Predictors of fatigue and work ability in cancer survivors.

Background: Workers diagnosed with cancer are at risk for job loss or work disability. Aims: To determine predictors of fatigue and work ability at 36 months after diagnosis in a population of cancer survivors. Methods: Individuals diagnosed with cancer and who applied for work disability benefit at 24 months of sick leave were surveyed at the time of application and again 12 months later. Fatigue was measured using the Functional Assessment of Chronic Illness-Fatigue scale questionnaire and work ability was measured using the work ability index. Linear regression analyses were applied to identify predictors. Results: There were 336 participants. Participants who were divorced or widowed had more physical limitations, more depressive symptoms and were more fatigued at baseline, and who worked in health care demonstrated higher levels of fatigue. Lower fatigue was predicted by having received chemotherapy. A higher level of work ability was predicted by having received chemotherapy, better global health and better work ability at baseline. Lower work ability was predicted by being principal wage earner, insecurity about being free of disease, having more physical limitations and having greater wage loss. Conclusions: Socio-demographic, health- and work-related factors were associated with fatigue and work ability in cancer survivors on long-term sick leave. As fatigue and poor work ability are important risk factors for work disability, addressing the identified predictive factors may assist in mitigation of work disability in cancer survivors.

Therapeutic Work as a Facilitator for Return to Paid Work in Cancer Survivors.

Purpose The increase of flexible employment in European labour markets has contributed to workers' risk of job loss. For sick-listed workers with chronic illnesses, such as cancer, and especially those without an employment contract, participation in therapeutic work may be an important step towards paid employment. The purpose of this study was to determine the role of therapeutic employment as facilitator for return to paid work, in a cohort of sick-listed cancer survivors (CSs) with and without an employment contract. Methods In this longitudinal study, data were used from a cohort of Dutch CSs (N = 192), who applied for disability benefits after 2 years of sick leave. The primary outcome measure was return to paid work after 1 year. Logistic regression analysis was applied. Results Of the participating CSs (mean age 50.7 years, 33 % male), 69 % had an employment contract at baseline. CSs without an employment contract participated significantly less in therapeutic work (p < 0.001) and were less likely to return to paid work after 1 year (p = 0.001), than those with a contract. Participation in therapeutic work significantly increased the chance of return to paid work after 1 year (OR 6.97; 95 % CI 2.94-16.51), adjusted for age, gender, level of work disability and having an employment contract. Conclusions Participation in therapeutic work could be an important facilitator for return to paid work in sick-listed CSs. The effectiveness of therapeutic work as a means to return to paid employment for sick-listed workers should be studied in an experimental setting.

Work disability assessment of cancer survivors: insurance physicians' perspectives.

BACKGROUND: Assessing work disability in cancer survivors is a complex decision-making process. In the Netherlands, physicians employed by the Dutch Social Security Agency (SSA) play a key role in assessing work disability of cancer survivors on long-term sick leave. AIMS: To investigate the aspects physicians consider in assessing work disability in cancer survivors, their experiences related to the use of guidelines and their needs related to the use of a prediction rule that aims to support work disability assessments. METHODS: A qualitative study involving three consecutive focus group interviews, using a predetermined topic list. The interviews were recorded, transcribed and independently analysed using standard procedures of thematic analysis. RESULTS: The 29 participating physicians reported feeling responsible primarily for making correct assessments of cancer survivors' work disability, in which they predominantly investigate medical factors. Secondarily, non-medical factors related to the person, their work and/or their social environment were considered. Adherence to guidelines aiming to support physicians making such assessments was variable. CONCLUSIONS: In assessing work disability among cancer survivors on long-term sick leave, physicians considered medical and non-medical factors. The relevance of non-medical factors became more prominent in cases where medical issues were less obvious. There seems to be a need to enhance adherence to guidelines in order to support the work disability assessment of cancer survivors. The development of an implementation strategy for a prediction rule to support the work disability assessment of cancer survivors should be considered.

Predictors of return to work and employment in cancer survivors: a systematic review.

The objective of this study was to provide an overview of the prognostic factors for return to work and employment of cancer survivors. Cohort studies were selected if the population consisted of cancer patients between 18 and 65 years of age, with return to work, employment or equivalent concepts as main outcome measure, studying at least one prognostic factor. The methodological quality of the included studies and level of evidence for each prognostic factor were assessed. Twenty-eight cohort studies met the inclusion criteria. Heavy work and chemotherapy were negatively associated with return to work. Less invasive surgery was positively associated with return to work. Breast cancer survivors had the greatest chance of return to work. Old age, low education and low income were negatively associated with employment. Moderate evidence was found for extensive disease being negatively associated with both return to work and employment, and for female gender being negatively associated with return to work. The review shows that in cancer survivors, a limited number of prognostic factors of return to work and employment can be identified. Physicians primarily engaged in the process of vocational rehabilitation of cancer survivors should be aware of the potential role these factors exert.