Usefulness and engagement with a guided workbook intervention (WorkPlan) to support work related goals among cancer survivors Design of a multicentre randomized controlled trial to evaluate the effectiveness of a tailored clinical support intervention to enhance return to work for gastrointestinal cancer patients Return to work of cancer patients after a multidisciplinary intervention including occupational counselling and physical exercise in cancer patients: a prospective study in the Netherlands Case management vocational rehabilitation for women with breast cancer after surgery: a feasibility study incorporating a pilot randomised controlled trial Municipal return to work management in cancer survivors undergoing cancer treatment: a protocol on a controlled intervention study Cancer@Work — a nurse-led, stepped-care, e-health intervention to enhance the return to work of patients with cancer: study protocol for a randomized controlled trial Effectiveness of a Hospital-Based Work Support Intervention for Female Cancer Patients – A Multi-Centre Randomised Controlled Trial Effectiveness of work-related medical rehabilitation in cancer patients: study protocol of a cluster-randomized multicenter trial
Background Returning to work after cancer is associated with improved physical and psychological functioning , but managing this return can be a challenging process . A workbook based intervention ( WorkPlan ) was developed to support return-to-work among cancer survivors . The aim of this study was to explore how participants using the workbook engaged with the intervention and utilised the content of the intervention in their plan to return-to-work . Methods As part of a feasibility r and omised controlled trial , 23 participants from the intervention group were interviewed 4-weeks post intervention . Interviews focussed on intervention delivery and data was analysed using Framework analysis . Results Participants revealed a sense of empowerment and changes in their outlook as they transitioned from patient to employee , citing the act of writing as a medium for creating their own return-to-work narrative . Participants found the generation of a return-to-work plan useful for identifying potential problems and solutions , which also served as a tool for aiding discussion with the employer on return-to-work . Additionally , participants reported feeling less uncertain and anxious about returning to work . Timing of the intervention in coordination with ongoing cancer treatments was crucial to perceived effectiveness ; participants identified the sole or final treatment as the ideal time to receive the intervention . Conclusions The self-guided workbook supports people diagnosed with cancer to build their communication and planning skills to successfully manage their return-to-work . Further research could examine how writing plays a role in this process . Trial registration Current Controlled Trials IS RCT N56342476 . Retrospectively registered 14 October 2015 Background Gastrointestinal ( GI ) cancer is frequently diagnosed in people of working age , and many GI cancer patients experience work-related problems . Although these patients often experience difficulties returning to work , supportive work-related interventions are lacking . We have therefore developed a tailored work-related support intervention for GI cancer patients , and we aim to evaluate its cost-effectiveness compared with the usual care provided . If this intervention proves effective , it can be implemented in practice to support GI cancer patients after diagnosis and to help them return to work . Methods / Design We design ed a multicentre r and omized controlled trial with a follow-up of twelve months . The study population ( N = 310 ) will include individuals aged 18–63 years diagnosed with a primary GI cancer and employed at the time of diagnosis . The participants will be r and omized to the intervention or to usual care . ‘ Usual care ’ is defined as psychosocial care in which work-related issues are not discussed . The intervention group will receive tailored work-related support consisting of three face-to-face meetings of approximately 30 min each . Based on the severity of their work-related problems , the intervention group will be divided into groups receiving three types of support ( A , B or C ) . A different supportive healthcare professional will be available for each group : an oncological nurse ( A ) , an oncological occupational physician ( B ) and a multidisciplinary team ( C ) that includes an oncological nurse , oncological occupational physician and treating oncologist/physician . The primary outcome measure is return to work ( RTW ) , defined as the time to a partial or full RTW . The secondary outcomes are work ability , work limitations , quality of life , and direct and indirect costs . Discussion The hypothesis is that tailored work-related support for GI cancer patients is more effective than usual care in terms of the RTW . The intervention is innovative in that it combines oncological and occupational care in a clinical setting , early in the cancer treatment process . Trial registration METC protocol number NL51444.018.14/Netherl and s Trial Register number NTR5022 . Registered 6 March 2015 Objectives To support return to work ( RTW ) among cancer patients , a multidisciplinary rehabilitation