Barriers and opportunities for return-to-work of cancer survivors: time for action—rapid review and expert consultation

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Abstract

Background

The spread of early detection and the improvement of cancer treatment have led to an increased prevalence of cancer survivors, including in the working age population. Return-to-work (RTW) of cancer survivors has become a key issue for national cancer control plans. This study aims (1) to identify the factors that have an impact on RTW of cancer survivors and to draw a risk profile supporting health professionals in the screening of those at risk for barriers of RTW and (2) to sharpen these results with input from health, social security and academic Belgian experts and to provide evidence-based recommendations that facilitate RTW of cancer survivors.

Methods

A rapid review was conducted, based on the methodology elaborated by The Knowledge to Action Research Programme and researchers from the University of York, including a quality assessment of retained studies. Next, the Delphi method was used to organize a consultation with experts in order to discuss, validate and complement the results.

Results

Forty-three out of 1860 studies were included. We identified nine risk factors grouped into four categories: socio-demographic, disease and treatment-related, work-related, and personal and subjective factors. Experts suggested dividing them into two even groups: factors which are modifiable and those which are not. The awareness of health professionals regarding the identified factors, a better assessment of work capacities, clarity on the rights and obligations of employers and workers alike, and the setup of a positive discrimination employment policy for cancer survivors were acknowledged as factors facilitating RTW of cancer survivors.

Conclusions

The awareness of health professionals regarding barriers of RTW may improve the early identification of cancer survivors at risk for prolonged time to RTW and may allow early supportive intervention. Social and employment policies should be better tailored to support both employers and cancer survivors in the RTW process, providing incentives to positively discriminate cancer survivors on prolonged sick leave.

Electronic supplementary material

The online version of this article (doi:10.1186/s13643-016-0210-z) contains supplementary material, which is available to authorized users.

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Most cited references 15

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Cancer survivors and unemployment: a meta-analysis and meta-regression.

Angela G. E. M. de Boer, Taina Taskila, Anneli Ojajärvi … (2009)

Nearly half of adult cancer survivors are younger than 65 years, but the association of cancer survivorship with employment status is unknown. To assess the association of cancer survivorship with unemployment compared with healthy controls. A systematic search of studies published between 1966 and June 2008 was conducted using MEDLINE, CINAHL, EMBASE, PsycINFO, and OSH-ROM databases. Eligible studies included adult cancer survivors and a control group, and employment as an outcome. Pooled relative risks were calculated over all studies and according to cancer type. A Bayesian meta-regression analysis was performed to assess associations of unemployment with cancer type, country of origin, average age at diagnosis, and background unemployment rate. Twenty-six articles describing 36 studies met the inclusion criteria. The analyses included 20,366 cancer survivors and 157,603 healthy control participants. Studies included 16 from the United States, 15 from Europe, and 5 from other countries. Overall, cancer survivors were more likely to be unemployed than healthy control participants (33.8% vs 15.2%; pooled relative risk [RR], 1.37; 95% confidence interval [CI], 1.21-1.55). Unemployment was higher in breast cancer survivors compared with control participants (35.6% vs 31.7%; pooled RR, 1.28; 95% CI, 1.11-1.49), as well as in survivors of gastrointestinal cancers (48.8% vs 33.4%; pooled RR, 1.44; 95% CI, 1.02-2.05), and cancers of the female reproductive organs (49.1% vs 38.3%; pooled RR, 1.28; 95% CI, 1.17-1.40). Unemployment rates were not higher for survivors of blood cancers compared with controls (30.6% vs 23.7%; pooled RR, 1.41; 95% CI, 0.95-2.09), prostate cancers (39.4% vs 27.1%; pooled RR, 1.11; 95% CI, 1.00-1.25), or testicular cancer (18.5% vs 18.1%; pooled RR, 0.94; 95% CI, 0.74-1.20). For survivors in the United States, the unemployment risk was 1.5 times higher compared with survivors in Europe (meta-RR, 1.48; 95% credibility interval, 1.15-1.95). After adjustment for diagnosis, age, and background unemployment rate, this risk disappeared (meta-RR, 1.24; 95% CI, 0.85-1.83). Cancer survivorship is associated with unemployment.

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European cancer mortality predictions for the year 2013.

