The mediating role of coping between self-reported health complaints and functional limitations, self-assessed work ability and work status of long-term sick-listed cancer survivors.

Our purpose was to investigate the possible mediating role of active coping and passive coping between self-reported health complaints and functional limitations, as assessed by an insurance physician (IP), self-assessed work ability and work status in cancer survivors on long-term sick leave. Validated questionnaires were used for self-reported health complaints, work ability and work status. The functional limitations of the respondents were transformed into scales for mental and physical limitations and limitations in working hours. Using LISREL, we constructed a model with coping in a mediating role. Active coping mediated between fewer self-reported physical limitations, more depressive symptoms, better cognitive functioning and more fatigue on the one hand, and more physical limitations and limitations in working hours on the other hand. Passive coping played no mediating role and was associated with more self-reported depressive symptoms only. More functional limitations were associated with lower self-assessed work ability of cancer survivors, and with not being at work, whereas higher self-assessed work ability was associated with being at work. Regarding the role of active and passive coping strategies in cancer survivors on long-term sick leave, more longitudinal research is needed to confirm causality.

Sustained employability and health-related quality of life in cancer survivors up to four years after diagnosis.

BACKGROUND: Most cancer survivors are able to return to work at some point after diagnosis. However, literature on sustained employability and health-related quality of life (HRQoL) is limited. Therefore, the aims of this study were to explore the influence of change in employment status on HRQoL in cancer survivors long term after diagnosis, and to identify predictors of work continuation in occupationally active survivors. MATERIAL AND METHODS: We used prospective data (T0 = two years after diagnosis, T1 = one-year follow-up, and T2 = two-year follow-up) from a cohort of cancer survivors that had an employment contract and were of working age at T0 (N = 252, 69.8% female). Groups were formed on the basis of change in employment status: 'continuously not working' (19.8%), 'positive change in employment status' (5.6%), 'negative change in employment status' (14.7%), and 'continuously working' (59.9%). ANCOVA was used to explore the relationship between change in employment status and HRQoL at T1. Generalized estimating equations (GEE) were used to identify predictors of work continuation (at T1 and T2) in survivors that were occupationally active at T0 (N = 212). RESULTS: 'Continuously working' survivors scored significantly better on the EORTC QLQ-C30 scales: role functioning, fatigue, pain, constipation, global health/QoL and the Summary score, than 'continuously not working' survivors, and better on physical, role and emotional functioning, fatigue, financial impact, global health/QoL and the Summary score than survivors with a 'negative change in employment status' (effect size range = 0.49-0.74). In occupationally active survivors, a high score on current work ability was associated with work continuation one year later [odds ratio (OR) 1.46; 95% CI 1.11-1.92]. CONCLUSION: Cancer survivors 'continuously working' function better and have a better health and QoL than those who are not able to work. However, in occupationally active cancer survivors, one should monitor those with low self-perceived work ability, because they have an increased risk to discontinue their work.

Factors associated with work disability in employed cancer survivors at 24-month sick leave.

BACKGROUND: Identification of factors associated with work disability in cancer survivors on long term sick leave may support these survivors in choosing effective measures to facilitate vocational rehabilitation and return to work. Therefore, this study aims to disclose factors associated with work disability in cancer survivors at 24 months of sick leave. METHODS: A cross sectional study was conducted. The study population consisted of employed sick-listed cancer survivors, aged between 18 and 64 years. They received a questionnaire at 24-month sick leave, the maximum period of sick leave allowed by Dutch social security legislation. Data were linked with the outcome of work disability assessment, as performed by the Dutch social security agency. A hierarchical multivariate logistic regression analysis was performed to identify factors associated with work disability. RESULTS: Data of 351 valid cases were analysed. The multivariate analysis showed that, for cancer survivors at 24-month sick leave, Dutch nationality, higher education, receiving hormone therapy, metastatic disease, physical limitations and low self-reported work ability were associated with an increased risk for work disability. CONCLUSIONS: This study identified factors associated with work disability of employed cancer survivors at 24 months of sick leave. The results of the current study may serve as a starting point to investigate the course of work disability beyond the maximum period of 24 months of sick leave. In order to enhance work participation of cancer survivors beyond this term, prospective data on work disability in the Netherlands are required.

Physical and psychosocial problems in cancer survivors beyond return to work: a systematic review.

OBJECTIVE: Attention for the expanding group of cancer survivors at work, and the late effects they are confronted with while working, has been limited. The objective of this systematic review is to identify and summarize studies, exploring ongoing physical and/or psychosocial problems related to functioning of employees with a history of cancer, beyond their return to work. METHODS: Publications were identified through computerized Medline, Psychinfo, Embase, and Cinahl searches (January 2000-March 2013). Studies had to be directed at cancer survivors, who were employed during the study. Both qualitative and quantitative studies were included. Quality assessment of these studies was performed. Two reviewers independently extracted data from each publication, e.g., physical and/or psychosocial problems (e.g., fatigue and cognitive limitations), outcome measures (e.g., work productivity), and qualitative and quantitative results. RESULTS: The search identified 8979 articles. After exclusion on title and abstract, 64 were retrieved for full text screening, of which 30 met the inclusion criteria. A total of 20 studies reported quantitative and 10 studies reported qualitative results. The majority of studies assessed psychosocial problems in cancer survivors at work. Cognitive limitations, coping issues, fatigue, depression, and anxiety were reported to influence work ability. Physical problems, such as difficulties with lifting and treatment-induced menopausal symptoms, were frequently described to affect functioning at work. CONCLUSIONS: Ongoing physical and/or psychosocial problems are present in occupationally active cancer survivors, which may cause serious difficulties at work. The results of this study may be used as input for developing supportive interventions for these survivors.

Prognostic factors of work disability in sick-listed cancer survivors.

PURPOSE: Sick-listed cancer survivors may face lasting side-effects, even after a successful completion of treatment. As a consequence, they are at risk of work disability, which may lead to job loss. Knowledge of prognostic factors of work disability may support cancer survivors in their trajectory of vocational rehabilitation. The purpose of this study was to identify prognostic factors of work disability in sick-listed cancer survivors. METHODS: From the first day of sick leave, a cohort of 131 cancer survivors was followed for 24 months. Included participants were aged between 20 and 63 years. Data were collected, using questionnaires, at 10 months after reporting sick. The level of work disability, i.e., entitlement for disability compensation, was assessed by an insurance physician and a labour expert at 24 months. Univariate and multiple logistic regression analyses were performed. RESULTS: In the univariate analysis, 14 variables were found to be associated with the level of work disability at 24 months. These factors were related to socio-demographics, health characteristics, work-related characteristics, and return to work (RTW) expectations. Multiple logistic regression showed that at 10-month sick leave, perception of health care providers on cancer survivors' work ability and experienced influence on RTW, both reported by workers, were significantly associated with the level of work disability at 24 months. CONCLUSION: It seems in the interest of cancer survivors to take an active role in planning their RTW trajectory and to discuss RTW with their health care providers. IMPLICATIONS FOR CANCER SURVIVORS: The potential role healthcare providers may play in counselling cancer survivors on RTW must not be underestimated. Cancer survivors may benefit in having control on their RTW trajectory.