Enhancing return-to-work in cancer patients, development of an intervention and design of a randomised controlled trial

ABSTRACT: BACKGROUND: Compared to healthy controls, cancer patients have a higher risk of unemployment, which has negative social and economic impacts on the patients and on society at large. Therefore, return-to-work of cancer patients needs to be improved by way of an intervention. The objective is to describe the development and content of a work-directed intervention to enhance return-to-work in cancer patients and to explain the study design used for evaluating the effectiveness of the intervention. METHODS: Development and content of the intervention The work-directed intervention has been developed based on a systematic literature review of work-directed interventions for cancer patients, factors reported by cancer survivors as helping or hindering their return-to-work, focus group and interview data for cancer patients, health care professionals, and supervisors, and vocational rehabilitation literature. The work-directed intervention consists of: 1) 4 meetings with a nurse at the treating hospital department to start early vocational rehabilitation, 2) 1 meeting with the participant, occupational physician, and supervisor to make a return-to-work plan, and 3) letters from the treating physician to the occupational physician to enhance communication. Study design to evaluate the intervention The treating physician or nurse recruits patients before the start of initial treatment. Patients are eligible when they have a primary diagnosis of cancer, will be treated with curative intent, are employed at the time of diagnosis, are on sick leave, and are between 18 and 60 years old. After the patients have given informed consent and have filled out a baseline questionnaire, they are randomised to either the control group or to the intervention group and receive either care as usual or the work-directed intervention, respectively. Primary outcomes are return-to-work and quality of life. The feasibility of the intervention and direct and indirect costs will be determined. Outcomes will be assessed by a questionnaire at baseline and at 6, 12, 18, and 24 months after baseline. DISCUSSION: This study will provide information about the effectiveness of a work-directed intervention for cancer patients. The intention is to implement the intervention in normal care if it has been shown effective. Trial registration: NTR165

Return-to-work of sick-listed workers without an employment contract – what works?

BACKGROUND: In the past decade flexible labour market arrangements have emerged as a significant change in the European Union labour market. Studies suggest that these new types of labour arrangements may be linked to ill health, an increased risk for work disability, and inadequate vocational rehabilitation. Therefore, the objectives of this study were: 1. to examine demographic characteristics of workers without an employment contract sick-listed for at least 13 weeks, 2. to describe the content and frequency of occupational health care (OHC) interventions for these sick-listed workers, and 3. to examine OHC interventions as possible determinants for return-to-work (RTW) of these workers. METHODS: A cohort of 1077 sick-listed workers without an employment contract were included at baseline, i.e. 13 weeks after reporting sick. Demographic variables were available at baseline. Measurement of cross-sectional data took place 4-6 months after inclusion. Primary outcome measures were: frequency of OHC interventions and RTW-rates. Measured confounding variables were: gender, age, type of worker (temporary agency worker, unemployed worker, or remaining worker without employment contract), level of education, reason for absenteeism (diagnosis), and perceived health. The association between OHC interventions and RTW was analysed with a logistic multiple regression analysis. RESULTS: At 7-9 months after the first day of reporting sick only 19% of the workers had (partially or completely) returned to work, and most workers perceived their health as fairly poor or poor. The most frequently reported (49%) intervention was 'the OHC professional discussed RTW'. However, the intervention 'OHC professional made and discussed a RTW action plan' was reported by only 19% of the respondents. The logistic multiple regression analysis showed a significant positive association between RTW and the interventions: 'OHC professional discussed RTW'; and 'OHC professional made and discussed a RTW action plan'. The intervention 'OHC professional referred sick-listed worker to a vocational rehabilitation agency' was significantly associated with no RTW. CONCLUSION: This is the first time that characteristics of a large cohort of sick-listed workers without an employment contract were examined. An experimental or prospective study is needed to explore the causal nature of the associations found between OHC interventions and RT

Enhancing Emotional Skills of Managers to Support the Return to Work of Cancer Survivors: A Research Opinion Focusing on Value, Feasibility and Challenges

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Advice about Work-Related Issues to Peers and Employers from Head and Neck Cancer Survivors.