M Malvezzi, P Bertuccio, F Levi … (2013)

Estimated cancer mortality statistics were published for the years 2011 and 2012 for the European Union (EU) and its six more populous countries. Using logarithmic Poisson count data joinpoint models and the World Health Organization mortality and population database, we estimated numbers of deaths and age-standardized (world) mortality rates (ASRs) in 2013 from all cancers and selected cancers. The 2013 predicted number of cancer deaths in the EU is 1 314 296 (737 747 men and 576 489 women). Between 2009 and 2013, all cancer ASRs are predicted to fall by 6% to 140.1/100 000 in men, and by 4% to 85.3/100 000 in women. The ASRs per 100 000 are 6.6 men and 2.9 women for stomach, 16.7 men and 9.5 women for intestines, 8.0 men and 5.5 women for pancreas, 37.1 men and 13.9 women for lung, 10.5 men for prostate, 14.6 women for breast, and 4.7 for uterine cancer, and 4.2 and 2.6 for leukaemia. Recent trends are favourable except for pancreatic cancer and lung cancer in women. Favourable trends will continue in 2013. Pancreatic cancer has become the fourth cause of cancer death in both sexes, while in a few years lung cancer will likely become the first cause of cancer mortality in women as well, overtaking breast cancer.

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Work in cancer survivors: a model for practice and research.

Michael Feuerstein, Briana Todd, Michal C Moskowitz … (2010)

As with other illnesses, several variables can impact the transition back to the workplace, long-term work productivity, or job retention among cancer survivors. We developed a model related to work and cancer based in part on the general area of work disability and the specific literature on cancer survivors and work. A systematic search of the literature on work and cancer was conducted to determine whether an evidence base existed to support the proposed model. Forty-five papers met the review criteria. The percentage of studies that addressed modifiable categories included in the proposed model was: health and well-being (20%), symptoms (16%), function (24%), work demands (9%), work environment (18%), and policy, procedures, and economic factors (16%). Return to work was the most common work outcome studied although problems with productivity and retention are reported in the general cancer and work literature. Wide variation in definition of cancer survivor was reported and breast cancer survivors were studied most often. Each of the categories in the model has some empirical support. The model considers the health, functional status in relation to demands, work environment, and policy, procedures, and financial factors. The model allows the clinician and survivor to consider factors that can be addressed by the health care provider, survivor, and workplace. Implications for Cancer Survivors. This model provides a framework to aid in conceptualizing problems related to work.

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Author and article information

Contributors

Régine Kiasuwa Mbengi: 0032 2 642 57 65 , +32 479 3926 58 , regine.kiasuwambengi@wiv-isp.be , kiasuwa-mbengi.regine.levo@ulb.ac.be

Renée Otter: Renee.otter@gmail.com

Katrien Mortelmans: Katrien.mortelmans@mensura.be

Marc Arbyn: Marc.arbyn@wiv-isp.be

Herman Van Oyen: Herman.vanoyen@wiv-isp.be

Catherine Bouland: Catherine.bouland@ulb.ac.be

Christophe de Brouwer: De.brouwer.christophe@ulb.ac.be

Journal

Journal ID (nlm-ta): Syst Rev

Journal ID (iso-abbrev): Syst Rev

Title: Systematic Reviews

Publisher: BioMed Central (London )

ISSN (Electronic): 2046-4053

Publication date (Electronic): 24 February 2016

Publication date PMC-release: 24 February 2016

Publication date Collection: 2016

Volume: 5

Electronic Location Identifier: 35

Affiliations

[ ]Center for Environmental Health and Occupational Health, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium

[ ]Belgian Cancer Center, Department of Public Health and Surveillance, Scientific Institute of Public Health, Brussels, Belgium

[ ]Unit of Cancer Epidemiology, Department of Public Health and Surveillance, Scientific Institute of Public Health, Brussels, Belgium

[ ]Department of Public Health and Surveillance, Scientific Institute of Public Health, Brussels, Belgium

[ ]Department of Research and Development, Mensura, Antwerp, Belgium

Article

Publisher ID: 210

DOI: 10.1186/s13643-016-0210-z

PMC ID: 4765094

PubMed ID: 26912175

SO-VID: 831e0036-7ea0-430e-84d1-cf498f845e1f

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 30 September 2015

Date accepted : 10 February 2016

Funding

Funded by: Belgian National Cancer Plan

Custom metadata

ScienceOpen disciplines: Public health

Keywords: return-to-work,rapid review,risk factors,cancer survivors,expert consultation

Data availability:

ScienceOpen disciplines: Public health

Keywords: return-to-work, rapid review, risk factors, cancer survivors, expert consultation

Barriers and opportunities for return-to-work of cancer survivors: time for action—rapid review and expert consultation

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Abstract

Background

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Electronic supplementary material

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Chinese Journal of School Health

Most cited references 15

Cancer survivors and unemployment: a meta-analysis and meta-regression.

European cancer mortality predictions for the year 2013.

Work in cancer survivors: a model for practice and research.

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