programme was developed which combined occupational counselling with a supervised physical exercise programme during chemotherapy . The aim was to investigate RTW rates of cancer patients and to evaluate changes in work-related quality of life and physical outcomes . Design Longitudinal prospect i ve intervention study using a one-group design . Setting Two hospitals in the Netherl and s. Participants Of the eligible patients , 56 % participated ; 93 patients with a primary diagnosis of cancer receiving chemotherapy and on sick leave were included . Patients completed question naires on RTW , the importance of work , work ability ( WAI ) , RTW self-efficacy , fatigue ( MFI ) , and quality of life ( EORTC QLQ C-30 ) at baseline and 6 , 12 and 18 months follow-up . Before and after the exercise programme 1-repetition maximum ( 1RM ) muscle strength and cardiorespiratory fitness ( VO2 peak ) were assessed . Results Six months after the start of a multidisciplinary rehabilitation programme that combined occupational counselling with a supervised physical exercise programme , 59 % of the cancer patients returned to work , 86 % at 12 months and 83 % at 18 months . In addition , significant improvements ( p<0.05 ) in the importance of work , work ability , RTW self-efficacy , and quality of life were observed , whereas fatigue levels were significantly reduced . After completing the exercise programme , 1RM muscle strength was significantly increased but there was no improvement in VO2 peak level . Conclusions RTW rates of cancer patients were high after completion of the multidisciplinary rehabilitation programme . A multidisciplinary rehabilitation programme which combines occupational counselling with a supervised physical exercise programme is likely to result in RTW , reduced fatigue and increased importance of work , work ability , and quality of life Background There is a paucity of method ologically robust vocational rehabilitation ( VR ) intervention trials . This study assessed the feasibility and acceptability of a VR trial of women with breast cancer to inform the development of a larger interventional study . Methods Women were recruited in Scotl and and r and omised to either a  case management VR service or to usual care .  Data were collected on eligibility , recruitment and attrition rates to assess trial feasibility , and interviews conducted to determine trial acceptability . Sick leave days ( primary outcome ) were self-reported via postal question naire every 4 weeks during the first 6 months post-surgery and at 12 months . Secondary outcome measures were change in employment pattern , quality of life and fatigue . Results Of the 1,114 women assessed for eligibility , 163 ( 15 % ) were eligible . The main reason for in eligibility was age ( > 65 years , n = 637 , 67 % ) . Of those eligible , 111 ( 68 % ) received study information , of which 23 ( 21 % ) consented to participate in the study . Data for 18 ( 78 % ) women were analysed ( intervention : n = 7 ; control : n = 11 ) . Participants in the intervention group reported , on average , 53 fewer days of sick leave over the first 6 months post-surgery than those in the control group ; however , this difference was not statistically significant ( p = 0.122 ; 95 % confidence interval −15.8 , 122.0 ) . No statistically significant differences were found for secondary outcomes . Interviews with trial participants indicated that trial procedures , including recruitment , r and omisation and research instruments , were acceptable . Conclusions Conducting a pragmatic trial of effectiveness of a VR intervention among cancer survivors is both feasible and acceptable , but more research about the exact components of a VR intervention and choice of outcomes to measure effectiveness is required . VR to assist breast cancer patients in the return to work process is an important component of cancer survivorship plans . Trial registration IS RCT Background Cancer survivors are often left on their own to deal with the challenges of resuming work during or after cancer treatment , mainly due to unclear agreements between stakeholders responsible for occupational rehabilitation . Social ine quality exists in cancer risk , survival probability and continues with regard to the chance of being able to return to work . The aim is to apply an early , individually tailored occupational rehabilitation intervention to cancer survivors in two municipalities parallel with cancer treatment focusing on enhancing readiness for return to work . Methods / Design In a controlled trial municipal job consultants use acceptance and commitment therapy dialogue and individual-placement- and -support-inspired tools with cancer survivors to engage them in behaviour changes toward readiness for return to work . The workplace is involved in the return to work process . Patients referred to surgery , radiotherapy or chemotherapy at the Oncology Department , Aarhus University Hospital , Denmark for the diagnoses ; breast , colon-rectal , head and neck , thyroid gl and , testicular , ovarian or cervix cancer are eligible for the study . Patients must be residents in the municipalities of Silkeborg or R and ers , 18–60 years of age and have a permanent or temporary employment ( with at least 6 months left of their contract ) at inclusion . Patients , for whom the