Employment and work-related issues in cancer survivors
Introduction
Although cancer is still one of the leading causes of morbidity and mortality worldwide, early detection and progress in multimodal treatment regimes have markedly improved the prognosis for many cancer patients during recent years. An estimated 3,191,600 cancer cases were diagnosed in Europe in 2006 [1]. The most common form of cancers was breast cancer (13.5% of all cancer cases), followed by colorectal cancers (12.9%) and lung cancer (12.1%) [1].
Although cancer is a disease more likely to occur in older populations, a significant number of patients will experience the cancer diagnosis during an age, when career and work-related issues play an important role in individual and family lives. As the increase in cancer incidence and the improvement in survival rates through use of enhanced treatment regimes have led to a growing number of cancer survivors, the importance of work ability, (re-)employment and social reintegration have gradually emerged as critical topics within psycho-oncological and cancer survivorship research. Moreover, the (re-)integration of individuals with disabilities, chronic health conditions, diseases and handicaps into working life is one important aspect of participation according to the International Classification of Functioning, Disability and Health (ICF) [2].
Yet, while a large body of psychosocial cancer research has noted the importance of distressing factors, individual coping attempts, psychosocial burden and resources in understanding both health-related quality of life (QoL) and psychological adjustment to cancer, considerably less attention has been focused on understanding the impact of cancer on daily activities, work ability and employment, particularly in the context of extended and long-term cancer survivorship. Aim of this literature review was to identify the current state of knowledge about cancer survivorship issues related to employment and work. In particular, the review focuses on prevalence of employment and return to work, factors related to employment and return to work, barriers related to not returning to work and job loss, sick leave and length of absence from work, reduction in work hours, wages and work changes, work ability and perceived job strain, career changes, job satisfaction, and employer accommodation, as well as physical and psychological disablement and QoL. A further objective was to identify emerging issues with regard to the impact of cancer and its treatment on work predominantly relevant to further research.
Section snippets
Search strategy
A systematic literature review on return to work and employment in cancer survivors was undertaken. Criteria for considering studies for this review were original papers published in English in peer-reviewed journals between 01/2000 and 11/2009. The databases PubMed, Medline, Embase and PsycInfo/Psyndex were searched extensively using a search string of “cancer OR neoplasm OR carcinoma OR oncology” combined with each of the following terms: “work”, “employment/employed”,
Results
The database search and the review of reference lists of the identified articles and literature reviews resulted in 417 potentially relevant articles. All abstracts were screened for eligibility. Out of 417 articles, 353 were excluded according to the defined exclusion criteria. Sixty-four articles met the inclusion criteria for this review. Detailed findings are shown in Table 1.
The majority of studies2
Research model for the investigation of work-related aspects in cancer survivorship
Fig. 1 shows a research model including a range of independent factors, mediating factors and outcome criteria that have guided research about work and employment in cancer survivorship through recent years. Following the diagnosis of cancer, disease specific factors such as early vs. advanced cancer stage, and cancer site as well as treatment-related factors such as surgery and multimodal treatments have been frequently included as independent variables. This review identified a large number
Discussion
This literature review aimed to provide an overview over the current state of knowledge about cancer survivorship issues related to employment and work-related aspects. Sixty-four studies published between 01/2000 and 11/2009 were included into this review and analyzed in detail with regard to frequency of employment and return to work, factors related to employment and return to work, barriers related to not returning to work and job loss, absence from work, reduction in work hours, wages and
Conclusion
Developing a better understanding of cancer and treatment-induced work-related problems will facilitate cancer survivorship research. Developing new measures of work-related aspects in cancer survivors is critical to improving the understanding and assessment of central dimensions of work and occupational aspects in cancer survivorship. Although significant findings have emerged using existing measures of cancer and treatment-induced work-related aspects in cancer patients, the importance of
Reviewers
Professor Peter Herschbach, Munich Technical University, Department of Psychosomatic Medicine & Psychotherapy, Munich, Germany.
Dr. Angela E.M. de Boer, Coronel Institute for Occupation Health, Amsterdam, Netherlands.
Acknowledgments
I would like to thank Sigrun Vehling and Yi Chen for the additional duplicate search and review of the abstracts. I also like to thank the reviewers for their valuable suggestions to improve this review. This research has been supported by grants from the Fritz und Hildegard Berg-Stiftung (grant number T133/18267/2008) and the Stiftung Wissenschaft Hamburg (grant number T148/18268/2008) within the Donors’ Association for the Promotion of Sciences and Humanities in Germany, Essen,
Anja Mehnert, Ph.D., is a research associate at the Department of Medical Psychology at the University Medical Center Hamburg-Eppendorf, Germany, since 1999. In 2005, she completed her Ph.D. (summa cum laude) and worked at the Department of Psychiatry and Behavioral Sciences at Memorial Sloan-Kettering Cancer Center, New York, as a postdoctoral research fellow (2007–2008). She has been principal investigator and co-investigator in several funded psycho-oncological research projects. Her
References (80)
- et al.
