Return to work of breast cancer survivors: toward an integrative and transactional conceptual model

Feasibility, reliability and validity of smartphone administered cognitive ecological momentary assessments in breast cancer survivors

Objective

Breast cancer and its treatment are associated with cancer-related cognitive impairments (CRCI). Cognitive ecological momentary assessments (EMA) allow for the assessment of individual subjective and objective cognitive functioning in real world environments and can be easily administered via smartphones. The objective of this study was to establish the feasibility, reliability, and validity of a cognitive EMA platform, NeuroUX, for assessing CRCI in breast cancer survivors.

Methods

Using a prospective design, clinical cognitive assessments (neuropsychological testing; patient reported outcomes) were collected at baseline, followed by an 8-week EMA smartphone protocol assessing self-reported cognitive concerns and objective cognitive performance via mobile cognitive tests once per day, every other day. Satisfaction and feedback questions were included in follow-up data collection. Feasibility data were analyzed using descriptive methods. Test-retest reliability was examined using intraclass correlation coefficients for each cognitive EMA (tests and self-report questions), and Pearson's correlation was used to evaluate convergent validity between cognitive EMAs and baseline clinical cognitive variables.

Results

105 breast cancer survivors completed the EMA protocol with high adherence (87.3%) and high satisfaction (mean 87%). Intraclass correlation coefficients for all cognitive EMAs were strong (>0.73) and correlational findings indicated moderately strong convergent validity (|0.23| < r < |0.61|).

Conclusion

Fully remote, self-administered cognitive testing for 8-weeks on smartphones was feasible in breast cancer survivors who completed adjuvant treatment and the specific cognitive EMAs (cognitive EMA tests and self-report questions) administered demonstrate strong reliability and validity for CRCI.

Return to work or leaving work? Differences of return to work between breast cancer patients and the general population and determinants of return to work

PURPOSE

It was examined whether employment among breast cancer survivors was lower than in the general population 4 to 6 years after surgery. We also examined whether disease severity, post-surgical treatment, social, and workplace characteristics have effects on employment as primary outcome, and whether the distance from surgery to observation may determine employment.

METHODS

We performed a multicentric observational study with four survey waves. Data were collected based on mailed surveys and patient records. Patients were up to 63 years old at entry with TNM-tumour stages T0 to TIV. Comparisons with the general population were performed by drawing controls from the German Socio-Economic Panel.

RESULTS

N = 372 breast cancer survivors participated in all surveys (= 82.2% of the initial sample). Their rate of occupationally active women was lower than in the general population (ORpatients = 0.59; 95% CI = 0.42-0.84; p < 0.01). Among patients, tumour stage had no effects on employment 12 months after surgery; 4-6 years later, this was the case only among patients with the most unfavourable tumour stage (OR = 0.16; p = 0.01; 95% CI = 0.04-0.58). Antihormone therapy was unrelated with employment (OR = 0.80; p = 0.27; 95% CI = 0.54-1.19); inpatient rehabilitation was negatively associated at 12 months after surgery (OR = 0.47; p = 0.02; 95% CI = 0.25-0.89) and unrelated at the last survey wave (OR = 0.95; p = 0.86; 95% CI = 0.55-1.64). Compared with the lowest level of occupational autonomy, it was unrelated with employment 12 months after surgery (OR = 0.79; p = 0.75; 95% CI = 0.18-4.41), but for the highest level of autonomy, it had significant effects 4 to 6 years later (OR = 4.56; p = 0.04; 95% CI = 1.10-18.81). Effort-reward imbalance as a continuously scaled indicator of pre-surgery occupational distress was significantly associated with return to work 12 months after surgery (OR = 0.13; p < 0.01; 95% CI = 0.06-0.31), but it had no effect at the last survey wave (OR = 0.64; p = 0.31; 95% CI = 0.28-1.50). One year after surgery, education at higher levels had no significant effects on return to work (OR = 1.30; p = 0.57; 95% CI = 0.56-3.00 for the highest level compared with the lowest one), only at the last measurement marked differences by education emerged (OR = 2.23; p = 0.03; 95% CI = 1.08-4.63).

CONCLUSION

Temporal distance between surgery and survey wave determines whether potentially influencing factors have effects. Disease severity and post-surgical treatment were unrelated to employment. Whether work-related and socio-demographic factors are determining employment depends on the date of measurement.

Characterizing cancer-related cognitive impairments and impact on quality of life in women with metastatic breast cancer

PURPOSE

Little is known about cancer-related cognitive impairments (CRCI) in women with metastatic breast cancer (MBC). The purpose of this study is to (1) comprehensively describe CRCI and any associated psychosocial and behavioral symptoms, (2) determine observable sociodemographic and clinical risk factors for CRCI, and (3) explore cognitive and psychosocial predictors of quality of life and social functioning in women living with MBC.

METHODS

Using a cross-sectional design, women with MBC completed assessments (objective and subjective measures of CRCI including 3 open-ended questions, measures of psychosocial and behavioral factors, and assessments of quality of life and social function), and data were analyzed using descriptive statistics, qualitative content analysis, correlation analyses, t tests, analysis of variance, and linear regression models.