PurposeThe purpose of this exploratory and descriptive study is to contribute to the sparse return-to-work literature on head and neck cancer (HNC) survivors. Interview participants were asked to reflect upon their work-related experience with cancer by answering two specific questions: (1) What advice would you give someone who has been newly diagnosed with head and neck cancer? (2) What advice would you give to employers of these people?MethodsData were gathered through 10 individual semi-structured in-depth interviews with HNC clinic patients at a regional cancer center's head and neck clinic in Ontario, Canada. A constant comparative method of theme development was used. Codes identified in and derived from the data were discussed by research team members until consensus was reached. Codes with similar characteristics were grouped together and used to develop overarching themes.ResultsWork-related advice for peers focused on personal self-care and interactions within workplaces. Work-related advice to employers focused on demonstrating basic human values as well as the importance of communication.DiscussionThe study results suggest HNC clinic patients should be proactive with employers and help to set reasonable expectations and provide a realistic plan for work to be successfully completed. HNC clinic patients should develop communication skills to effectively disclose their cancer and treatment to employers.ConclusionsIn this exploratory study, HNC clinic patients' advice was solution-focused underscoring the importance of self-care and pro-active communication and planning with employers. Employers were advised to demonstrate core human values throughout all phases of the work disability episode beginning at diagnosis

Work-related experiences of head and neck cancer survivors: an exploratory and descriptive qualitative study

This exploratory and descriptive study contributes to the growing knowledge about the return-to-work (RTW) experience of head and neck cancer (HNC) survivors. Viewing RTW as a process, participants were asked to consider the work-related experience with HNC at different phases: (1) at diagnosis/pre-treatment, (2) working during treatment (if the respondent did not take a work disability leave), and (3) post-treatment/RTW (if the respondent took a work disability leave). Data were gathered in nine individual semi-structured in-depth interviews with patients receiving treatment at a quaternary cancer center's HNC clinic in Ontario, Canada. Using a constant comparative method of theme development, codes were identified in and derived from the data. Codes with similar characteristics were grouped, used to develop overarching themes, and were organized according to the RTW factors identified in the literature. Each phase has different barriers that are in turn addressed by different facilitators. As reflected in the literature, we found that RTW or the process of work continuation is complex. Many players and interactions contribute to the worker's experience. By recognizing that work-related experiences differ by phases, clinicians and employers can better support HNC survivors depending on the phase of the RTW process. Implications for Rehabilitation Our findings suggest that when rehabilitation specialists are working with survivors to develop interventions, the return-to-work phase and work context rather than diagnosis should be considered as a starting point. At every phase, supportive and empathetic managers are a key to successful work experiences for people who have been diagnosed and are being treated for head and neck cancer. Rehabilitation specialists should help survivors to seek supportive interactions with the environment that are essential to enable the ability to wor

Work-related and personal risk factors for occupational contact dermatitis: A systematic review of the literature with meta-analysis

The objective of this review is to identify work-related and personal risk factors for contact dermatitis (CD), and assess their association with this frequently occurring occupational disease. A systematic review of the literature from 1990 to June 2, 2020, was conducted using Medline and Embase. Prospective cohort and case–control studies were included, and meta-analyses were conducted when feasible. Quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation. Twenty-nine studies were identified, comprising 26 study populations and with a total of 846 209 participants investigating 52 risk factors for CD. Meta-analyses were performed for five risk factors, all of them for irritant contact dermatitis (ICD). Moderate-quality evidence was found for associations between wet work and ICD (OR: 1.56, 95%CI: 1.21–2.01). High-quality evidence was found for the association between atopic dermatitis and ICD (OR: 2.44, 95%CI: 1.89–3.15). There was no evidence for an association between ICD and sex or history of hand dermatitis, respiratory and mucosal atopy. In conclusion, several work-related and personal risk factors associated with CD were identified. Our data emphasize the need for the assessment of both, work-related and personal, risk factors to prevent occupational CD