Sickness absence following breast cancer surgery: a two-year follow-up cohort study

Social characteristics and social benefit use among premenopausal breast cancer survivors in Denmark: a population-based cohort study

PURPOSE

In 2020, one million women aged < 55 years were diagnosed with breast cancer globally. The impact of breast cancer and its treatments on these women's ability to work and need for social benefits may differ by social characteristics. We evaluated social benefit use following breast cancer by education and cohabitation.

METHODS

We conducted a nationwide population-based cohort study, including women aged 18-55 years diagnosed with stage I-III breast cancer in Denmark during 2002-2011. Statistics Denmark provided information on cohabitation, education, and social benefit use from 1 year pre-diagnosis to 10 years post-diagnosis. We calculated weekly proportions of self-support, unemployment, disability pension, flexi jobs, and sick leave according to education and cohabitation.

RESULTS

Of 5345 women, 81.8% were self-supporting, 4.5% received disability pensions, 1.6% had flexi jobs, 3.6% were on sick leave, and 5.5% were unemployed 1 year pre-diagnosis. Ten years post-diagnosis, the proportions were 69.0%, 13.0%, 10.5%, 3.4%, and 2.0% of 3663 survivors. Disability pensions and flexi jobs increased from 12.1 to 26.4% and 2.8 to 13.5% in women with short education, from 4.1 to 12.8% and 1.8 to 12.2% in women with medium education, and from 0.8 to 6.0% and 0.9 to 6.9% in longer educated. Disability pensions increased more in women living alone (7.8 to 19.9%), than in cohabiting women (3.6 to 11.3%).

CONCLUSIONS

Use of social benefits reflecting lost ability to work was highest in less educated women and in women living alone.

IMPLICATIONS FOR CANCER SURVIVORS

Awareness of these groups is crucial when tailoring efforts to support work participation in cancer survivors.

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.

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.

Sickness absence and disability pension among women with breast cancer: a population-based cohort study from Sweden

BACKGROUND

Women's return to work after diagnosis of breast cancer (BC) is becoming more prevalent. However, register-based national investigation on sickness absence (SA) and disability pension (DP) in BC women is lacking. The aim of the study was to explore SA and DP before and after a first BC diagnosis and the possibility to predict new cancer-related SA by using disease-related and sociodemographic factors.

METHODS

A longitudinal register study of the 3536 women in Sweden aged 19-64 with a first BC diagnosis in 2010 was conducted by linkage of five nationwide registers. Particularly, detailed information on SA and DP was obtained from the National Social Insurance Agency. Descriptive statistics on SA and DP 2 years before through 3 years after the BC diagnosis were performed. The risk of having a new SA spell due to BC or BC-related diagnoses was modeled using logistic regression.

RESULTS

The proportion of women with SA increased during the year following the BC diagnosis date and declined over the next 2 years to proportions before diagnosis. At the time of BC diagnosis, half of the women began a new SA spell > 14 days with cancer, cancer-related, or mental diagnosis. Disease-related and sociodemographic factors including occupational sector, living area, age, cancer stage, educational level, and number of previous SA days showed statistical significance (p < 0.05) in predicting a new SA around BC diagnosis. By using these factors, it was possible to correctly predict 67% of the new SA spell.

CONCLUSIONS

SA among women with BC was elevated mainly in the first year after diagnosis. New SA following BC diagnosis can accurately be predicted.

Predictors of resignation and sick leave after cancer diagnosis among Japanese breast cancer survivors: a cross-sectional study

BACKGROUND

In Japan, 55.5% of breast cancer survivors (BCSs) are of working age, so various perspectives regarding return to work (RTW) after cancer diagnosis need to be considered. Therefore, this study aimed to clarify the risk factors for resignation and taking sick leave (SL) among BCSs in continued employment at the time of diagnosis.

