rehabilitation process.

Source: Kollár A, Müller S, Limacher A, Briner I, Klenke F, Bernhard J, Praxis, 2021 Jan; Vol. 110 (1), pp. 22-29.

Relationship of perceived everyday cognitive function and work engagement in breast cancer survivors

Purpose Breast cancer survivors (BCS) who represent approximately 3.5 million survivors in the USA frequently report ongoing cognitive dysfunction that may impact work outcomes. However, little is known about how perceived everyday cognitive function may affect work engagement (a measure of work efficacy and work well-being) in BCS who have completed treatment.The purpose of this study was to examine the relationship between perceived everyday cognitive function and work engagement in BCS. Methods A convenience sample of 68 employed BCS seen at a Midwest NCI-Cancer Center who were at least 1-year post-treatment, completed a cross-sectional questionnaire assessing demographic and medical characteristics, and perceived everyday cognitive function (Everyday Cognition Scale) and work engagement (Utrecht Work Engagement Scale). Descriptive statistics, Pearson's r, and separate regression models controlling for age and education were used to analyze the data. Results BCS who were on average 52 (SD = 8.6) years old, 5 (SD = 3.8) years post-treatment, and primarily employed full-time (79%) participated. A subset of BCS (12%) identified poorer everyday cognitive function after BC diagnosis and treatment. Everyday cognition, including subscales vigor and dedication, were correlated with work engagement (p˂0.01), controlling for age and education. Conclusions Findings indicate the important role of perceived everyday cognitive function in work engagement well into survivorship. Reducing cognitive dysfunction may be an important area for future intervention research to support BCS who return to work. Healthcare providers need to assess and address perceived cognitive dysfunction to promote work-related outcomes in BCS well into survivorship.

Source: Von Ah D, Crouch A, Supportive care in cancer: official journal of the Multinational Association of Supportive Care in Cancer, 2021 Jan 07

Perceptions of clinical support for employed breast cancer survivors managing work and health challenges

Purpose A substantial portion of breast cancer survivors are active in the workforce, yet factors that allow survivors to balance work with cancer management and to return to work are poorly understood. We examined breast cancer survivors' most valued/desired types of support in early survivorship. Methods Seventy-six employed breast cancer survivors answered an open-ended survey question assessing the most valued/desired support to receive from healthcare providers during early survivorship to manage work and health. Cutrona's (Journal of Social and Clinical Psychology 9:3-14, 1990) optimal matching theory and House's (1981) conceptualization of social support types informed our analyses. Data were content-analyzed to identify themes related to support, whether needed support was received or not, and the types of healthcare providers who provided support. Results We identified six themes related to types of support. Informational support was valued and mostly received by survivors, but they expected more guidance related to work. Emotional support was valued but lacking, attributed mainly to providers' lack of personal connection and mental health support. Instrumental (practical) support was valued but received by a small number of participants. Quality of life support to promote well-being and functionality was valued and often received. Other themes included non-specific support and non-support. Conclusions This study expands our understanding of how breast cancer survivors perceive work-related support from healthcare professionals. Findings will inform targeted interventions designed to improve the support provided by healthcare professionals. Breast cancer survivors managing work and health challenges may benefit by having their unmet support needs fulfilled.

Source: Dugan AG, Decker RE, Namazi S, Cavallari JM, Bellizzi KM, Blank TO, Dornelas EA, Tannenbaum SH, Shaw WS, Swede H, Salner AL, Journal of cancer survivorship : research and practice, 2021 Jan 06

Facteurs prédictifs de maintien en emploi et de retour au travail après un cancer