RESULTS

Data from 52 women were analyzed. 69.2% of the sample reported clinically significant CRCI and 46% of the sample scored < 1 standard deviation below the standardized mean on one or more cognitive tests. Those with triple-negative MBC (compared to HER2+), recurrent MBC (compared to de novo), and no history of chemotherapy had worse subjective CRCI, and those without history of surgery and older age had worse objective CRCI. Subjective CRCI, but not objective CRCI, was significantly associated with quality of life and social functioning.

CONCLUSION

Subjective and objective CRCI are likely a common problem for those with MBC. Subjective CRCI is associated with poorer quality of life and lower social functioning. Healthcare providers should acknowledge cognitive symptoms, continually assess cognitive function, and address associated unmet needs across the MBC trajectory.

Validation of the Return-to-Work Obstacles and Self-Efficacy Scale for Women on Sick Leave Due to Breast Cancer (ROSES-BC)

PURPOSE

Breast cancer (BC) is the most frequently diagnosed cancer among women. Approximately 40% of BC survivors are diagnosed during the peak years of their professional career. Women face numerous obstacles when returning to work (RTW) after BC. Their decision-making process and self-efficacy to overcome these barriers may undergo alterations. The objective of this study was to validate the Return-to-work Obstacles and Self-Efficacy Scale (ROSES) for BC survivors, with a focus on three psychometric properties: construct validity, test-retest reliability, and predictive validity.

METHODS

This prospective study consists of three phases: Phase 1 (baseline, during sick leave) was conducted to evaluate construct validity, Phase 2 (2 weeks later) assessed test-retest reliability, and Phase 3 (6-month follow-up, RTW or not) aimed to evaluate predictive validity. A total of 153 BC survivors participated in Phase 1 of the study, where they completed the 10 dimensions of the ROSES (e.g., fear of relapse, cognitive difficulties). Confirmatory factor analyses (CFA), Pearson correlations, and Cox regressions were performed, with respect to each phase.

RESULTS

The mean duration for RTW with the same employer was 62.7 weeks. CFAs confirmed the ROSES structure, which had previously been established for other health conditions, showing satisfactory coefficients. Significant Pearson correlation coefficients were observed between the ROSES dimensions from Phase 1 to Phase 2, ranging from 0.66 to 0.88. When considering various confounding variables, chemotherapy treatment and cognitive difficulties (ROSES dimension) emerged as the only significant predictors of RTW.

CONCLUSION

These findings support the utilization of the ROSES in clinical and research settings for BC survivors to improve their successful RTW. After an initial screening using the ROSES, occupational health professionals can further conduct a focused and thorough evaluation of specific dimensions, such as cognitive difficulties. Additional research and information are required to assist BC survivors in dealing with cognitive impairments induced by chemotherapy when they return to work.

[Sustainable job retention for people diagnosed with a cancer in a changing world of work]

INTRODUCTION

The growing number of people diagnosed with a cancer of working age prompts us to explore the sustainability of their working conditions and avenues of intervention in their work situations to promote sustainable job retention in a context of work intensification.

METHODS

Narrative review of the literature on people diagnosed with a cancer, their work situation, participation in the labour market, return to work (RTW) and sustainable employment.

RESULTS

Transformations in the world of work are increasing the unpredictability and variability of work situations, making strategies for managing functional deficiencies after diagnosis of the disease more complex. Reinforcing socio-technical and organizational leeways (STOL), i.e. self-regulation capacities to cope with the demands of the work situation by deploying effective and healthy work strategies, implies optimizing the (external) resources available at the level of the work situation through ergonomic actions and/or improving individual (internal) resources through supportive care or rehabilitation and/or vocational training.

DISCUSSION

Interventions to help people diagnosed with a cancer to stay at work in the long term must give primacy to the accommodation of the work situation and identify the ergonomic levers for improving their STOL.

Ecosystem Barriers and Facilitators Linked to the Fear of Cancer Recurrence: An Umbrella Review

The fear of cancer recurrence is an important topic in the healthcare field. In general, approximately 40% of survivors experience high levels of fear of recurrence. This study aims to fill this gap by synthesizing the findings of systematic reviews studies investigating ecosystems, correlates or predictors, and barriers and facilitators of fear of cancer recurrence among cancer survivors. An umbrella meta-synthesis was conducted using the following databases: MEDLINE, PsycINFO, PsycARTICLES, CINAHL, Business source premier, and SOCindex, ending in April 2024 with PRISMA methods. A total of 24 systematic reviews, representing 729 articles, were included in the study. In total, six ecosystems were identified, including family, work, friends, the healthcare system, caregivers, and religion. As part of this umbrella review, 55 specific ecosystemic factors were identified that may contribute to fear of cancer recurrence. Furthermore, the umbrella review identified 12 facilitators and 12 barriers related to fear of cancer recurrence. This umbrella meta-synthesis contributed significantly to our review's strength in synthesizing the main ecosystem and its influence on fears of cancer recurrence. Understanding the interdependence of ecosystems should enable future research on intervention effectiveness or the development of interventions that could reduce the fear of cancer recurrence.

