A Systematic Review of the Definitions, Measures, and Study Designs in the Cancer and Employment Literature
1National Cancer Institute, United States of America; 2Memorial Sloan Kettering Cancer Center; 3University of Virginia School of Medicine
Background: A growing literature suggests that cancer frequently leads to work limitation and job loss. However, the definition and measurement of employment outcomes and study methodology varies widely. To inform the development of a common taxonomy of work outcomes, a systematic review was conducted to characterize the measures and methods in the cancer and employment literature. Methods: 15,006 English-language articles were identified using 30 key words and 9 MeSH terms describing cancer and work. Review of the titles and abstracts and a subsequent full-text review identified 215 papers published after 2006 which examined employment as an outcome. Results: Multiple terms were used to describe employment outcomes. Other than employment status, the most frequently measured employment outcomes were work hours (43%), sick leave (35%), and work ability (21%). Depending on the specific outcome, 33-70% of papers failed to describe how employment was measured. When described, employment outcomes were measured using a mix of single or multiple-item scales and validated instruments. Measurement using a validated instrument was most frequent for productivity at work and least frequent for work hours. Over 94% of studies were observational, of which only 17% included a non-cancer comparison group. Comparison groups tended to be drawn from national registries (42%), population-based surveys (32%), or the same survey from which the cancer survivors were drawn (23%). Conclusions: The development of standardized definitions and metrics for work outcomes are needed to support research about the magnitude and duration of cancer-related work limitations and the effectiveness of interventions. Whenever possible, observational studies should incorporate a non-cancer comparison group to adjust for natural age-related changes in employment and secular labor market trends. Additional research is also needed to develop and test interventions to improve work outcomes among cancer survivors.
The Capability Set For Work In Workers With Multiple Sclerosis
1University of Tilburg; Tilburg School of Social and Behavioral Sciences, Netherlands, The; 2National Multiple Sclerosis Foundation, Rotterdam, Mathenesserlaan 378, 3023 HB, The Netherlands; 3Department of Psychology, Section Health, Medical and Neuropsychology, Leiden University, Leiden, PO Box 9555, 2300 RB, The Netherlands; 4Department of Neurology, Elisabeth-TweeSteden Hospital, Tilburg, PO Box 90151, 5000 LC, The Netherlands; 5Department of Care Ethics, University of Humanistic Studies, Utrecht, PO Box 797, 3500 AT, The Netherlands
Background: Multiple Sclerosis (MS) is a chronic disorder of the central nervous system, often diagnosed in young or middle adulthood. Work participation is often compromised in individuals with MS. The aim of the current study was to examine whether work capabilities differ between workers with Multiple Sclerosis (MS) and workers from the general population. The second aim was to investigate whether the capability set was related to work and health outcomes
Methods: A total of 163 workers with MS from the MS@Work study and 163 workers from the general population were matched for gender, age, educational level and working hours. All participants completed online questionnaires on demographics, health and work functioning. The Capability Set for Work Questionnaire was used to explore whether a set of seven work values is considered valuable (A), is enabled in the work context (B), and can be achieved by the individual (C).
Results: Despite lower physical work functioning, lower work ability and worse self-reported health workers with MS had a larger capability set than the general population and found the seven work values more important (A), were more enabled in the work context (B) and more able to achieve (C) than workers from the general working population.
In workers with MS, a larger capability set was associated with better flexible work functioning, work ability, self-rated health and with less absenteeism, presenteeism, cognitive/neuropsychiatric impairment, depression, anxiety and fatigue.
Conclusions: Workers with MS rate work values as more important and have a larger capability set than workers from the general population. A larger capability set was related with better work outcomes in all workers and better health outcomes in workers with MS. Workers with MS felt they were given more opportunities (B) and were actually able to achieve work values better (C), compared to the general population.
Everybody Benefits: Linking Private Investors To Occupational Healthcare In An Early Return To Work Intervention For Cancer Patients
1TNO, Institute for Applied Research, Leiden, The Netherlands; 2Tranzo, Scientific Center for Care and Welfare, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands; 3Department of Human Resource Studies, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands; 4HumanTotalCare/ArboNed, Utrecht, The Netherlands; 5Nyenrode Business University, Breukelen, The Netherlands
Funding rehabilitation interventions for patients with cancer and other chronic illnesses is challenging across Western countries. The investments and profits of such interventions are unevenly distributed among stakeholders, contributing to a hesitancy in public and private partners to invest. Furthermore, investments by commercial parties is, rightfully, a matter of public debate, as patients’ wellbeing should not compete with profits. On the other hand, public funds for interventions and research have a ceiling, which inhibits the pace of innovation in work disability prevention. This is particularly evident in the need to develop new interventions for cancer patients, where a steep climb in survival rates has opened up a whole chapter of work-related challenges because of treatment-induced long-term and chronic health problems. Research is well on its way in this area, but in order to increase work participation in cancer patients, new interventions as well as innovative funding are essential.
