国際生活機能分類(International Classification of Functioning, Disability and Health: ICF)にみた福祉・保健・医療の専門職協働における連携に関する貢献と課題

Context Nearly half of adult cancer survivors are younger than 65 years, but the association of cancer survivorship with employment status is unknown. Objective To assess the association of cancer survivorship with unemployment compared with healthy controls. Data Sources A systematic search of studies published between 1966 and June 2008 was conducted using MEDLINE, CINAHL, EMBASE, PsycINFO, and OSH-ROM databases. Study Selection Eligible studies included adult cancer survivors and a control group, and employment as an outcome. Data Extraction Pooled relative risks were calculated over all studies and according to cancer type. A Bayesian meta-regression analysis was performed to assess associations of unemployment with cancer type, country of origin, average age at diagnosis, and background unemployment rate. Results Twenty-six articles describing 36 studies met the inclusion criteria. The analyses included 20 366 cancer survivors and 157 603 healthy control participants. Studies included 16 from the United States, 15 from Europe, and 5 from other countries. Overall, cancer survivors were more likely to be unemployed than healthy control participants (33.8% vs 15.2%; pooled relative risk [RR], 1.37; 95% confidence interval [CI], 1.21-1.55). Unemployment was higher in breast cancer survivors compared with control participants (35.6% vs 31.7%; pooled RR, 1.28; 95% CI, 1.11-1.49), as well as in survivors of gastrointestinal cancers (48.8% vs 33.4%; pooled RR, 1.44; 95% CI, 1.02-2.05), and cancers of the female reproductive organs (49.1% vs 38.3%; pooled RR, 1.28; 95% CI, 1.17-1.40). Unemployment rates were not higher for survivors of blood cancers compared with controls (30.6% vs 23.7%; pooled RR, 1.41; 95% CI, 0.95-2.09), prostate cancers (39.4% vs 27.1%; pooled RR, 1.11; 95% CI, 1.00-1.25), or testicular cancer (18.5% vs 18.1%; pooled RR, 0.94; 95% CI, 0.74-1.20). For survivors in the United States, the unemployment risk was 1.5 times higher compared with survivors in Europe (meta-RR, 1.48; 95% credibility interval, 1.15-1.95). After adjustment for diagnosis, age, and background unemployment rate, this risk disappeared (meta-RR, 1.24; 95% CI, 0.85-1.83). Conclusion Cancer survivorship is associated with unemployment.

https://jamanetwork.com/journals/jama/articlepdf/183387/jcr90000_753_762.pdf

Cancer survivors and unemployment: a meta-analysis and meta-regression.

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.

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Employment and work-related issues in cancer survivors

Purpose To identify correlates of return to work for employed breast cancer survivors. Patients and Methods Patients included 416 employed women with newly diagnosed breast cancer identified from the Metropolitan Detroit Cancer Surveillance System. Patients were interviewed by telephone 12 and 18 months after diagnosis. Correlates of return to work at 12 and 18 months were identified using multivariate logistic regression. Results More than 80% of patients returned to work during the study period, and 87% reported that their employer was accommodating to their cancer illness and treatment. After adjusting for demographic characteristics, health status, cancer stage, treatment, and job type, heavy lifting on the job (odds ratio 0.42; 95% CI, 0.18 to 0.99), perceived employer accommodation for cancer illness and treatment (odds ratio 2.2; 95% CI, 1.03 to 4.8), and perceived employer discrimination because of a cancer diagnosis (odds ratio 0.27; 95% CI, 0.10 to 0.71) were independently associated with return to work at 12 months after breast cancer diagnosis, and perceived employer accommodation (odds ratio 2.3; 95% CI, 1.06 to 5.1) was independently associated with return to work at 18 months after breast cancer diagnosis. Conclusion A high percentage of employed breast cancer patients returned to work after treatment, and workplace accommodations played an important role in their return. In addition, perceived employer discrimination because of cancer was negatively associated with return to work for breast cancer survivors. Employers seem to have a pivotal role in breast cancer patients’ successful return to work.

/pdf/correlates-of-return-to-work-for-breast-cancer-survivors-15jlb6aihq.pdf

Correlates of Return to Work for Breast Cancer Survivors

Goals
To examine the prevalence of chemotherapy-or radiotherapy-associated side effects and related treatment burden, and correlates of fatigue and missed work days among cancer patients.

Symptoms and treatment burden associated with cancer treatment: results from a cross-sectional national survey in the U.S.

Background: A better understanding of how cancer treatments affect patient's employment may help patients and physicians make more informed choices between treatment alternatives. This study examined the number of days employed patients undergoing treatment for either breast or prostate cancer were absent from their jobs.

Method: Using the Detroit Surveillance, Epidemiology, End-Results registry, all potentially eligible women diagnosed with breast cancer and men diagnosed with prostate cancer were selected. Subjects who were employed full-time were included in this analysis.