Supporting the return to work of breast cancer survivors: perspectives from Canadian employer representatives

PUR POSE: A significant proportion of women with breast cancer want to RTW (return to work) after treatment. Employers play a key role in facilitating RTW for these employees who face distinct challenges. However, the portrait of these challenges remains to be documented from the perspective of employer representatives. The purpose of this article is to describe the perceptions of Canadian employer representatives regarding the management of the RTW of BCSs (breast cancer survivors).

METHODS

Thirteen qualitative interviews were conducted with representatives from businesses of various sizes (< 100 employees, 100-500 employees, > 500 employees). Transcribed data were subjected to iterative data analysis.

RESULTS

Three major themes emerged to describe employer representatives' perceptions of managing RTW of BCS. These are (1) providing tailored support; (2) remaining 'human' while managing RTW; and (3) facing the challenges of RTW management after breast cancer. The first two themes were perceived as facilitating RTW. The challenges identified concern uncertainty, communication with the employee, maintaining a supernumerary work position, balancing employee and organizational interests, reconciling with colleagues' complaints, and collaboration among stakeholders.

CONCLUSIONS

Employers can adopt a humanistic management style by offering flexibility and increased accommodation for BCS who RTW. They can also be more sensitive to this diagnosis, leading some to seek more information from those around them who have experienced it. Employers require increased awareness about diagnosis and side effects, be more confident to communicate, and improved collaboration between stakeholders to facilitate the RTW of BCS.

IMPLICATIONS FOR CANCER SURVIVORS

Employers who focus on the individual needs of cancer survivors during RTW can facilitate creative and personalized solutions for a sustainable RTW and help survivors recover their lives after cancer.

Return to work and psychosocial trajectories after breast cancer: a longitudinal and sequential approach

PURPOSE

We aimed to describe the psychosocial adjustments according to return to work (RTW) trajectories in breast cancer survivors (BCS) using a sequential and temporal approach.

METHODS

We used BCS data included from February 2015 to April 2016 in the Longitudinal Study on Behavioural, Economic and Sociological Changes after Cancer (ELCCA) cohort. RTW trajectories were identified using the sequence analysis method followed by a clustering. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale and the EORTC quality of life questionnaire was used at inclusion and all follow-up visits to assess Health-Related Quality of Life (HRQoL).

RESULTS

Fifty-two BCS were included in the study among whom four clusters of RTW trajectories were identified and labeled: slow RTW (N = 10), quick RTW (N = 27), partial RTW (N = 8), and part-time work (N = 7). Quick and slow RTW clusters showed slightly lower baseline mean levels of anxiety and higher levels of HRQoL. In the 4 years following diagnosis, BCS in the quick RTW cluster tended to report higher HRQoL in terms of functioning and less symptoms of pain and fatigue while those in the partial RTW cluster showed a lower HRQoL on almost all dimensions. All clusters showed an increase in pain and fatigue symptoms until 6 months followed by a tendency to recover baseline levels.

CONCLUSIONS

The results of this study suggest that BCS who return to full-time work (slow and quick RTW patterns) recover better than patients who return to part-time work (partial and part-time RTW patterns).

Work-health balance of cancer survivors returning to work: A meta-ethnography

PURPOSE

This meta-ethnography investigates the multifaceted health-related experiences of cancer survivors returning to work (RTW), recognizing the pivotal role of employment in overall well-being, particularly in the context of increasing cancer cases among working-age adults.

METHOD

Following the methodology of Noblit and Hare, a comprehensive literature search was conducted from 2013 to 2023 in databases including PubMed, Scopus, CINAHL, PsycINFO, and Embase. Qualitative studies assessing cancer survivors' experiences, motivation, concern, resilience, and need in the process of RTW were identified. Eligible studies were assessed for quality using the Critical Appraisal Skills Program Checklist, and their findings were subsequently synthesized.

RESULTS

Seventeen studies were included for analysis. The finding revealed five key themes: motivations (voluntary and involuntary), cancer-related concerns, resilience, needs for cancer healthcare support, and workplace accommodation. Voluntarily RTW was primarily linked to desires of normalcy, while involuntary RTW was often financially driven. Cancer survivors often face physical, psychological, and social challenges in the RTW process. Resilience played a crucial role in their readaptation to the workplace. Participants expressed the need for additional guidance from healthcare providers and tailored support from the workplace to facilitate a smoother RTW experience.

CONCLUSION

Cancer survivors aspire to be actively engaged, have their specific needs addressed, and achieve success in their return-to-work endeavors. Occupational guidance and accommodation from healthcare providers and employers play a pivotal role in empowering survivors to balance cancer and work, facilitating the return-to-work process, and enhancing the quality of survivorship.

Comparison of Machine Learning Methods in the Study of Cancer Survivors' Return to Work: An Example of Breast Cancer Survivors with Work-Related Factors in the CONSTANCES Cohort

PURPOSE

Machine learning (ML) methods showed a higher accuracy in identifying individuals without cancer who were unable to return to work (RTW) compared to the classical methods (e.g. logistic regression models). We therefore aim to discuss the value of these methods in relation to RTW for cancer survivors.

METHODS

Breast cancer (BC) survivors who were working at diagnosis within the CONSTANCES cohort were included in the study. RTW was assessed five years after the BC diagnosis (early retirement was considered as non-RTW). Age and occupation at diagnosis, and physical occupational job exposures assessed using the Job Exposure Matrix, JEM-CONSTANCES, were evaluated as predictors of RTW five years after BC diagnosis. The following four ML methods were used: (i) k-nearest neighbors; (ii) random forest; (iii) neural network; and (iv) elastic net.

