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Journal ArticleDOI

Employment challenges for cancer survivors.

01 Jun 2013-Cancer (John Wiley & Sons, Ltd)-Vol. 119, pp 2151-2159
TL;DR: An overview of the current state of scientific research in cancer survivorship and work, including factors that promote and hinder return to work and work performance, and intervention studies and programs that focus on psychological, physical, pharmacologic, or multidisciplinary approaches to work is provided.
Abstract: There is a considerable body of evidence about the adverse effects of cancer and cancer treatments on employment, work ability, work performance, and work satisfaction among cancer survivors. There is also a growing consensus that cancer survivorship research needs to address the large variety of short-term and long-term work-related problems and that programs to support return to work and employment should be developed and integrated into the follow-up survivorship care of cancer patients. Cancer survivorship and employment can be considered from the perspective of the cancer survivor, the caregiver and the family, the employer and coworkers, the health care providers, and the community or society—elements that comprise many similarities but also differences between Europe and the Unites States and that may affect employment and return to work among cancer survivors in different ways. Previous research has specifically addressed the likelihood and timeliness of work return, including factors that promote and hinder return to work and work performance, and intervention studies and programs that focus on psychological, physical, pharmacologic, or multidisciplinary approaches to work. The area of work disability has emerged as an international field with research from areas throughout the globe. In this article, the authors provide an overview of the current state of scientific research in these areas and further provide a cancer survivorship and work model that integrates significant individual cancer-related, treatment-related, and work-related factors and outcomes. The report concludes with a discussion of European and American contributions and possible future directions for the enhancement of current efforts. Cancer 2013;119(11 suppl):2151-59. V C 2013 American Cancer Society.

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Journal ArticleDOI
TL;DR: Cancer survivors, especially the working-age population, commonly experience material and psychological financial hardship.
Abstract: PurposeTo estimate the prevalence of financial hardship associated with cancer in the United States and identify characteristics of cancer survivors associated with financial hardship.MethodsWe identified 1,202 adult cancer survivors diagnosed or treated at ≥ 18 years of age from the 2011 Medical Expenditure Panel Survey Experiences With Cancer questionnaire. Material financial hardship was measured by ever (1) borrowing money or going into debt, (2) filing for bankruptcy, (3) being unable to cover one’s share of medical care costs, or (4) making other financial sacrifices because of cancer, its treatment, and lasting effects of treatment. Psychological financial hardship was measured as ever worrying about paying large medical bills. We examined factors associated with any material or psychological financial hardship using separate multivariable logistic regression models stratified by age group (18 to 64 and ≥ 65 years).ResultsMaterial financial hardship was more common in cancer survivors age 18 to 64 ...

362 citations


Cites background from "Employment challenges for cancer su..."

  • ...A cancer diagnosis and subsequent treatment may interrupt employment and have a lasting negative impact on earnings, career development, retirement decisions, and sense of self-efficacy.(51,52) We observed that cancer...

