Prognostic Factors for Return to Work and Work Disability among Colorectal Cancer Survivors; A Systematic Review
1VU University Medical Center, Netherlands, The; 2Academic Medical Center, University of Amsterdam, The Netherlands; 3Institute of Health & Society, Newcastle University, Newcastle, United Kingdom; 4Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Göteburg, Sweden; 5Department of Surgical Sciences, University of Torino, Torino, Italy
Background: Colorectal cancer is diagnosed progressively in employed patients due to screening programs and increasing retirement age. The objective of this study was to identify prognostic factors for return to work and work disability in patients with colorectal cancer.
Methods: The research protocol was published at PROSPERO with registration number CRD42017049757. A systematic review of cohort and case-control studies in colorectal cancer patients above 18 years, who were employed when diagnosed, and who had a surgical resection with curative intent were included. The primary outcome was return to work or work disability. Potentially prognostic factors were included in the analysis if they were measured in at least three studies. Risk of bias was assessed according to the QUality In Prognosis Studies tool. A qualitative synthesis analysis was performed due to heterogeneity between studies. Quality of evidence was evaluated according to Grading of Recommendation Assessment, Development and Evaluation.
Results: Eight studies were included with a follow-up period of 26 up to 520 weeks. (Neo)adjuvant therapy, higher age, and more comorbidities had a significant negative influence on return to work. A previous period of unemployment, extensive surgical resection and postoperative complications significantly increased the risk of work disability. The quality of evidence for these prognostic factors was considered very low to moderate.
Conclusion: Health care professionals need to be aware of these prognostic factors to select patients eligible for timely intensified rehabilitation in order to optimize the return to work process and prevent work disability.
Return to Work Self-Efficacy (RTWSE) And Actual Return To Work In A Population Of Cancer Patients
1Aarhus University, Denmark; 2DEFACTUM, Central Denmark Region, Aarhus, Denmark; 3The National Research Center of Cancer Rehabilitation, Research Unit of General Practice, University of Southern Denmark, Denmark; 4Unit for Psycho Oncology and Health Psychology, Department of Psychology, Aarhus University, Aarhus, Denmark; 5Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
Cancer patients and cancer survivors have an increased risk of sickness absence, unemployment, and early retirement. Considering the societal costs and the impact on quality-of-life (QoL) of cancer patients and their families, improving work ability and the return to work (RTW) process for cancer patients is of major importance. Self-efficacy (SE) has been found to be an important factor in understanding the RTW process among employees with various health problems. Return to work self-efficacy (RTWSE) has proved to be a strong predictor of actual RTW in workers on sickness absence due to both psychological and physiological causes. However, the predictive value of RTWSE has not yet been investigated in employees on sickness absence due to cancer. The aim of this study is to investigate the predictive value of RTWSE in sick listed cancer patients undergoing chemotherapy.
In a prospective, longitudinal design, cancer patients (n = 150) with different diagnosis and in different stages of the disease will be included during 1 year. The inclusion criteria are: age 18-62, employed but on sick leave at baseline, starting chemotherapy at Aarhus University Hospital. At the beginning of chemotherapy, the cancer patients fill out the 19-items RTWSE questionnaire. Demographics and illness related factors are also measured. The main outcome measure is RTW (yes/no) during 12 months of follow-up.
An association between a high level of RTWSE at baseline and a short time to RTW is expected. The results will be presented at the conference.
To improve the work ability and the process of RTW for cancer patients, it is necessary to obtain a better understanding of the RTW process of cancer patients. Work related SE may play a key role in that process.
Oncologists’ Views On Their Role On Return To Work After Breast Cancer: Findings From A Qualitative Study
1UMRESTTE UMR T9405, Université Claude Bernard Lyon 1, France; 2Collège Universitaire de Médecine Générale, Lyon, France; 3CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Université Lyon 1, F-69100 Villeurbanne, France; 4Service de Biostatistique et Bioinformatique, Hospices Civils de Lyon, F-69003 Lyon, France; 5Health Services and Performance Research EA7425, Université Claude Bernard Lyon 1, France; 6Département Cancer et Environnement, Centre Léon Bérard, Lyon, France; 7Centre de Recherche en Cancérologie de Lyon, UMR INSERM 1052-CNRS 5286, F-69008 Lyon, France; 8Occupational health and medicine department, Hospices Civils de Lyon, France
Return to work (RTW) of breast cancer survivors (BCS) faces many barriers. Oncologists are valued by BCS as key informants from whom they expect guidance about RTW. Women also report disappointment, with a feeling of abandonment and helplessness at the end of cancer care. In the frame of the FASTRACS project (Facilitate and sustain RTW after breast cancer), the aim of this study was to explore the views of oncologists as to their role in the RTW process of their breast cancer patients.
A qualitative inquiry was conducted by means of individual semi-structured interviews among 20 oncologists. Participants were selected by theoretical, purposive and snowball sampling to include a varied sample according to age, gender, medical specialty and hospital. An interview guide was drafted upon the literature, and revised during the data collection. All interviews were taped and transcribed. A thematic qualitative content analysis was performed with MAXDA software to explore and describe the views of oncologists.
The respondents had different representations about their patients’ work, from a total absence of consideration to frequent discussions. They shared common interrogations regarding “the right moment and the right way” to talk about work, given the variety of individual situations and their evolution. Some negative impacts of chemotherapy on work issues were mentioned. Workplace and job characteristics were hardly mentioned as potential barriers to RTW, whereas women’s personal motivation was mentioned repeatedly as a key facilitator.