RESULTS

The training sample included 683 BC survivors (RTW: 85.7%), and the test sample 171 (RTW: 85.4%). The elastic net method had the best results despite low sensitivity (accuracy = 76.6%; sensitivity = 31.7%; specificity = 90.8%), and the random forest model was the most accurate (= 79.5%) but also the least sensitive (= 14.3%).

CONCLUSION

This study takes a first step towards opening up new possibilities for identifying the occupational determinants of cancer survivors' RTW. Further work, including a larger sample size, and more predictor variables, is now needed.

Breast Cancer Survivors' Experiences of Managers' Actions During the Return to Work Process: A Scoping Review of Qualitative Studies

PURPOSE

Managers' actions can facilitate the return to work (RTW) process for breast cancer survivors (BCS). However, data on BCS' experiences of managers' actions regarding RTW are dispersed across multiple qualitative studies and do not offer useful insights for managers to support employees returning to work. This study aimed to summarize and map managers' actions experienced by BCS over three RTW phases (before, during, after) and categorize them as facilitating or hindering RTW.

METHODS

A scoping review of qualitative studies was conducted. Four databases (MEDLINE, PsycINFO, Cochrane Library, EMBASE) were systematically searched for articles published between 2000 and 2022. Studies and participant characteristics were extracted using an excel spreadsheet. A thematic analysis with a predominantly deductive and semantic approach was conducted.

RESULTS

Twenty-nine studies were included after screening 1042 records. Five themes were generated from the data. Two themes addressed the phase 'before RTW': 'managers' interpersonal skills' and 'preparing for RTW'; three in the 'during RTW' phase: 'managers' interpersonal skills', 'offering work flexibility', and 'offering work accommodations', and only one, 'paying attention to follow-up', was addressed in the 'after RTW' phase.

CONCLUSION

This review mapped managers' actions experienced by BCS in three phases of the RTW process. Results suggested that, according to BCS, managers need to mobilize specific skills to provide appropriate support during the RTW process. Further research is needed to better understand the skills underlying managers' actions facilitating the RTW process.

Symptom Clusters in Survivorship and Their Impact on Ability to Work among Cancer Survivors

BACKGROUND

Cancer survivors often experience a range of symptoms after treatment which can impact their quality of life. Symptoms may cluster or co-occur. We aimed to investigate how symptoms and symptom clusters impact the ability to work among cancer survivors.

METHODS

We used symptom severity data and ability to work data routinely collected from cancer survivors attending a survivorship clinic after primary treatment with curative intent. We defined symptom clusters using single linkage and a threshold on the rescaled distances of <10. We then conducted a logistic regression to examine how symptoms and symptom clusters were related to the ability to work.

RESULTS

We analysed data from 561 cancer survivors, mean age 58 years and 1.5 years post diagnosis, with mixed diagnoses including breast (40.5%), colorectal (32.3%), and haematological cancers (15.3%). Limitations to work ability were reported by 34.9% of participants. Survivors experiencing pain, emotional, and cognitive symptom clusters were 14-17% more likely to report limitations in their ability to work. Older survivors and those with a higher stage disease were more likely to report limitations in their ability to work.

CONCLUSION

A better understanding and management of symptom severity and symptom clusters may help the sizable proportion of cancer survivors experiencing symptoms to participate in work after treatment.

Qualitative Assessment of Perceived Organizational Support for Employed Breast Cancer Survivors

OBJECTIVE

A more detailed understanding of unmet organizational support needs and workplace-based best practices for supporting cancer survivors is needed.

METHODS

Ninety-four working breast cancer survivors responded to an open-ended survey question regarding the desired types of organizational support that were and were not received during early survivorship. We performed content-analysis of qualitative data.

RESULTS

Major themes included instrumental support, emotional support, and time-based support. The need for flexible arrangements and reduced workloads was mostly met. Unmet needs included navigation/coordination, understanding/empathy, and time off for treatment and recovery.

CONCLUSIONS

Organizational support can help cancer survivors manage their health and work roles, diminishing work-health conflict and turnover intent. Study findings can be used to design targeted interventions to fulfill cancer survivors' unmet organizational support needs, which may also apply to workers with other chronic health conditions.

Content validity evidence of the Brazilian version of the Cognitive Symptom Checklist-Work-21

OBJECTIVE

to cross-culturally adapt and assess the content validity evidence of the Cognitive Symptom Checklist-Work-21 for the Brazilian context.

METHOD

a psychometric study of cross-cultural adaptation, covering the stages of translation, reconciliation, back-translation, intercultural equivalence assessment and content validity evidence analysis, considering Content Validity Ratio parameters in breast cancer survivors.

RESULTS

the translations were equivalent to the original version. Colloquial expressions were modified, tense, verbal adjusted, and two items containing multiple commands were separated. The final version now contains 22 items, presenting semantic, conceptual, idiomatic and experimental equivalences. The pre-test indicated good understanding and ease in the response process.

CONCLUSION

the final version was defined as "Lista de verificação de sintomas cognitivos relacionados ao trabalho - 22 itens", showing good linguistic equivalence and strong evidence of content validity in the Brazilian context.