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Journal ArticleDOI
TL;DR: Evaluated randomised controlled trials of the effectiveness of interventions aimed at enhancing RTW in cancer patients compared to alternative programmes including usual care or no intervention found low quality evidence that less radical, functioning conserving approaches had similar RTW rates as more radical treatments.
Abstract: Background Cancer patients are 1.4 times more likely to be unemployed than healthy people. Therefore it is important to provide cancer patients with programmes to support the return-to-work (RTW) process. This is an update of a Cochrane review first published in 2011. Objectives To evaluate the effectiveness of interventions aimed at enhancing RTW in cancer patients compared to alternative programmes including usual care or no intervention. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL, in the Cochrane Library Issue 3, 2014), MEDLINE (January 1966 to March 2014), EMBASE (January 1947 to March 2014), CINAHL (January 1983 to March, 2014), OSH-ROM and OSH Update (January 1960 to March, 2014), PsycINFO (January 1806 to 25 March 2014), DARE (January 1995 to March, 2014), ClinicalTrials.gov, Trialregister.nl and Controlled-trials.com up to 25 March 2014. We also examined the reference lists of included studies and selected reviews, and contacted authors of relevant studies. Selection criteria We included randomised controlled trials (RCTs) of the effectiveness of psycho-educational, vocational, physical, medical or multidisciplinary interventions enhancing RTW in cancer patients. The primary outcome was RTW measured as either RTW rate or sick leave duration measured at 12 months' follow-up. The secondary outcome was quality of life. Data collection and analysis Two review authors independently assessed trials for inclusion, assessed the risk of bias and extracted data. We pooled study results we judged to be clinically homogeneous in different comparisons reporting risk ratios (RRs) with 95% confidence intervals (CIs). We assessed the overall quality of the evidence for each comparison using the GRADE approach. Main results Fifteen RCTs including 1835 cancer patients met the inclusion criteria and because of multiple arms studies we included 19 evaluations. We judged six studies to have a high risk of bias and nine to have a low risk of bias. All included studies were conducted in high income countries and most studies were aimed at breast cancer patients (seven trials) or prostate cancer patients (two trials). Two studies involved psycho-educational interventions including patient education and teaching self-care behaviours. Results indicated low quality evidence of similar RTW rates for psycho-educational interventions compared to care as usual (RR 1.09, 95% CI 0.88 to 1.35, n = 260 patients) and low quality evidence that there is no difference in the effect of psycho-educational interventions compared to care as usual on quality of life (standardised mean difference (SMD) 0.05, 95% CI -0.2 to 0.3, n = 260 patients). We did not find any studies on vocational interventions. In one study breast cancer patients were offered a physical training programme. Low quality evidence suggested that physical training was not more effective than care as usual in improving RTW (RR 1.20, 95% CI 0.32 to 4.54, n = 28 patients) or quality of life (SMD -0.37, 95% CI -0.99 to 0.25, n = 41 patients). Seven RCTs assessed the effects of a medical intervention on RTW. In all studies a less radical or functioning conserving medical intervention was compared with a more radical treatment. We found low quality evidence that less radical, functioning conserving approaches had similar RTW rates as more radical treatments (RR 1.04, 95% CI 0.96 to 1.09, n = 1097 patients) and moderate quality evidence of no differences in quality of life outcomes (SMD 0.10, 95% CI -0.04 to 0.23, n = 1028 patients). Five RCTs involved multidisciplinary interventions in which vocational counselling, patient education, patient counselling, biofeedback-assisted behavioral training and/or physical exercises were combined. Moderate quality evidence showed that multidisciplinary interventions involving physical, psycho-educational and/or vocational components led to higher RTW rates than care as usual (RR 1.11, 95% CI 1.03 to 1.16, n = 450 patients). We found no differences in the effect of multidisciplinary interventions compared to care as usual on quality of life outcomes (SMD 0.03, 95% CI -0.20 to 0.25, n = 316 patients). Authors' conclusions We found moderate quality evidence that multidisciplinary interventions enhance the RTW of patients with cancer.

276 citations

Journal ArticleDOI
TL;DR: A review of the literature on return to work among breast cancer survivors concluded that employment status and work performance is associated with a combination of individual factors, work environment, culture, and resources.
Abstract: Breast cancer survivors in their employment years are likely to try to go back to work after the primary treatment. Because the literature on return to work among breast cancer survivors is limited, we have undertaken a review of the literature to summarize what is known, including identifying important contributing variables and outcomes. This knowledge may be used to develop hypotheses and potential interventions to support breast cancer survivors who wish to return to work. We searched the following databases: CINAHL, MEDLINE, SCOUP, and PUBMED, within a 10-year timeframe (2004 to 2014). The majority of reviewed articles (N = 25) focused on three outcomes: return-to-work period, work ability, and work performance. The most frequently studied independent variables were collapsed into the following groups: health and well-being, symptoms and functioning, work demands and work environment, individual characteristics, and societal and cultural factors. Gaps in the literature include evidence of effective interventions to support return to work among breast cancer survivors and research to better understand the roles of government and business-related policy. All the studies reported a reduced work engagement and work ability. Employment status and work performance is associated with a combination of individual factors, work environment, culture, and resources. Significant gaps are apparent in the literature addressing breast cancer survivorship and return to work. This is a complex problem and it will likely require interdisciplinary research teams to develop effective and feasible interventions for this population.