Estimates of the cancer incidence and mortality in Europe in 2006
Ann Oncol
(2007) - et al.
Cancer, fatigue and the return of patients to work-a prospective cohort study
Eur J Cancer
(2003) - et al.
Short-term effects of breast cancer on labor market attachment: results from a longitudinal study
J Health Econ
(2005) - et al.
The impact of education and occupation on the employment status of cancer survivors
Eur J Cancer
(2004) - et al.
Breast cancer survival, work, and earnings
J Health Econ
(2002) - et al.
Risk for unemployment of cancer survivors: A Danish cohort study
Eur J Cancer
(2008) - et al.
Health care utilisation and characteristics of long-term breast cancer survivors: nationwide survey in Denmark
Eur J Cancer
(2009) - et al.
Comparative study of work ability between cancer survivors and their referents
Eur J Cancer
(2007) ICF—International Classification of Functioning, Disability and Health
(2001)- et al.
Factors reported to influence the return to work of cancer survivors: a literature review
Psychooncology
(2002)
Factors affecting cancer survivors’ employment and work ability
Acta Oncol
Cancer survivorship and employment: epidemiology
Occup Med
Cancer survivors at work: a generation of progress
CA: Cancer J Clin
Assessing the impact of cancer on work outcomes: what are the research needs?
Cancer
Cancer survivors and unemployment: a meta-analysis and meta-regression
JAMA
Experiences and concerns about ‘returning to work’ for women breast cancer survivors: a literature review
Psychooncology
Work ability and return-to-work in cancer patients
Br J Cancer
Cancer survivorship and work: symptoms, supervisor response, co-worker disclosure and work adjustment
J Occup Rehabil
Quality of life and social integration after allogeneic hematopoietic SCT
Bone Marrow Transpl
Return to work of cancer survivors: a prospective cohort study into the quality of rehabilitation by occupational physicians
Occup Env Med
Predictors of return to work ten months after primary breast cancer surgery
Acta Oncol
Return to paid work after cancer: a British experience
J Cancer Surviv
Correlates of return to work for breast cancer survivors
J Clin Oncol
Return to work after early-stage breast cancer: a cohort study into the effects of treatment and cancer-related symptoms
J Occup Rehabil
Factors associated with return to work after breast cancer treatment
Acta Oncol
Factors related to return to work by women with breast cancer in northern France
J Occup Rehabil
Employment patterns of long-term cancer survivors
Psychooncology
Impact of breast cancer diagnosis and treatment on work-related life and factors affecting them
Breast Cancer Res Treat
State vocational services and employment in cancer survivors
J Cancer Surviv
Quality of life and rehabilitation in social and professional life after autologous stem cell transplantation
Ann Oncol
The impact of changes in employment status on psychosocial well-being: a study of breast cancer survivors
J Psychosoc Oncol
The return to work experiences of colorectal cancer survivors
AAOHN J
The impact of physical and psychosocial factors on work characteristics after cancer
Psychooncology
Long-term breast cancer survivors: confidentiality, disclosure, effects on work and insurance
Psychooncology
Employment in a cohort of breast cancer patients
Occup Med
Employment outcomes of men treated for prostate cancer
J Natl Cancer Inst
Employment status and work-related difficulties in stomach cancer survivors compared with the general population
Br J Cancer
Work situation after breast cancer: results from a population-based study
J Natl Cancer Inst
Not working 3 years after breast cancer: predictors in a population-based study
J Clin Oncol
Employment in a cohort of cancer patients in Spain. A predictive model of working outcomes
Clin Transl Oncol
Cited by (593)
Cognitive and affective-motivational states as mediators of the association between presenteeism and job satisfaction
2023, Revue Europeenne de Psychologie AppliqueeNon-medical interventions to enhance return to work for people with cancer
2024, Cochrane Database of Systematic ReviewsAn application of psychology of working theory to chronic health issues: Importance of decent work
2024, Career Development Quarterly
Anja Mehnert, Ph.D., is a research associate at the Department of Medical Psychology at the University Medical Center Hamburg-Eppendorf, Germany, since 1999. In 2005, she completed her Ph.D. (summa cum laude) and worked at the Department of Psychiatry and Behavioral Sciences at Memorial Sloan-Kettering Cancer Center, New York, as a postdoctoral research fellow (2007–2008). She has been principal investigator and co-investigator in several funded psycho-oncological research projects. Her academic qualification is documented by more than 30 research papers in national and international journals. Research topics included psychological aspects of predictive genetic testing for hereditary breast and ovarian cancer susceptibility; neuropsychological functioning and quality of life in the course of cancer treatment; prevalence of psychosocial distress, psychiatric disorders, need and utilization of psychosocial support in cancer patients, and work-related aspects in cancer survivorship.