The main barriers reported by oncologists’ to their involvement in RTW of their patients were mainly lack of time, lack of knowledge, lack of awareness, lack of skills, and a professional attitude exclusively focused on cure objectives. These findings will guide the development of the FASTRACS programme to improve inter-professional collaboration and women’s pathway from cancer care to the workplace.
Developing An Intervention in General Practice To Prevent Work Disability After Breast Cancer By Using Intervention Mapping
1Université Claude Bernard Lyon 1, France; 2Collège Universitaire de Médecine Générale, Lyon, France; 3Centre Léon Bérard, Lyon, France; 4Université Lumière Lyon 2, France; 5Hospices Civils de Lyon, France
Return to work (RTW) after breast cancer (BC) faces many barriers, among which a lack of collaboration between cancer care, primary care and occupational health services. This study aimed at defining the role of general practitioners (GP) in the frame of the FASTRACS project in France (facilitate and sustain return to work after breast cancer).
The intervention mapping protocol was used to develop the logic model of the problem (step 1), to define program outcomes and logic model of change (step 2), design and product the programme (step 3 and 4). Qualitative data were collected with 3 focus groups of GPs, 3 focus groups and 19 semi-structured interviews with BCS. Discussions were audiotaped, transcribed, and analysed with MAXQDA qualitative software. Matrices of change were built (step 2) and evidence-based change methods were chosen (step 3) by an interdisciplinary research team.
GP express the skills to guide patients between hospital treatment and RTW. They need more information about administrative resources and side effects of BC treatments. BCS don’t think about GP as a key person to facilitate RTW. A transition consultation in general practice will be proposed to BCS at the end of radiation therapy, with five performance objectives for the GPs:
- To evaluate the BCS’s needs and capacities to RTW
- To evaluate the BCS’s motivations to RTW
- To schedule the follow-up with the BCS according to the RTW project defined together
- To organize an early visit with the occupational physician
- To organize part-time RTW
This consultation in primary care will set a path for BCS between cancer care and occupational health services to facilitate RTW.
A randomized controlled trial will be conducted in 2019 to evaluate the process and the effects of the FASTRACS intervention.
Cognitive Challenges at Work Output among Breast Cancer Survivors in China: A Multicentre Study
1The Hong Kong Polytechnic University, Hong Kong S.A.R. (China); 2The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; 3Consultant in Cancer Survivorship, Gaithersburg, Maryland, USA
Objective To determine whether work output was related to cognitive limitations in occupationally active breast cancer survivors (BCS) employed in China.
Methods Measures of demographics, job type, job stress, general distress (anxiety, depression), fatigue, work-related cognitive limitations, and work output were obtained using self-report measures in both BCS and healthy controls (n=267/ group) from the Department of Oncology in four regions of China: Cheungdu, Changsha, Guangzhou, and Hong Kong.
Results Groups hadsimilareducational backgrounds, job types and levels of job stress. The BCS group was a median of 3.2 years post -primary treatment, slightly older, more likely to be divorced, have children, and was more likely working part-time. The BCS group reported higher levels of fatigue, general distress and lower levels of work output (p <. 05). A multivariate regression adjusting for group differences indicated that cognitive symptoms at work were related to lower levels of quantity, quality, and timeliness of completed work in the BCS group (adj. R2=.57, unstandardized coefficient = 1.062, 95% CI = .436 to 1.689).
Conclusion Cognitive limitations were associated with lower levels of reported work output exclusively in the BCS group. This study provides further evidence that cognitive limitations reported in the context of work in a developing country like China is similar to that of BCS working in more developed economies. Solutions to this problem may be applicable across countries.
Work-related Medical Rehabilitation and Return to Work in Cancer Survivors – A Cluster Randomized Multicenter Trial
University of Lübeck, Institute for Social Medicine and Epidemiology, Germany
Background: Effective multidisciplinary rehabilitation programs supporting the return to work have become increasingly relevant for cancer survivors as about half of them are in working age when cancer is diagnosed and treated. In Germany, work-related medical rehabilitation programs consider treatment modules of work-related diagnostics, work-related functional capacity training, psychosocial groups, and intensified social counseling. Our study investigated the effectiveness of work-related medical rehabilitation as compared with conventional medical rehabilitation in a cluster randomized multicenter trial (German Clinical Trial Register: DRKS00007770).
Methods: A total of 484 cancer patients aged 18 to 60 years were recruited in four rehabilitation centers. Patients of a center starting their rehabilitation in the same week represented a cluster. These clusters were randomly assigned with computer-generated randomization schedules to intervention (IG) or control group (CG). The primary outcome was role functioning at the 12-month follow-up as assessed by the corresponding scale of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire. Secondary outcomes were other quality of life domains and return to work.
Results: Analysis of delivered dose of treatments indicated a successful implementation of work-related medical rehabilitation. 379 patients, 197 in the IG, were included in the analysis of the 12-month follow-up. There was no significant difference between IG and CG in the primary outcome (role functioning: b=3.69; 95% CI: -2.01–9.39; p=0.204) and secondary outcomes. Return to work rates were 72% and 75% for the IG and CG. Median time from baseline to return to work was 242 days in patients with a high risk and 54 days in patients with a low risk of early retirement.
Conclusions: Despite effects at the end of rehabilitation and the 3-month follow-up work-related medical rehabilitation in cancer survivors had no long-term effect on quality of life and return to work as compared with medical rehabilitation.