The focus in this study is two-fold. We combine the design and evaluation of an early-return-to-work intervention for cancer patients with an innovative health impact bond that contains investors, a bank, an insurer, and an occupational healthcare provider. They invest in the intervention together and share profits of return to work. Return to work is the main goal of the intervention, which was designed to accompany cancer patients through stages of grieve, treatments and recovery, and is offered in an occupational healthcare setting. Both the intervention (in a controlled trial) and the health impact bond (using mixed-methods) will be evaluated.
This study contains two innovative elements: a new intervention and an innovative way of funding the intervention. During our presentation, we would like to inform and discuss with fellow researchers on the practical and moral aspects of health impact bonds and similar constructs in work disability prevention research.
Prognostic Accuracy Of A Screening Instrument Predicting Future RTW Chance Of Patients With Chronic Diseases
1German Federal Pension Insurance, Berlin, Germany; 2Institute for Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
The effectiveness of rehabilitation depends on the individual non return to work (RTW) risk. Therefore, a risk score (SIMBO) was developed to predict the future RTW chance supporting the referral management. The study tested the diagnostic accuracy of the SIMBO (0 to 100 points) and, as a result, provided evidence for the main diseases in rehabilitation.
Patients in the rehabilitation setting (18 to 65 years) were included. Data were obtained from questionnaires at admission and 3 months after rehabilitation. The occurrence of critical RTW events in the follow-up was the primary outcome. All analyses were weighted for age, gender and ICD-10 diagnosis group with regard to the German rehabilitation population in 2015.
Data from 2,422 patients out of nine different disease groups were included. In these groups between 9% and 47% reported critical RTW events in the follow-up (total: 35.2%). The area under curve (AUC) criteria laid between .844 and .899 (total: .891). The standardised mean differences in the SIMBO score between patients with and without a critical RTW event was 1.22 to 1.48 (total: 1.43).
Sensitivity and specificity rates varied depending on the chosen threshold. Using optimal thresholds they ranged from 74% to 93% as well as 72% to 87%. The identification of critical RTW events could be increased threefold due to the SIMBO.
The SIMBO screening predicts the non RTW risk after rehabilitation regardless of the disease group. The screening can be used as generic screening identifying patients having a high risk for a non RTW and a need for an intensified work-related rehabilitation strategy.
Successful Return-to-work of Employees Diagnosed with Cancer: Development of a Weighted Outcome Measure
1Amsterdam UMC, University of Amsterdam, Coronel Institute of Occupational Health, Amsterdam Public Health research institute, Amsterdam, The Netherlands; 2Maastricht University, Department of Social Medicine, CAPHRI, Maastricht, The Netherlands
Effectiveness of return-to-work (RTW) interventions are predominantly valued on the basis of time until RTW, with interventions aiming to shorten the period until RTW. Previous research suggest that this measure of effectiveness does not correspond with employees’ perspectives of successful RTW. This study aims to develop an outcome measure for ‘successful RTW’, based on perspectives of employees with cancer on successful RTW.
The Delphi method was used, consisting of (1) focus groups with employees with cancer (n=12), to generate a long-list of elements that may constitute successful RTW; and (2) two Delphi questionnaire rounds with employees with cancer (n=109), to shorten this long-list into a short-list of elements that are perceived to constitute successful RTW most importantly. During Delphi round two, participants selected their five most important elements. The percentage of participants that selected a certain element was calculated and the most selected elements became part of the outcome measure ‘successful RTW’.
Forty-five elements were identified during the focus groups. A considerable variance concerning most important elements was observed. The most selected elements were: ‘enjoyment in work’ (63%), ‘work without compromising health’ (48%), ‘open communication with employer’ (39%), ‘confidence of employer without assumptions about workability’ (39%), ‘feel welcome at work’ (34%), ‘good work-life balance’ (30%), ‘joint satisfaction about the work situation (employer and employee)’ (27%). The abovementioned elements were incorporated in the weighted outcome measure ‘successful RTW’.
The outcome measure ‘successful RTW’ consists of seven items representing the seven elements that constitute successful RTW most importantly according to employees with cancer. The outcome measure is tailored for each employee; the items are weighted on the basis of their relative importance for the individual. Future research should study construct validity and test-retest reliability of the outcome measure, to determine its usefulness for effect evaluation of RTW interventions.