Supporting Return to Work after Breast Cancer: A Mixed Method Study

Breast cancer (BC) is the most common invasive cancer in the world. Most BC survivors (BCSs) continue working while dealing with cancer-related disabilities. BCSs' return-to-work (RTW) after cancer treatment is an important stage of their recovery and is associated with a higher survival rate. In this study, we addressed the RTW of BCSs with the intention of facilitating this process through direct action in the workplace. Thirty-two women who requested assistance from January to December 2022 were enrolled in the study. Semi-structured interviews and medical examinations were conducted by a team of three physicians. Interviews were analyzed using Thematic Analysis. Moreover, a quantitative cross-sectional study was conducted to compare the health status of BCSs with that of a control group of 160 working women, using standardized questionnaires on work ability, fatigue, sleep problems, anxiety, depression, and happiness. BCSs were also asked to rate the level of organizational justice they perceived at work prior to their illness. From the qualitative analysis emerged three facilitating/hindering themes: (1) person-related factors, (2) company-related factors, and (3) society-related factors. In the quantitative analysis, BCSs had significantly higher scores for anxiety, depression, sleep problems and fatigue, and lower levels of happiness than controls. The RTW of BCSs entails adapting working conditions and providing adequate support. The work-related analysis of each case made it possible to highlight the measures that need to be taken in the workplace to promote RTW. The treatment of cancer should be paired with advice on the best way to regain the ability to work.

Subjective cancer-related cognitive impairments and salience network connectivity in breast cancer survivors

PURPOSE

Little is known about the neural basis of subjective cancer-related cognitive changes. The purpose of this study was to explore salience network connectivity in relation to subjective executive and memory dysfunction in breast cancer survivors compared to controls.

METHODS

A retrospective cross-sectional analysis of neuroimaging, subjective cognitive, clinical, and demographic data in chemotherapy-treated primary breast cancer survivors compared to frequency matched controls was used. Functional connectivity within salience network hubs (anterior cingulate, bilateral insula) was determined using resting state functional MRI. Mann-Whitney U tests were used to evaluate group differences and Spearman's rho correlations were examined among the behavioral measures and salience network connectivity.

RESULTS

We included 65 breast cancer survivors and 71 controls. Survivors demonstrated greater subjective executive dysfunction and memory complaints (p < .001) and lower salience network connectivity (p < .05) than controls. Executive functioning correlated with bilateral insula and left anterior cingulate connectivity (rho >  - 0.29, p < .05). Distress did not correlate with salience network connectivity.

CONCLUSION

These findings suggest that salience network connectivity may represent a biomarker of subjective cancer-related cognitive changes.

IMPLICATIONS FOR CANCER SURVIVORS

Subjective cancer-related cognitive changes are common following treatment and associated with objective changes in brain connectivity.

Impact of breast cancer care pathways and related symptoms on the return-to-work process: results from a population-based French cohort study (CONSTANCES)

BACKGROUND

Breast cancer (BC) treatments and related symptoms may affect return to work (RTW). The objective of this study was to investigate the impact of BC care pathways (timing and sequence of treatments) and related symptoms on RTW.

METHODS

The study population included working-age women with BC who were enrolled in the French CONSTANCES cohort from 2012 to 2018. BC treatments, antidepressant/anxiolytic and antalgic drug deliveries (used as proxies of depression and pain, respectively) and statutory sick pay (used to estimate RTW and time to RTW) were assessed monthly using data from the French national healthcare system database. BC care pathways were identified with the sequence analysis method. Cox models with time-dependent covariates were used to investigate the impact of BC care pathways and related symptoms on RTW and time to RTW, after adjusting for age and socioeconomic characteristics.

RESULTS

73.2% (231/303) of women returned to work within 2 years after BC diagnosis. Five BC care pathway patterns were identified: (i) BC surgery only, (ii) BC surgery and radiotherapy, (iii) BC surgery and chemotherapy, (iv) BC surgery and chemotherapy and radiotherapy, and (v) BC surgery and long-term alternative chemotherapy/radiotherapy. The hazards ratios of non-RTW were significantly higher for women who received BC surgery and long-term alternative chemotherapy/radiotherapy and for > 55-year-old women. Time to RTW was significantly longer in women who received chemotherapy (patterns iii to v) and in women with antidepressant/anxiolytic and antalgic drug deliveries.

CONCLUSION

This study highlights the value of considering the dynamic, cumulative and temporal features of BC care pathways and related symptoms to facilitate the RTW of women with BC.

Patient engagé : faire de mon expérience une réelle opportunité

L’accompagnement professionnel des patients en âge de travailler est d’une importance de santé publique majeure en cancérologie. Toutefois, qu’ils reprennent le travail ou non, la priorité reste de préserver leur qualité de vie. D’ailleurs, pour certains patients, un arrêt de la carrière professionnelle peut avoir lieu au profit d’un engagement associatif et/ou auprès des services de soin et de recherche scientifique. Il s’agit d’un vrai retour à l’activité qui peut être également synonyme de tremplin professionnel lorsque les patients concernés sont en mesure de se construire une nouvelle trajectoire professionnelle en cumulant leurs compétences professionnelles initiales et leurs savoirs expérientiels acquis ; tel est l’éclairage que nous souhaitons apporter dans cet article, à l’aide d’une étude de cas. De nouvelles questions de recherche seront proposées.