METHODS

A web-based retrospective cross-sectional survey was conducted on BCSs using data from a 2018 Japanese national research project (Endo-Han) commissioned by the Ministry of Health, Labour and Welfare of Japan. The subjects were women aged 18-69 years who had been diagnosed with breast cancer for the first time at least 1 year previously. The risk factors for resignation and taking SL after breast cancer diagnosis, including age at diagnosis, education level, cancer stage, surgery, chemotherapy, radiotherapy, employment status, and occupational type, were then analyzed using a logistic regression model.

RESULTS

In total, 40 (14.9%) of 269 BCSs quit their jobs at least 1 year after being diagnosed with breast cancer. The results of the multivariable analysis indicated that lower education level (odds ratio [OR]: 3.802; 95% confidence interval [CI]: 1.233-11.729), taking SL (OR: 2.514; 95%CI: 1.202-5.261), and younger age at diagnosis (OR: 0.470; 95%CI: 0.221-0.998) were predictors of resignation. Of 229 patients who continued working, SL was taken by 72 (31.4%). In addition, undergoing surgery was found to be a predictor of taking SL (OR: 8.311; 95%CI: 1.007-68.621).

CONCLUSIONS

In total, 40 (14.9%) of 269 BCSs quit their jobs at least 1 year after being diagnosed with breast cancer. The results of this study indicated that younger age, lower education level, and taking SL were predictors of resignation after breast cancer diagnosis.

Important factors associated with sick leave after allogeneic haematopoietic stem cell transplantation-a 1-year prospective study

Purpose

This study examines sick leave (SL) and factors associated with full-time SL 1 year after allogeneic haematopoietic stem cell transplantation (allo-HSCT) in patients of working age from 2009 to 2016 (n = 122).

Methods

Questionnaire data were collected on admission to the allo-HSCT unit, at 7 months and 1 year after allo-HSCT. Associations between factors and SL were analysed using logistic regression analyses.

Results

One year after allo-HSCT, 76% of participants were on SL, with 36% on full-time SL. In univariable analyses, chronic graft-versus-host-disease (cGvHD) (OR 3.07; 95% CI 1.34–7.07; p = 0.01), having symptoms of depression at 7 months (OR 4.81; 95% CI 1.69–13.69; p = 0.00) and low levels of vocational satisfaction at 7 months after treatment (OR 3.27; 95% CI 1.27–8.41; p = 0.01) were associated with full-time SL 1 year after allo-HSCT. cGvHD (OR 3.43; 95% CI 1.35–8.73; p = 0.01) and having symptoms of depression at 7 months after allo-HSCT (OR 3.37; 95% CI 1.2–11.58; p = 0.02) remained significant in multivariable analysis.

Conclusion

The majority of allo-HSCT survivors were on SL 1 year after treatment, and cGvHD, low vocational satisfaction and depressive symptoms were associated with full-time SL 1 year after allo-HSCT.

Implications for Cancer Survivors

Healthcare professionals need to be observant of and manage the consequences of cGvHD and patients’ symptoms of depression in order to support them appropriately in their return-to-work process.

Trajectories of sickness absence and disability pension in the 2 years before and 3 years after breast cancer diagnosis: A Swedish longitudinal population-based cohort study

BACKGROUND

After breast cancer (BC) diagnosis, work incapacity often occurs among working-age women. We investigated the trajectories of previous and subsequent sickness absence and/or disability pension (SA/DP) days, and risk factors for consistently high levels of future SA/DP among these women.

METHODS

This longitudinal cohort study included all 3536 women in Sweden aged 19-64 years who received a first BC diagnosis in 2010. Their annual SA/DP net days from 2 years before to 3 years after diagnosis were calculated. SA/DP patterns were depicted by a group-based trajectory model. Logistic regressions were used to calculate odds ratios (ORs) with 95% CIs of >90 or >180 SA/DP days/year.