Results: Women treated for breast cancer missed an average of 44.5 days from work; the median days missed was 22. The median days missed by women treated with surgery and chemotherapy was 40. Men diagnosed with prostate cancer missed an average of 27 days (median days=20) from work. The median days missed for men treated surgically without hormone or radiation therapy was 25. In multivariable analyses, taking a leave of absence and greater elapsed time from diagnosis to interview were associated with the greatest number of days absent from work for all patients. Men treated with hormone and/or radiation therapy or who were not treated missed fewer days from work relative to men undergoing surgery.

Conclusion: Research and interventions are needed to minimize work loss for cancer patients. Vocational rehabilitation programs may minimize the impact of treatment on work. Information on how treatments may infringe the ability for patients to earn a living may influence treatment decisions. Copyright © 2005 John Wiley & Sons, Ltd.

Absenteeism from work: the experience of employed breast and prostate cancer patients in the months following diagnosis.

Nearly 60% of cancer survivors are of working age, making inquiries into work-related disabilities particularly relevant. This paper describes work-related physical and cognitive disability estimates 12 and 18 months after diagnosis and treatment in a sample of employed breast and prostate cancer patients. We recruited employed, newly diagnosed patients (n = 447 breast, n = 267 prostate) from the Metropolitan Detroit Cancer Surveillance System for telephone interviews 12 and 18 months after diagnosis. We defined disability by work task activity limitation. Disability estimates and employment were compared using Pearson chi-square tests. Duration of hours worked was compared by disability status using t-tests. Approximately 60% of women reported physical disability at 12 months which decreased to 36% at 18 months. Cognitive disability was reported by 34% and 22% of women at 12 and 18 months, respectively. Fewer men reported physical disability, only 29% at 12 months, decreasing to 17% at 18 months. Cognitive disability was reported by 12% and 7% of men at 12 and 18 months, respectively. More individuals with disability left the workforce at each timeframe than those without disability. A significant proportion of breast and prostate cancer patients experienced work-related disabilities 1 year or more following treatment. Physical disability was more problematic than cognitive disability.

Work task disability in employed breast and prostate cancer patients

https://www.jenonline.org/article/S1540-2487(05)00111-2/pdf

Rapid Assessment of the Needs and Health Status in Santa Rosa and Escambia Counties, Florida, after Hurricane Ivan, September 2004

Some cancers are rapidly becoming chronic conditions that are more and more often diagnosed in working-age individuals. The authors developed a research agenda to study the labor market outcomes attributable to detection and treatment for cancer, and research design and data collection strategies to improve upon other research on these questions. In this article, they describe their approach to combining secondary data sources, primary data collection, and cancer registry data to evaluate the impact cancer has on labor market outcomes such as employment, hours worked, wages, and health insurance. They then critically assess how well their study design and data collection strategy accomplished its objectives. The intention is to offer guidance on how researchers, who are interested in the economic consequences of cancer, as well as of other chronic conditions, might develop and execute studies that examine labor market outcomes. As more attention is placed on the economic aspects of disease, the methods used to estimate productivity loss and other economic outcomes attributable to these conditions require careful scrutiny so that reliable findings can be used to shape health care decisions and policy.

Combining registry, primary, and secondary data sources to identify the impact of cancer on labor market outcomes.

PURPOSE To compare patient reported cancer treatments with data obtained by trained abstractors in the Metropolitan Detroit Cancer Surveillance System (MDCSS) to assess the reliability of patient interviews as a source for cancer treatments. METHODS Patients (n=492 breast patients and n=291 prostate patients) were identified from the MDCSS and interviewed approximately 6 months after initial diagnosis for receipt of cancer treatment. Kappa statistics compared agreement between patient's report of their treatments and the MDCSS. RESULTS Breast cancer patients had moderate levels of agreement regarding receipt of chemotherapy and radiation and excellent agreement for surgery. In contrast, prostate cancer patients and registry reports achieved excellent concordance for radiation therapy, very good agreement for surgery, and moderate levels of agreement for hormone therapy. Sensitivity of chemotherapy, surgery, and radiation reporting exceeded 90% for both patient cohorts. Overall, patients reported more treatment than was recorded i n M DCSS. CONCLUSION Patients can be reliabledata sources for medical information pertaining to cancer therapies, although recall may vary by treatment type and time since treatment. Protocols involving patient interviews may wish to consider these encounters as timely, reliable data source options.

Kathleen Oberst

Papers

Absenteeism from work: the experience of employed breast and prostate cancer patients in the months following diagnosis.

Work task disability in employed breast and prostate cancer patients

Rapid Assessment of the Needs and Health Status in Santa Rosa and Escambia Counties, Florida, after Hurricane Ivan, September 2004

Combining registry, primary, and secondary data sources to identify the impact of cancer on labor market outcomes.

Breast and prostate cancer patient's reliability of treatment reporting.