Objectif L’objectif principal de ce travail était d’identifier les facteurs sociodémographiques liés à la pathologie cancéreuse influençant le retour au travail professionnel.Méthodes Étude descriptive et prospective qui se rapportait au retour au travail des patients cancéreux, en activité professionnelle, ayant bénéficié d’un traitement et d’un suivi au niveau du service de carcinologie à l’hôpital Tahar Mâamouri, durant la période allant de septembre 2015 jusqu’à décembre 2019.Résultats Notre étude avait recensé 89 patients. L’âge moyen était de 45 ans ± 8. La population était à prédominance féminine (59 %). Il s’agissait d’employés dans 45 % des cas. Les localisations cancéreuses les plus représentées étaient le sein (45 %) et le colon (20 %). Après la fin du traitement, 34 patients avaient repris leur emploi. Il s’agissait de femmes dans 79 % des cas et de cancer du sein dans 70 % des cas. L’étude des facteurs prédictifs de reprise du travail a révélé en analyse univariée une corrélation du retour en emploi avec le sexe (p = 0,002), la profession (p < 10−3), la durée initiale d’arrêt du travail au cours du traitement (p = 0,015), les mesures d’aménagement (p = 0,01), la nature de la tumeur primitive (p = 0,001), le stade de la maladie (p = 0,037), le traitement (p = 0,014) et la réponse aux traitements (p = 0,024).Conclusion Notre étude a mis l’accent sur l’importance de la mise en place d’une plateforme pluridisciplinaire basée sur la collaboration entre le médecin du travail et le médecin traitant afin de faciliter le retour au travail et le maintien dans l’emploi des patients après un cancer.

Source: Mersni M, Belfkih H, Bani M, Youssef I, Rais H, Bulletin du cancer, 2021 Jan 14

Predictors of resignation and sick leave after cancer diagnosis among Japanese breast cancer survivors: a cross-sectional study

Purpose In Japan, 55.5% of breast cancer survivors (BCSs) are of working age, so various perspectives regarding return to work (RTW) after cancer diagnosis need to be considered. Therefore, this study aimed to clarify the risk factors for resignation and taking sick leave (SL) among BCSs in continued employment at the time of diagnosis. Methods A web-based retrospective cross-sectional survey was conducted on BCSs using data from a 2018 Japanese national research project (Endo-Han) commissioned by the Ministry of Health, Labour and Welfare of Japan. The subjects were women aged 18-69 years who had been diagnosed with breast cancer for the first time at least 1 year previously. The risk factors for resignation and taking SL after breast cancer diagnosis, including age at diagnosis, education level, cancer stage, surgery, chemotherapy, radiotherapy, employment status, and occupational type, were then analyzed using a logistic regression model. Results In total, 40 (14.9%) of 269 BCSs quit their jobs at least 1 year after being diagnosed with breast cancer. The results of the multivariable analysis indicated that lower education level (odds ratio [OR]: 3.802; 95% confidence interval [CI]: 1.233-11.729), taking SL (OR: 2.514; 95%CI: 1.202-5.261), and younger age at diagnosis (OR: 0.470; 95%CI: 0.221-0.998) were predictors of resignation. Of 229 patients who continued working, SL was taken by 72 (31.4%). In addition, undergoing surgery was found to be a predictor of taking SL (OR: 8.311; 95%CI: 1.007-68.621). Conclusions In total, 40 (14.9%) of 269 BCSs quit their jobs at least 1 year after being diagnosed with breast cancer. The results of this study indicated that younger age, lower education level, and taking SL were predictors of resignation after breast cancer diagnosis.

Source: Mitsui K, Endo M, Imai Y, Ueda Y, Ogawa H, Muto G, Yan Y, Deshpande GA, Terao Y, Takeda S, Tanigawa T, Nishimura K, Hayashi K, Saito M, Kokaze A, BMC public health, 2021 Jan 14; Vol. 21 (1), pp. 138

Return to work in survivors of Primary Brain Tumours treated with Intensity Modulated Radiotherapy