RESULTS

Three trajectories of SA/DP days/year were identified: increasing only in year₊₁ (61% of all), increasing then decreasing in year₊₃ (30%), and constantly very high (9%). The risk factors associated with annual SA/DP days >90 (long) and >180 days (extreme long) were similar. Factors associated with having >90 SA/DP days for years 1-3 were: stage II (OR, 4.59; 95% CI, 2.98-7.07), stage III+IV (OR, 26.57; 95% CI, 13.52-52.22), prediagnosis SA 1-30 days (OR, 2.73; 95% CI, 1.30-5.70), prediagnosis SA >90 days (OR, 24.52; 95% CI, 12.25-49.08), and prediagnosis DP (OR, 659.97; 95% CI, 292.52->999.99). Conversely, adjusting for prediagnosis SA/DP and stage, sociodemographic factors were not associated with high levels of SA/DP.

CONCLUSION

After BC diagnosis, SA/DP increased significantly but then decreased. The absolute majority had no SA/DP during year 3. Advanced cancer stage and previous high SA/DP rendered the greatest risk for future high SA/DP. More knowledge is needed for applying the information in rehabilitation and return-to-work planning.

Quality of life, fatigue and changes therein as predictors of return to work during breast cancer treatment

PURPOSE

To our knowledge, only one study has assessed Quality of Life (QOL) as a predictor of return to work (RTW) during breast cancer treatment and one has evaluated multidimensional cancer-related fatigue (CRF) as a determinant of RTW. However, no study has assessed the impact of changes in these variables on RTW. The objective of this study was to evaluate QOL, multidimensional CRF and changes in these variables as determinants of RTW during breast cancer treatment.

METHODS

We performed a longitudinal study of 68 patients with a mean age of 46.97 years (SD = 6.92), who were employed at the time of diagnosis. Women were assessed at the beginning of adjuvant treatments (T0) and followed up with by telephone at three (T1) and 6 months later (T2), using questionnaires (QLQ-C30; MFI-20).

RESULTS

Global QOL, OR = 1.12 [1.01-1.25], sleep disturbance, OR = 1.04 [1.002-1.08], fatigue (QLQ-C30), OR = 0.93 [0.88-0.99], nausea-vomiting, OR = 0.84 [0.73-0.97], reduced motivation, OR = 1.49 [1.05-2.11] and general fatigue, OR = 0.79 [0.63-0.99] at T0 were associated with RTW at T1. At T2 global QOL, OR = 1.09 [1.01-1.17], cognitive functioning, OR = 1.10 [1.03-1.17], general fatigue, OR = 1.82 [1.04-3.17] and mental fatigue, OR = 0.29 [0.11-0.81] were associated with RTW. Furthermore, changes in mental fatigue were associated with RTW at T2, OR = 0.02 [0.001-0.29].

CONCLUSIONS

Quality of life, fatigue and their changes in them, especially cognitive functioning and mental fatigue, can play an important role in predicting the RTW of women with breast cancer. This confirms the importance of multidisciplinary care for cancer and the emergence of a theoretical psychological model of RTW.

Factors Affecting Sick Leave Duration for Non-Work-Related Temporary Disabilities in Brazilian University Public Servants

Sickness absenteeism in public institutions compromises the execution of services, and may also generate direct impacts on the population that receives coverage. To determine if sick leave duration for temporary disabilities is associated with non-work-related illnesses (NWRI), a historical cohort study was carried out of workers at a Brazilian University. The Charlson Comorbidity Index (CCI) was obtained from the most prevalent diagnoses in each expert examination and from the corresponding days of sick leave per episode, adjusting simple and multiple Cox regression models. As a result, 70% of the NWRI temporary disabilities were due to depressive disorders, convalescence, and dorsalgia with a sick leave duration between 4 and 320 days. The factors of protection for sick leave durations until the rehabilitation were non-insulin-dependent diabetes mellitus and hypertension. Long-term sick leaves were observed in the cases that required rehabilitation of those workers diagnosed with recurrent depressive disorders, conjunctivitis, acute sinusitis, skin disorders, calculus of kidney and ureter, abdominal and pelvic pain, and same-level fall accidents. It is also worth noting that even in a disease that can justify long-term sick leaves, such as breast cancer, the duration may be shorter according to the worker’s capacity and self-efficacy.