Effectiveness of Physical Activity Interventions on Return to Work After a Cancer Diagnosis: A Systematic Review and Meta-analysis

Purpose The aim of this study was to assess the effectiveness of physical activity (PA) interventions on return to work (RTW) in cancer survivors, compared to usual care, and to determine the dose of PA needed to improve this outcome. Methods A systematic review and meta-analysis were conducted according to PRISMA guidelines. Six electronic databases including PubMed, Embase, Web of Science, CENTRAL, PsycINFO, and Scopus were searched to identify studies, and completed by a search of grey literature and health organization websites. Two authors performed screening, selection, and data extraction independently. Study and intervention characteristics were extracted and summarized. Pooled risk ratio (RR) was estimated using a weight random-effects model with 95% confidence intervals (CIs). Results A total of 2655 records were identified, of which 8 intervention studies were included. The sample size of the included studies varied between 41 and 240, giving a total of 1087 participants aged between 18 and 75 years. Compared with usual care, PA interventions had a significant positive effect on RTW among cancer survivors with a pooled RR of 1.29 (95% CI 1.17, 1.42). We found that PA interventions (aerobic and resistance exercises) with an exercise dose between 7.6 METs.h/week and 15 METs.h/week, consisting in 50-60 min per session of moderate to vigorous physical exercise, twice a week seems relevant in improving RTW. Conclusions Our results showed, with moderate quality evidence that PA interventions are more effective than usual care in increasing the rate of RTW in cancer survivors. SYSTEMATIC REVIEW REGISTRATION: PROSPERO Registration Number, CRD42020203614.

Assessing cancer-related cognitive function in the context of everyday life using ecological mobile cognitive testing: A protocol for a prospective quantitative study

Objective

Millions of cancer survivors are at risk for cancer-related cognitive impairment (CRCI), yet accurate and accessible assessments of cognitive functioning remain limited. Ecological mobile cognitive testing (EMCT) could offer a solution. This paper presents the protocol for a study that aims to (1) establish the reliability and validity of EMCT to assess CRCI in breast cancer survivors, and (2) prospectively evaluate within-person processes (and interactions) among context, mood, and behavior that explain cognitive variability, everyday functioning, and quality of life of cancer survivors.

Methods

Participants will include breast cancer survivors (>21 years old) who are within 5 years of completing chemotherapy treatment. Participants will complete two virtual visits (baseline, follow-up) 2 months apart to assess self-reported cognitive symptoms and cognitive performance, sociodemographic characteristics, clinical history, everyday functioning, and quality of life. Between virtual visits, EMCT will be used to sample cognitive functioning every other day (28 times total). We will use linear mixed-effect regressions and single-level multiple regression models to analyze the data.

Results

We anticipate a minimum of 124 breast cancer survivors enrolling and completing data collection. Study results will be published in peer-reviewed scientific journals.

Conclusions

Our findings will have broad implications for assessing CRCI in an ecologically valid and person-centered way using EMCT. We aim to provide this protocol to aid researchers who would like to apply this approach to their studies.

Views of breast cancer survivors on work participation guidance by general practitioners: a qualitative study

Background

Breast cancer survivors can be at high risk of having work-related problems. Previous studies suggest that GPs could discuss work participation with cancer patients and provide guidance.

The aim this study is to explore the experiences and expectations of breast cancer survivors with their GPs’ role regarding guidance on work participation and return to work.

Methods

A qualitative study with Dutch female breast cancer survivors was held in the Netherlands. Four focus groups with 25 participants were conducted and audio-taped. Transcripts were analysed using thematic analysis.

Results

Breast cancer survivors reported a wide range of experiences with guidance from their GPs regarding work participation. Patients who contacted their GPs with work-related issues felt listened to during the consultation. Some patients experienced very limited or no guidance, while others were intensively guided by their GPs. The guidance was provided in the form of counseling, psychosocial support, and referral to other health care professionals. When cancer patients experienced problems with reintegration in work, they expected GPs to have a supportive and referring role in work participation guidance.

Conclusion

In returning to work, breast cancer survivors expect their GPs to play a supportive role, especially when they encounter difficulties in reintegrating. However, their actual experience of guidance received from their GPs varied, from none received at all, to intensive support provided.

Cancer survivors and adverse work outcomes: associated factors and supportive interventions

INTRODUCTION

The number of cancer survivors in a working age is rising. An awareness of factors associated with adverse work outcomes, and of supportive interventions, is needed.

SOURCES OF DATA

A narrative review of research obtained via several databases, including Medline and PsycINFO, was conducted.

AREAS OF AGREEMENT

A range of factors is associated with adverse work outcomes such as prolonged sick leave, delayed return to work, disability pension and unemployment in cancer survivors. They include the cancer type and treatment, fatigue, cognitive functioning, work factors and elements of health care systems. Effective supportive interventions encompass physical and multicomponent interventions.

AREAS OF CONTROVERSY

The role of behaviour determinants and legislative and insurance systems is unclear. It is furthermore uncertain what the optimal timing of delivering supportive interventions is.