120 citations

Journal ArticleDOI
TL;DR: To identify employer‐related barriers and facilitators for work participation of cancer survivors from the perspective of both employers and cancer survivors, and to synthesise these perceived barriers andfacilitators to understand their perceived consequences.
Abstract: Objective To identify employer-related barriers and facilitators for work participation of cancer survivors from the perspective of both employers and cancer survivors, and to synthesise these perceived barriers and facilitators to understand their perceived consequences. Methods A systematic review of qualitative studies focusing on employers' and cancer survivors' perspectives on the work participation of cancer survivors was performed. Four databases (MEDLINE, EMBASE, PsycINFO, and Business Source Premier) were systematically searched, and the quality of studies included was assessed using the CASP checklist. Perceived barriers and facilitators were extracted and synthesised to conduct a content analysis. Results Five studies representing the employers' perspectives and 47 studies representing the cancer survivors' perspectives were included. Employers perceived barriers and facilitators related to support, communication, RTW policies, knowledge about cancer, balancing interests and roles, and attitude. Survivors perceived barriers and facilitators related to support, communication, work environment, discrimination, and perception of work ability. The synthesis found that the employers' willingness to support can be understood by perceptions they have of the survivor, goals of the employer, and national or organisational policies. Employers require knowledge about cancer and RTW policies to be able to support survivors. Conclusions This review identified a plurality of and a large variety in perceived employer-related barriers and facilitators for work participation of cancer survivors, which can be understood to be related to both employers' willingness and ability to support. There is a need for interventions targeting employers, with the aim of enhancing the sustainable work participation of cancer survivors.

95 citations

References
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Journal ArticleDOI
TL;DR: The Delphi method was originally developed in the 50s by the RAND Corporation and was used more often especially for national science and technology foresight and therefore the value of the process as such was acknowledged.
Abstract: The Delphi method was originally developed in the 50s by the RAND Corporation in Santa Monica, California. This approach consists of a survey conducted in two or more rounds and provides the participants in the second round with the results of the first so that they can alter the original assessments if they want to-or stick to their previous opinion. Nobody 'looses face' because the survey is done anonymously using a questionnaire (the first Delphis were panels). It is commonly assumed that the method makes better use of group interaction (Rowe et al. 1991, Häder/Häder 1995) whereby the questionnaire is the medium of interaction (Martino 1983). The Delphi method is especially useful for long-range forecasting (20-30 years), as expert opinions are the only source of information available. Meanwhile, the communication effect of Delphi studies and therefore the value of the process as such is also acknowledged. During the last ten years, the Delphi method was used more often especially for national science and technology foresight. Some modifications and methodological improvements have been made, meanwhile. Nevertheless, one has to be aware of the strengths and weaknesses of the method so that it cannot be applied in every case. It is useful for an assessment of new things to come and in cases, which can be explained very shortly. This means for complex themes, it is better to use other methodologies like scenarios and to take into account what Delphi results can provide as single information pieces. Thus, Delphi studies were mainly applied in science, technology and education contexts, but one can think of different occasions. Delphi studies are rather complex procedures and require some resources depending on the breadth of the study planned. Delphi studies are processes that include the preparation, a survey in two or more rounds and some analyses and application (implementation) when the survey is finished. All three phases are important and are addressed during the course. For the preparation phase and the implementation, some practical exercises in small groups are conducted so that the participants gain a feeling for a Delphi procedure.

