A randomized controlled trial of support group intervention after breast cancer treatment: results on sick leave, health care utilization and health economy

Psychological and educational support for cancer patients who return to work: A scoping review

BACKGROUND: Many patients with cancer experience challenges when they return to work (RTW) following cancer diagnosis and treatment. Psycho-educational support is important to facilitate the RTW process. OBJECTIVE: This scoping review examined published reports on psycho-educational support for patients with cancer who RTW. METHODS: We followed the preferred reported items for systematic reviews and meta-analyses statement and the framework of Arksey and O’Malley. We searched the Cochrane Central Register of Controlled Trials database, PubMed, CINAHL (EBSCO), and ICHUSHI and performed manual searches. RESULTS: We retrieved 1,586 articles and retained 48 for analysis (published January 2000 to December 2020). Physicians, occupational physicians, nurses, social workers, and psychologists provide considerable support in hospitals. Delivery modes included individual, face-to-face, and workbook. Psychological support included emotional, stress coping, counseling, and knowledge. Educational support included information or advice provision, communication skills, problem discussion, and work planning. Employment status was typically the primary outcome. We included 50 measurement scales across quality of life, cognitive functioning and illness, self-efficacy, psychological distress, and fatigue. CONCLUSION: This review elucidated psycho-educational support for patients with cancer who RTW, and measurement tools for related effects. Based on the characteristics of the psycho-educational support revealed in this study, future studies should examine the development, intervention, and implementation of support programs for patients’ RTW.

A systematic review of work-related interventions for breast cancer survivors: Potential contribution of occupational therapists

BACKGROUND: A high number of breast cancer survivors need to resume work. Therefore, interventions aimed at effective work-related transitions are important. OBJECTIVE: A systematic review to determine what occupational therapy interventions are effective in work-related transitions of breast cancer survivors. METHODS: Multiple databases were searched for studies on work-related interventions within the scope of occupational therapy. Studies were included if 70% or more study participants were working age (> 18 years) breast cancer survivors, and work-related transition outcome measures were used. RESULTS: The search yielded 2 872 articles, of which 12 met the inclusion criteria. When classified according to the International Classification of Function Framework, quantitative sources focussed on Body Structures and Functions component and Multicomponents (consists of the Body Structures and Functions Component and the Activities Component) showed positive effects on improving the work-related transitions of BC survivors, however, the effects were statistically insignificant and the strength of evidence was moderate. Participants in a qualitative source reported that after they underwent a physical exercise programme their work performance improved. A Multicomponents intervention study showed statistically significant improvements on self-reported work-related outcomes of BC survivors. Low evidence was found for implementing a vocational rehabilitation case management programme targeting the Activities component, which showed positive effects in reducing the sick leave days of BC survivors, but the effects were statistically insignificant. No evidence was found for programmes focussed on restoring the Participation component. CONCLUSION: The evidence included in this systematic review were insufficient to recommend occupational therapy interventions that are effective (showing statistically significant improvements) for work-related transitions of BC cancer survivors.

Rehabilitation interventions to support return to work for women with breast cancer: a systematic review and meta-analysis

Background

Research recommends the development and evaluation of interventions to support women with breast cancer in returning to, or managing, work. Despite this, there has historically been a paucity of rehabilitation interventions to support women with breast cancer to maintain or return to their work role. The aim of this systematic review was to examine key characteristics of rehabilitation interventions, and their effectiveness on work outcomes for women with breast cancer, compared to usual care.

Methods

A systematic review was conducted of controlled studies of rehabilitation interventions with work outcomes for women with breast cancer. Six databases were systematically searched: EMBASE, Web of Science, MEDLINE (OVID), CINAHL, PsycINFO, and the Cochrane Central Register of Controlled Trials (CENTRAL). Results are presented either as pooled odds ratio (OR) or pooled effect size (hedges g) between groups, with 95% confidence intervals (CI). Narrative synthesis was conducted on intervention outcomes not suitable for meta-analysis.

Results

Five thousand, five hundred and thirty-five studies were identified. Nine out of 28 abstracts met inclusion criteria. Heterogeneity of interventions and outcomes precluded meta-analysis for most outcomes. Of the interventions included in meta-analysis, no significant differences compared to usual care were found for sick leave (2 studies (12 months); OR 1.11 (95% CI: 0.66 to 1.87), number of sick days taken (2 studies (six months); difference in effect: − 0.08, (95% CI: − 0.48 to 0.38) or working hours (2 studies (12 months); 0.19, (95% CI: − 0.20 to 0.64). Only one study, with a multidisciplinary intervention, showed a significant difference for work outcomes when compared to usual care. Work-specific content featured in three interventions only, none of which provided conclusive evidence for improvement in work outcomes. Enhanced physical and psychological sequalae, and quality of life was observed in some studies.

Conclusion

There remains a lack of effective and methodologically rigorous rehabilitation intervention studies for breast cancer survivors. The development and evaluation of effective rehabilitation interventions to support return to work is warranted.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12885-021-08613-x.