GROWING POINTS

Further focus on vulnerable groups, including specific cancer types and those with lower income, lower educational level and in precarious employment, is needed.

AREAS TIMELY FOR DEVELOPING RESEARCH

Recent developments are tailored and timely interventions.

Identification of actions to be taken by managers to facilitate the return to work of cancer survivors: Consensus between managers and cancer survivors

Background

Managers are considered to be main stakeholders in the return to work (RTW) of cancer survivors. However, the perspectives of cancer survivors and managers differ on what managerial actions should be taken during the RTW of cancer survivors. This difference might put effective collaboration and successful RTW at risk. Therefore, this study aims to reach consensus among managers and cancer survivors on the managerial actions to be taken during the four different RTW phases of cancer survivors (i.e., Disclosure, Treatment, RTW plan, Actual RTW).

Methods

The Technique for Research of Information by Animation of a Group of Experts (TRIAGE) was implemented with managers and cancer survivors (hereafter referred to as “experts”). An initial list of 24 actions was derived from a previous study. Firstly, for each action, fifteen experts were asked to indicate individually how important this action is per RTW phase (Likert scale from 1 – “Not important at all” to 6 – “Very important”). Consensus was reached when ≥ 80% (i.e., ≥ twelve experts) of the experts rated that action ≥5. Secondly, for each phase of the RTW process, the 15 actions with the highest percentage were discussed with eight experts during the collective consultation, except for the actions that already reached consensus. After discussion, the experts voted whether each action was important (“yes” / “no”) and consensus required ≥ 87.5% (i.e., ≥ seven experts) of the experts to consider an action as important.

Results

Twenty-five managerial actions were finally retained for at least one of the RTW phases, e.g., Disclosure: “respect privacy” and “radiate a positive attitude”, Treatment: “show appreciation” and “allow sufficient sick leave”, RTW Plan: “tailor” and “communicate”, and Actual RTW: “support practically” and “balance interest”.

Conclusion

Cancer survivors and managers reached consensus on the importance of 25 managerial actions, distributed into each phase of the RTW process. These actions should be considered an interplay of managerial actions by different stakeholders on the part of the employer (e.g., direct supervisor, HR-manager), and should be a responsibility that is shared by these stakeholders. The collective implementation of these actions within the company will help cancer survivors feel fully supported.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14271-w.

Changes in working status after cancer diagnosis and socio-demographic, clinical, work-related, and psychological factors associated with it

BACKGROUND

While many studies investigated changes in working status in cancer survivors, most studies have been performed in survivors of breast cancer and few studies evaluated factors associated with changes in the working status of cancer survivors comprehensively. We aimed to evaluate the changes in the working status of cancer survivors after diagnosis and socio-demographic, clinical, work-related and psychological factors associated with it.

METHODS

We conducted a cross-sectional survey of adult patients with cancer who were working at the time of diagnosis. A trained interviewer inquired about participants' current working status, including leave of absence, discontinuing, continuing, and changing work. Sociodemographic, clinical, work-related and psychological factors were measured. Multinomial logistic regression was used to identify factors associated with changes in the working status.

RESULTS

Among the 730 patients, 29%, 18% and 6% were currently on a discontinued working, leave of absence and had changed jobs, respectively. Patients who discontinued working after cancer diagnosis were more likely to be female, have ≥ $3,000 of monthly family income, not be the principal wage earners for their families and be blue-collar workers. In clinical characteristics, advanced-stage cancer and experienced cancer recurrence was associated with leave of absence and discontinued working. In work-related and psychological factors, stress due to insufficient job control (relative risk ratio [RRR] = 2.26), interpersonal conflict (RRR = 1.86), job insecurity (RRR = 2.63), organizational system (RRR = 3.49), and lack of reward (RRR = 11.76), and less meaning to work were more likely to discontinue working after a cancer diagnosis.

CONCLUSION

Occupational health care professionals and other stakeholders need to openly communicate with patients with cancer about potential barriers during the return-to-work trajectory.

Informing the development of multidisciplinary interventions to help breast cancer patients return to work: a qualitative study

PURPOSE

Return to work (RTW) after breast cancer (BC) can be a major challenge for patients. Multidisciplinary interventions seem to be effective but the role of digital solutions is under-developed and therefore not evaluated. We explored the preferences, needs, and barriers regarding RTW interventions, including opinions about the use of digital approaches to deliver such interventions.

METHODS

We conducted a qualitative study based on interviews with 30 patients with BC and 18 healthcare providers in four French regions. Emergent themes were identified using thematic content analysis.

RESULTS

Most providers declared that they did not proactively address RTW with patients, mainly due to having other priorities and a lack of knowledge. The following themes emerged: several development and deployment barriers regarding RTW interventions exist, multidisciplinary interventions are preferred, and there is a need to maintain contact between the patient and workplace during sick leave, including pathways and interlocutors that can facilitate RTW. Participants had mostly positive representations of using digital tools to facilitate RTW; however, fear of loss of human contact and the exacerbation of inequalities were identified as possible risks associated with the development of digital-only interventions.

CONCLUSIONS

Interventions blending the needs and preferences of patients with BC and the healthcare system are warranted. A personalized multimodal approach with mixed digital and in-person features has surfaced as a possible solution to address the weaknesses of existing interventions.