2,245 citations

Posted Content
TL;DR: The 2011 Human Development Report argues that the urgent global challenges of sustainability and equity must be addressed together and identifies policies on the national and global level that could spur mutually reinforcing progress towards these interlinked goals as mentioned in this paper.
Abstract: The 2011 Human Development Report argues that the urgent global challenges of sustainability and equity must be addressed together – and identifies policies on the national and global level that could spur mutually reinforcing progress towards these interlinked goals. Bold action is needed on both fronts, the Report contends, if the recent human development progress for most of the world’s poor majority is to be sustained, for the benefit of future generations as well as for those living today. Past Reports have shown that living standards in most countries have been rising – and converging – for several decades now. Yet the 2011 Report projects a disturbing reversal of those trends if environmental deterioration and social inequalities continue to intensify, with the least developed countries diverging downwards from global patterns of progress by 2050.The Report shows further how the world’s most disadvantaged people suffer the most from environmental degradation, including in their immediate personal environment, and disproportionately lack political power, making it all the harder for the world community to reach agreement on needed global policy changes. The Report also outlines great potential for positive synergies in the quest for greater equality and sustainability, especially at the national level. The Report further emphasizes the human right to a healthy environment, the importance of integrating social equity into environmental policies, and the critical importance of public participation and official accountability. The 2011 Report concludes with a call for bold new approaches to global development financing and environmental controls, arguing that these measures are both essential and feasible.

831 citations

Journal ArticleDOI
18 Feb 2009-JAMA
TL;DR: Cancer survivorship is associated with unemployment, and the unemployment risk for survivors in the United States was 1.5 times higher compared with survivors in Europe.
Abstract: 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.

690 citations


"Employment challenges for cancer su..." refers background in this paper

  • ...been associated with a greater risk of unemployment and job loss, including liver, lung, and brain cancers; hematologic malignancies; gastrointestinal and pancreatic cancers; as well as head and neck and gynecologic cancers.(10,27,28,30-32) Perceived employer accommodation for cancerrelated and treatment-related symptoms and side effects,...

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

660 citations


"Employment challenges for cancer su..." refers background in this paper

  • ...There also are conceptual frameworks that possess many of the same empirically supported and hypothetical associations.(12,13,66-68) Furthermore, in 2006, a group of researchers and clinicians interested in the impact of cancer on work and employment met in London and then again a year later in Spain at the International Psychoso-...

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  • ...In an average population of cancer patients, the return to work is 62% after 12 months.(13) Vocational rehabilitation services are available in...

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  • ...European countries, such as Finland, Germany, and the Netherlands, identified younger age, higher levels of education, absence of surgery, fewer physical symptoms, shorter duration of sick leave, male gender, and Caucasian ethnicity as variables that were predictive of or associated with return to work.(13,17,19,21,31,35-37)...

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  • ...Overall, studies have indicated a steady increase in return to work with increasing time intervals after a cancer diagnosis (Table 1).(13) These results were based mainly on populations with early stage breast cancer...

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  • ...2011;77:109-130.(13) Employment Challenges/Mehnert et al...

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Journal ArticleDOI
TL;DR: Cancer survivors have poorer health outcomes than do similar individuals without cancer across multiple burden measures and these decrements are consistent across tumor sites and are found in patients many years following reported diagnosis.
Abstract: Background: Population trends in aging and improved cancer survival are likely to result in increased cancer prevalence in the United States, but few estimates of the burden of illness among cancer survivors are currently available. The purpose of this study was to estimate the burden of illness in cancer survivors in a national, population-based sample. Methods: A total of 1823 cancer survivors and 5469 age-, sex-, and educational attainment-matched control subjects were identified from the 2000 National Health Interview Survey. Multiple measures of burden, including utility, a measure of health, and days lost from work, were compared using two-sided tests of statistical significance for the two groups overall and for subgroups stratified by tumor site and time since diagnosis. Results: Compared with matched control subjects, cancer survivors had poorer outcomes across all burden measures (P<.01). Cancer survivors had lower utility values (0.74 versus 0.80; P<.001) and higher levels of lost productivity and were more likely to report their health as fair or poor (31.0% versus 17.9%; P<.001) than matched control subjects. Cancer survivors reported statistically significantly higher burden than did control subjects across tumor sites and across time since diagnosis (i.e., within the past year, 2-5 years, 6-10 years, and ≥11 years for the majority of measures. Conclusions: Cancer survivors have poorer health outcomes than do similar individuals without cancer across multiple burden measures. These decrements are consistent across tumor sites and are found in patients many years following reported diagnosis. Improved measurement of long-term burden of illness will be important for future prospective research.

587 citations