Employment and work-related issues in cancer survivors

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Abstract

Purpose of this systematic literature review was to identify current knowledge about employment in cancer survivors. Sixty-four studies met inclusion criteria that were original papers published between 01/2000 and 11/2009. Overall, 63.5% of cancer survivors (range 24–94%) returned to work. The mean duration of absence from work was 151 days. Factors significantly associated with a greater likelihood of being employed or return to work were perceived employer accommodation, flexible working arrangements, counseling, training and rehabilitation services, younger age and cancer sites of younger individuals, higher levels of education, male gender, less physical symptoms, lower length of sick leave and continuity of care. Cancer survivors had a significantly increased risk for unemployment, early retirement and were less likely to be re-employed. Between 26% and 53% of cancer survivors lost their job or quit working over a 72-month period post diagnosis. Between 23% and 75% of patients who lost their job were re-employed. A high proportion of patients experienced at least temporary changes in work schedules, work hours, wages and a decline in work ability compared to non-cancer groups.

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

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    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.

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