Exploratory Controlled Study of the Impact of a Hypnosis-Based Intervention on the Couple's Communication and Coping in the Context of Cancer

Emotional distress, communication, and dyadic coping difficulties are common among cancer patients and their partners. Hypnosis-based interventions can improve emotional distress in patients. We designed a group intervention combining self-hypnosis and self-care techniques. We hypothesized an effect of the intervention on emotional distress, conjugal communication, and dyadic coping, considered in patients and their partners. Our exploratory controlled study included 55 women with cancer and 55 partners. Participants completed questionnaires before and after the intervention, which was delivered to patients only. No significant effect of the intervention was revealed for patients or partners. Positive correlations between patients' and partners' communication and dyadic coping were revealed. However, to address couples' or partners' difficulties, interventions specifically designed for couples or partners must be tested.

Physical activity, return to work self-efficacy, and work status among employees undergoing chemotherapy for cancer - a prospective study with 12 months follow-up

Background

Numerous studies emphasize the positive effects of physical activity on health and well-being in cancer patients. The effects of physical activity on the working lives of cancer patients have received less attention. The aim of the present study was to examine the association between physical activity and work status in employees with cancer, and the mediating role of return to work self-efficacy (RTWSE) in this association.

Methods

Data from questionnaires (physical activity, RTWSE, performance status, sociodemographic), patient records, and Danish national registries (work status, education) were collected for 217 employees initiating chemotherapy for cancer. The associations of physical activity at baseline with work status at baseline and at twelve months follow-up, respectively, were estimated with logistic regression. The mediating role of RTWSE was investigated using the Sobel Goodmann test.

Results

Employees with moderate (> 30 min/day) or high (> 150 min/day) levels of current daily activity at baseline had significantly increased odds for working at baseline (OR = 2.83, 95%CI = 0.73–10.96 and OR = 6.13, 95%CI = 1.68–22.40, respectively) and at twelve months (OR = 3.90, 95%CI = 1.19–12.77 and OR = 3.43, 95%CI = 1.12–10.51, respectively), compared to sedentary employees. Likewise, employees, physically active in their leisure time (light or vigorous psychical activity) for 2–4 h/week or > 4 h/week of light activity at baseline, had increased odds for working at twelve months (OR range = 1.20 (95%CI = 0.40–3.61)–5.39(95%CI = 0.78–37.32)), compared to sedentary employees. RTWSE was not found to mediate the observed associations.

Conclusions

Physical activity appears positively associated with work status in employees undergoing treatment for cancer in the twelve months period after initiating chemotherapy.

Intervenções Grupais para Mulheres com Câncer de Mama: Desafios e Possibilidades

Resumo Este estudo teve por objetivo analisar a produção científica nacional e internacional sobre os grupos de reabilitação psicossocial para mulheres com câncer de mama. O levantamento bibliográfico foi realizado a partir das bases indexadoras LILACS, PubMed, PsycINFO e CINAHL. Foram selecionados 28 artigos, publicados no período de 2000 a 2015, que constituíram o corpus do estudo. Os achados foram agrupados por meio de análise de conteúdo. Os resultados evidenciaram que os grupos de apoio podem resultar em benefícios psicossociais, como redução de estresse, incremento da qualidade de vida, melhora do humor e compartilhamento de informações sobre as diversas opções de tratamentos disponíveis. Conclui-se que participar de grupos de apoio está associado a melhores desfechos psicológicos, contudo, não há evidências que comprovem aumento na expectativa de vida das mulheres.

Randomized controlled trial of an 8-week intervention combining self-care and hypnosis for post-treatment cancer patients: study protocol

Background

Cancer has a lot of consequences on patients’ quality of life (such as cancer-related fatigue (CRF), sleep difficulties and emotional distress) and on patients’ partners and their relationship, such as distress and communication difficulties. These consequences are undertreated, and interventions based on hypnosis often focus on breast cancer patients only. This paper describes the study protocol of a longitudinal randomized controlled trial aiming to assess the efficacy of an 8-week intervention combining hypnosis and self-care to improve cancer patients’ CRF, sleep and emotional distress and to indirectly improve their partners’ distress.

Methods

A power analysis required a total sample of 88 patients. To test the efficacy of the intervention, results of the experimental group receiving the intervention will be compared to those of the control group. Data will be collected by questionnaires, relaxation tasks, an attentional bias task, and everyday life assessments measured at four different times: 1.) before inclusion in the study (baseline); 2.) after the intervention; and 3.) at 4- and 12-month follow-up. Partners’ symptoms will also be evaluated with questionnaires at the same measurement times.

Discussion

There is a growing interest in alternative approaches (such as hypnosis) in addition to standard therapies in oncology settings. The results of this study should be useful for improving knowledge about long-term efficacy of hypnosis-based group interventions for CRF, sleep and distress among all types of cancer patients and their partners, and to better understand the mechanisms of emotional regulation in cancer patients through the attentional bias task.

Trial registration

ClinicalTrials.gov (NCT03144154). Retrospectively registered on the 1st of May, 2017.