Purpose Primary brain tumour (PBT) survivors have a high burden of morbidity. Return to work (RTW) is an important survivorship parameter and outcomes measure in these patients, especially in developing countries. This study was done to assess RTW after radiotherapy, reasons for no RTW, and relationship of RTW with treatment and patient factors. Methods A single centre study was done amongst PBT patients. Baseline and treatment details, education, employment was assessed. RTW assessed as: time to RTW, full/ part-time, reasons for no RTW and RTW at 6 months post-therapy, and last follow up. Results 67 PBT patients with a median age of 42 years were assessed. Most common diagnosis was low grade glioma. Over 66% patients were illiterate, and 62% had semi-skilled and unskilled jobs, mostly agriculture. About 64.4% patients returned to employment in a median time of 3 months. At 6 months post-treatment 58.2% had a job, with only 42% working full-time. 'Limb weakness' (21.4%), followed by 'loss of job/ no job' (16.7%), 'fatigue'/ 'tiredness' (14.3%), 'poor vision/ diminished vision' (11.9%) were the common reasons for no RTW. The factors found to be significantly associated with return to work were younger age (p = 0.042), male sex (0.013), the absence of complications during radiotherapy (p = 0.049), part time job prior to diagnosis (p = 0.047), and early return to work after RT (p < 0.001). Conclusion Studies are needed to identify the barriers in re- employment and steps to overcome them in cancer patients.

Source: Basalathullah MAR, Malik M, Valiyaveettil D, Elizabeth NB, Ahmed SF, Cancer treatment and research communications, 2021 Jan 05; Vol. 26.

Changes after cancer diagnosis and return to work: experience of Korean cancer patients

Purpose Cancer patients' return to work is a growing aspect of survivorship care, yet limited studies have been conducted in Korea to understand the work-related experience of cancer patients. The purpose of this study was to understand the unmet needs of cancer patients and identify the necessary factors to develop a vocational intervention program based on cancer patients' work-related experience after cancer diagnosis. Methods Semi-structured individual in-depth interviews were conducted with 50 cancer patients who were working at the time of diagnosis at a university hospital in Seoul, South Korea from July to September of 2017. Interview data were analyzed using qualitative content analysis. Results 'The changes patients experienced after cancer diagnosis' were categorized into Personal and socio-environmental changes. 'Personal changes' were changes within the patient that were further divided into 'physical', 'psychological' and 'spiritual' changes while 'socio-environmental changes' were changes in either 'attitude' and 'relationship' of other people cancer patients encountered. In addition to these post-diagnosis changes, the following 4 major factors related to return-to-work were identified to affect patients' experience: 'fear of cancer recurrence', 'financial status', 'informational support', and 'job-related work environment'. Conclusion Cancer patients' working status was determined by personal and socio-environmental changes after the cancer diagnosis which as well as psychological distress and practical issues such as fear of cancer recurrence, financial burden, and work environment. Educational materials and intervention programs informing patients on these changes and factors may facilitate their return-to-work after diagnosis.

Source: Bae KR, Cho J, BMC Cancer, 2021 Jan 21; Vol. 21 (1).

Occupational rehabilitation of male breast cancer patients: Return patterns, motives, experiences, and implications-A qualitative study

Purpose Knowledge regarding the occupational rehabilitation of male breast cancer patients (MBCPs) is currently scarce; however, there may exist unmet needs of men affected by this rare disease. Therefore, this exploratory study investigated the experiences of MBCPs in their return to work (RTW). Methods Interview data from 14 men with a breast cancer diagnosis were used for qualitative content analysis. Data were collected within the mixed-methods N-MALE project (Male breast cancer: patients' needs in prevention, diagnosis, treatment, rehabilitation, and follow-up care), conducted in Germany from 2016 to 2018. Results The eight identified motives for RTW were desire for normalcy, distraction, need for activity, social contacts, work as a source of pleasure, financial considerations, lack of self-perception of illness, and having a job requiring low physical effort. The participants reported positive experiences with their workplaces from diagnosis through RTW. However, stigmatisation occurred. The aftermath of the disease and treatment led to changes in the interviewees' productivity, for instance due to fatigue. Conclusion The findings of this study contribute to a better understanding of RTW processes, as new insights were gained about motives and experiences particular to MBCPs. Support needs after return were apparent and may help to reduce long-term effects that limit productivity.

Source: Hiltrop K, Heidkamp P, Halbach S, Brock-Midding E, Kowalski C, Holmberg C, Ernstmann N, European journal of cancer care, 2021 Jan 23.

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: (a) the extent to which hospital healthcare professionals conduct conversations about work-related issues with cancer survivors, (b) whether cancer survivors experience these conversations as helpful, and (c) 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 healthcare 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, 2021 Jan; Vol. 30 (1), pp. 27-34