Function and friction at work: a multidimensional analysis of work outcomes in cancer survivors.

OBJECTIVES: Cancer survivors can experience difficulties returning to and/or remaining at work. Sociodemographic, health and well-being, symptom burden, functional limitations in relation to work demands, work environment, and various work policies and procedures can be related to work function. METHODS: This study analyzed cross-sectional data of a sample of cancer survivors (n = 1,525) who were diagnosed and treated for various types of cancer. The data were obtained from a survey of cancer survivors collected by the LiveStrong Foundation. Using a cancer survivorship and work model proposed in 2010, this study used structural equation modeling to predict work ability (whether survivors reported lower work ability following cancer) and work sustainability (whether survivors had ever lost or left a job because of cancer, i.e., work retention). Potential predictors included health and well-being, symptom burden (e.g., fatigue, pain, and distress), cancer-related worry, worry about family's cancer risk, functional impairment (i.e., physical, cognitive, and interpersonal), workplace support, and workplace problems. RESULTS: The overall model predicting work ability (CFI = 0.961, TLI = 0.952, and RMSEA = 0.027) indicated that a greater level of functional limitations (B = 5.88, p < 0.01) and workplace problems (B = 0.22, p = 0.05) were significantly related to lower levels of work ability. Structural equation modeling (CFI = 0.961, TLI = 0.952, and RMSEA = 0.027) also indicated that workplace problems was a significant predictor (B = 0.498, p < 0.001) of the likelihood of losing or leaving a job because of cancer. CONCLUSIONS: Functional limitations and problems at work including poor treatment, discrimination, being passed over for promotion, and lack of accommodations were directly related to the ability to work. Problems at work were associated with lower work sustainability (work retention). IMPLICATIONS FOR CANCER SURVIVORS: Employed cancer survivors, health care providers, and employers need to be aware of the potential implications of limitations in function (e.g., physical, cognitive, and interpersonal/social) as it relates to ability to work. In many cases, these functional limitations are responsive to rehabilitation. Workplaces also need to be educated on how to better respond to the needs of cancer survivors at work.

Stressors, stress response, and cancer recurrence: a systematic review.

BACKGROUND: Cancer survivors assume that stress plays an important role in cancer recurrence. However, the role of stress in the etiology of cancer recurrence remains unclear. OBJECTIVE: A systematic review examining the causal role of exposure to stressors and/or stress response and cancer recurrence was conducted. METHODS: The authors screened the scientific literature published from December 1979 through April 2012. Prospective studies and randomized control trials that examined the link between exposure to stressors and/or stress response and cancer recurrence were included in the review. RESULTS: Fifteen studies examined exposures to stressors (life event questionnaires) and/or multiple indices of the stress response (mood, anxiety, depression, biological, and immune measures). The relationships between stressors and/or stress response and recurrence were observed as no relationship (80%), positive relationship (33%), and inverse relationship (27%). One of 3 randomized control trials reported a positive relationship between stress reduction and reduced risk of recurrence. CONCLUSIONS: The scientific literature to date indicates no clear evidence for a causal relationship between stress (measured as stressor exposure and/or stress response) and cancer recurrence. Although additional high-quality research is needed to provide a more definitive answer, the evidence to date does not support this hypothesis. IMPLICATIONS FOR PRACTICE: Although at present, there is no evidence indicating a causal relationship between stress and cancer recurrence, attending to the reduction in a cancer survivor's stress response can improve emotional well-being and quality of life.

Defining adolescent and young adult (AYA) exercise and nutrition needs: concerns communicated in an online cancer support community.

OBJECTIVE: To describe topics, needs, and concerns related to nutrition and exercise that adolescents and young adults affected by a serious illness (cancer) discuss online. METHODS: Investigators conducted a qualitative content analysis of messages related to nutrition and exercise posted on an online young adult cancer forum. RESULTS: AYAs described several functions achieved through nutrition and exercise, such as fighting cancer, losing weight, obtaining nutrients despite side effects of treatment, promoting general health, enjoyment, and promoting mental/emotional health. AYAs also discussed several problems that interfere with nutrition and exercise goals, such as side effects of steroids, physiological problems with eating, safety concerns or physical limitations due to treatment, poor follow through with behavioral change, stress, and low energy. CONCLUSION: AYAs discuss specific ways nutrition and exercise help achieve a variety of functions that may be physical or psychological, cancer-specific or general. AYAs describe several concerns and barriers that impede their nutrition and exercise goals. PRACTICE IMPLICATIONS: Clinicians should also consider relevant medical and personal variables that partly determine nutrition and exercise concerns. Clinicians can anticipate barriers to desired nutrition/exercise change and develop interventions that address these barriers in appropriately tailored ways, including using digital media.

Job stress and physical activity related to elevated symptom clusters in breast cancer survivors at work.

OBJECTIVE: To identify whether clusters of symptoms (depression, anxiety, fatigue, cognitive limitations) appear in employed breast cancer survivors, and whether clusters are related to job stress and aerobic activity. METHODS: Employed breast cancer survivors (n = 94) and women without a history of cancer (n = 100) completed questionnaires online in a cross-sectional study. RESULTS: A two-cluster solution of high or low symptom severity groups was observed. High symptom cluster was associated with breast cancer (odds ratio [OR] = 2.46; 95% confidence interval [CI], 1.22 to 4.93), more frequent job stress (OR = 1.78; 95% CI, 1.12 to 2.83), and lower levels of aerobic activity (OR = 0.55; 95% CI, 0.36 to 0.83). CONCLUSION: Levels of anxiety, depression, cognitive limitations, and fatigue are expressed as clusters with varying severity. Clusters are related to job stress and aerobic activity in breast cancer survivors at work. Findings suggest avenues for clinical management and research.

Work in cancer survivors: a model for practice and research.

INTRODUCTION: As with other illnesses, several variables can impact the transition back to the workplace, long-term work productivity, or job retention among cancer survivors. We developed a model related to work and cancer based in part on the general area of work disability and the specific literature on cancer survivors and work. METHODS: A systematic search of the literature on work and cancer was conducted to determine whether an evidence base existed to support the proposed model. RESULTS: Forty-five papers met the review criteria. The percentage of studies that addressed modifiable categories included in the proposed model was: health and well-being (20%), symptoms (16%), function (24%), work demands (9%), work environment (18%), and policy, procedures, and economic factors (16%). Return to work was the most common work outcome studied although problems with productivity and retention are reported in the general cancer and work literature. Wide variation in definition of cancer survivor was reported and breast cancer survivors were studied most often. Each of the categories in the model has some empirical support. DISCUSSION: The model considers the health, functional status in relation to demands, work environment, and policy, procedures, and financial factors. The model allows the clinician and survivor to consider factors that can be addressed by the health care provider, survivor, and workplace. Implications for Cancer Survivors. This model provides a framework to aid in conceptualizing problems related to work.