Electronic supplementary material

The online version of this article (10.1186/s12885-018-5046-6) contains supplementary material, which is available to authorized users.

Return-to-work coordination programmes for improving return to work in workers on sick leave

BACKGROUND

To limit long-term sick leave and associated consequences, insurers, healthcare providers and employers provide programmes to facilitate disabled people's return to work. These programmes include a variety of coordinated and individualised interventions. Despite the increasing popularity of such programmes, their benefits remain uncertain. We conducted a systematic review to determine the long-term effectiveness of return-to-work coordination programmes compared to usual practice in workers at risk for long-term disability.

OBJECTIVES

To assess the effects of return-to-work coordination programmes versus usual practice for workers on sick leave or disability.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 11), MEDLINE, Embase, CINAHL and PsycINFO up to 1 November 2016.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) that enrolled workers absent from work for at least four weeks and randomly assigned them to return-to-work coordination programmes or usual practice.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened titles, abstracts and full-text articles for study eligibility; extracted data; and assessed risk of bias from eligible trials. We contacted authors for additional data where required. We conducted random-effects meta-analyses and used the GRADE approach to rate the quality of the evidence.

MAIN RESULTS

We identified 14 studies from nine countries that enrolled 12,568 workers. Eleven studies focused on musculoskeletal problems, two on mental health and one on both. Most studies (11 of 14) followed workers 12 months or longer. Risk of bias was low in 10 and high in 4 studies, but findings were not sensitive to their exclusion.We found no benefits for return-to-work coordination programmes on return-to-work outcomes.For short-term follow-up of six months, we found no effect on time to return to work (hazard ratio (HR) 1.32, 95% confidence interval (CI) 0.93 to 1.88, low-quality evidence), cumulative sickness absence (mean difference (MD) -16.18 work days per year, 95% CI -32.42 to 0.06, moderate-quality evidence), the proportion of participants at work at end of the follow-up (risk ratio (RR) 1.06, 95% CI 0.86 to 1.30, low-quality evidence) or on the proportion of participants who had ever returned to work, that is, regardless of whether they had remained at work until last follow-up (RR 0.87, 95% CI 0.63 to 1.19, very low-quality evidence).For long-term follow-up of 12 months, we found no effect on time to return to work (HR 1.25, 95% CI 0.95 to 1.66, low-quality evidence), cumulative sickness absence (MD -14.84 work days per year, 95% CI -38.56 to 8.88, low-quality evidence), the proportion of participants at work at end of the follow-up (RR 1.06, 95% CI 0.99 to 1.15, low-quality evidence) or on the proportion of participants who had ever returned to work (RR 1.03, 95% CI 0.97 to 1.09, moderate-quality evidence).For very long-term follow-up of longer than 12 months, we found no effect on time to return to work (HR 0.93, 95% CI 0.74 to 1.17, low-quality evidence), cumulative sickness absence (MD 7.00 work days per year, 95% CI -15.17 to 29.17, moderate-quality evidence), the proportion of participants at work at end of the follow-up (RR 0.94, 95% CI 0.82 to 1.07, low-quality evidence) or on the proportion of participants who had ever returned to work (RR 0.95, 95% CI 0.88 to 1.02, low-quality evidence).We found only small benefits for return-to-work coordination programmes on patient-reported outcomes. All differences were below the minimal clinically important difference (MID).

AUTHORS' CONCLUSIONS

Offering return-to-work coordination programmes for workers on sick leave for at least four weeks results in no benefits when compared to usual practice. We found no significant differences for the outcomes time to return to work, cumulative sickness absence, the proportion of participants at work at end of the follow-up or the proportion of participants who had ever returned to work at short-term, long-term or very long-term follow-up. For patient-reported outcomes, we found only marginal effects below the MID. The quality of the evidence ranged from very low to moderate across all outcomes.

Effect of a Nurse-Led Psychoeducational Intervention on Healthcare Service Utilization Among Adults With Advanced Cancer

PURPOSE/OBJECTIVES

To examine differences in healthcare service utilization among patients with advanced cancer participating in a nurse-led psychoeducational intervention.

DESIGN

Secondary analysis of trial data.

SETTING

Four Michigan cancer centers.

SAMPLE

484 patients with advanced cancer.

METHODS

Patients were randomized to three groups.

MAIN RESEARCH VARIABLES

Study arm (brief, extensive, or control), ED visitation (one or more times versus none), inpatient hospitalizations (one or more times versus none), and covariates.

FINDINGS

No significant differences in ED visits or inpatient hospitalizations were observed among study arms. ED visits were more frequent for patients with lung or colorectal cancer, more comorbidities, and lower baseline QOL. Baseline QOL was associated with inpatient hospitalizations in the adjusted analysis.

CONCLUSIONS

The psychoeducational intervention, either in brief or extensive format, is unlikely to increase healthcare service utilization.

IMPLICATIONS FOR NURSING

Efficacious nurse-led psychoeducational interventions to improve QOL do not place undue burdens on the healthcare system and may improve care.