IMPLICATIONS FOR CANCER SURVIVORS

Since most women work at the time of diagnosis, it is of particular relevance to build interventions promoting RTW.

Supporting the Return to Work of Breast Cancer Survivors: From a Theoretical to a Clinical Perspective

Promoting the return to work of breast cancer survivors is of major interest to patients, healthcare and occupational health professionals, companies, governments, and researchers worldwide. We previously conducted a French consensus study resulting in a model describing the multifactorial process of the return to work of breast cancer survivors (the REWORK-BC model). Other work has identified the transtheoretical model as a relevant theoretical framework for interventions to promote the return to work of cancer survivors. In this opinion paper, we provide a theoretically-based clinical framework describing how to support breast cancer survivors at each stage of the return-to-work process. This clinical framework considers several essential aspects of supportive care for breast cancer survivors returning to work, such as: (i) helping the patient actively self-manage, by considering her to be the main decision-maker; (ii) respecting and adapting to the patient’s choice of professional project; (iii) respecting the temporality of the patient’s choices; (iv) proposing tailored interventions; (v) implementing simple tools to promote the return to work, shared representation between the patient and a multidisciplinary team, and improvement of working conditions and the knowledge of health and occupational professionals, and managers or employers; and (vi) maintaining certain flexibility aimed at proposing, but never imposing, changes in practices. This clinical framework, specific to breast cancer survivors, could be extrapolated to other tumor types, offering a practical guide for healthcare and occupational health professionals to better understand the return-to-work process of cancer survivors. This clinical framework aims to be a usable tool for any hospital or cancer care center wishing to implement a patient-centered intervention that promotes returning to work, regardless of the country.

Influence de la précarité sociale et du soutien social perçu, sur le retour au travail des femmes ayant un cancer du sein, dans l’année suivant le début des traitements adjuvants

L’objectif est d’étudier les liens entre précarité sociale, soutien social perçu et retour au travail (RAT) dans la première année suivant le début des traitements adjuvants du cancer du sein. Soixante-huit patientes incluses au début des traitements adjuvants (T0) ont été suivies à 3 (T1) et 12 mois (T2). Le soutien informatif des amis à T0 favorise le RAT à T1. La précarité et le soutien négatif à T0 et T2 sont des freins au RAT à T2. La prise en charge du RAT doit être proposée et adaptée dès le début des traitements.

Tailoring work participation support for cancer survivors using the stages of change: perspectives of (health care) professionals and survivors

PURPOSE

Interventions to support work participation in cancer survivors (CSs) have shown limited effectiveness. Applying a behavioral change framework (e.g., stages of change) could make work participation interventions for CSs more timely and tailored. We aimed to explore the application of the stages of change framework to work participation support for CSs and to generate stage-specific intervention content.

METHODS

Eighteen experts (e.g., occupational physicians, reintegration consultants) were individually interviewed, and three focus groups with CSs (n = 6, n = 5, n = 4) were conducted. Data were analyzed along the six work-related behavioral change stages purported by the readiness for return to work framework, which is based on the stages of change.

RESULTS

The following themes were identified: (1) pre-contemplation: emotional support and staying connected-encourage contact with the employer/colleagues; (2) contemplation: considering return to work is stressful-facilitate the deliberation process; (3) preparation self-evaluative: assess current capabilities-seek guidance from, e.g., occupational physicians; (4) preparation behavioral: planning return to work-allow for personalized solutions and encourage supervised return to work; (5) uncertain maintenance: guard against overload-train self-efficacy strategies and communication tactics; and (6) proactive maintenance: accept and prepare for the long term.

CONCLUSIONS

Our results support the potential utility of tailoring CSs' work participation support along the stages of change.

IMPLICATIONS FOR CANCER SURVIVORS

We provided recommendations for intervention content and developed a stage-specific work participation intervention for CSs, the effectiveness of which will be evaluated in an upcoming randomized controlled trial.

The Challenge of Return to Work after Breast Cancer: The Role of Family Situation, CANTO Cohort

Return to work (RTW) after breast cancer is associated with improved quality of life. The link between household characteristics and RTW remains largely unknown. The aim of this study was to examine the effect of the family situation on women’s RTW two years after breast cancer. We used data of a French prospective cohort of women diagnosed with stage I-III, primary breast cancer (CANTO, NCT01993498). Among women employed at diagnosis and under 57 years old, we assessed the association between household characteristics (living with a partner, marital status, number and age of economically dependent children, support by the partner) and RTW. Logistic regression models were adjusted for age, household income, stage, comorbidities, treatments and their side effects. Analyzes stratified by age and household income were performed to assess the association between household characteristics and RTW in specific subgroups. Among the 3004 patients included, women living with a partner returned less to work (OR = 0.63 [0.47–0.86]) and decreased their working time after RTW. Among the 2305 women living with a partner, being married was associated with decreased RTW among women aged over 50 (OR = 0.57 [0.34–0.95]). Having three or more children (vs. none) was associated with lower RTW among women with low household income (OR = 0.28 [0.10–0.80]). Household characteristics should be considered in addition to clinical information to identify vulnerable women, reduce the social consequence of cancer and improve their quality of life.