treating physician considers occupational rehabilitation to be unethical , or who are not reading or talking Danish are excluded . The  control group  has identical inclusion and exclusion criteria except for municipality of residence . Return to work is the primary outcome and is indentified in a social transfer payment register . Effect is assessed as relative cumulative incidences within 52 weeks and will be analysed in generalised linear regression models using the pseudo values method . As a secondary outcome ; co-morbidity and socio-economic status is analysed as effect modifiers of the intervention effect on return to work . Discussion The innovative element of this intervention is the timing of the occupational rehabilitation which is much earlier initiated than usual and the active involvement of the workplace . We anticipate that vulnerable cancer survivors will benefit from this approach and reduce the effects of social ine quality on workability . Trial registration Current Controlled Trials IS RCT N50753764 . Registered August 21st , 2014 Background Although the importance of work for patients with cancer is nowadays more acknowledged both in the literature as well as in cancer survivorship care , effective interventions targeting the return to work of these patients are still scarce . Therefore , we developed a nurse-led , stepped-care , e-health intervention aim ed at enhancing the return to work of patients with cancer . The objective of this study is to describe the content of the intervention and the study design used to evaluate the feasibility and ( cost ) effectiveness of the intervention . Methods We design ed a multi-centre r and omised controlled trial with a follow-up of 12 months . Patients who have paid employment at the time of diagnosis , are on sick leave and are between 18–62 years old will be eligible to participate . After patients have signed the informed consent form and filled in the baseline question naire , they are r and omly allocated to either the nurse-led , stepped-care , e-health intervention called Cancer@Work , or care as usual . The primary outcome is sustainable return to work . Secondary outcomes are sick leave days , work ability , work functioning , quality of life , quality of working life and time from initial sick leave to full return to work without extensive need for recovery . The feasibility of the Cancer@Work  intervention and direct and indirect costs will be determined . Outcomes will be assessed by question naires at 3 , 6 , 9 and 12 months of follow-up . Discussion The results of this study will provide new insights into the feasibility and ( cost ) effectiveness of Cancer@Work , a nurse-led , stepped-care , e-health intervention for cancer patients aim ed at enhancing their return to work . If proven effective , the intention is to implement the Cancer@Work intervention in usual psycho-oncological care . Trial registration NTR ( Netherl and s Trial Registry ) : NTR5190 . Registered on 18 June 2015 Objective One key aspect of cancer survivorship is return-to-work . Unfortunately , many cancer survivors face problems upon their return-to-work . For that reason , we developed a hospital-based work support intervention aim ed at enhancing return-to-work . We studied effectiveness of the intervention compared to usual care for female cancer patients in a multi-centre r and omised controlled trial . Methods Breast and gynaecological cancer patients who were treated with curative intent and had paid work were r and omised to the intervention group ( n = 65 ) or control group ( n = 68 ) . The intervention involved patient education and support at the hospital and improvement of communication between treating and occupational physicians . In addition , we asked patient 's occupational physician to organise a meeting with the patient and the supervisor to make a concrete gradual return-to-work plan . Outcomes at 12 months of follow-up included rate and time until return-to-work ( full or partial ) , quality of life , work ability , work functioning , and lost productivity costs . Time until return-to-work was analyzed with Kaplan-Meier survival analysis . Results Return-to-work rates were 86 % and 83 % ( p = 0.6 ) for the intervention group and control group when excluding 8 patients who died or with a life expectancy of months at follow-up . Median time from initial sick leave to partial return-to-work was 194 days ( range 14–435 ) versus 192 days ( range 82–465 ) ( p = 0.90 ) with a hazard ratio of 1.03 ( 95 % CI 0.64–1.6 ) . Quality of life and work ability improved statistically over time but did not differ statistically between groups . Work functioning and costs did not differ statistically between groups . Conclusion The intervention was easily implemented into usual psycho-oncological care and showed high return-to-work rates . We failed to show any differences between groups on return-to-work outcomes and quality of life scores . Further research is needed to study which aspects of the intervention are useful and which elements need improvement . Trial Registration Nederl and s Trial Register ( NTR ) Background Work is a central re source for cancer survivors as it not only provides income but also impacts health and quality of life . Additionally , work helps survivors to cope with the perceived critical life event . The German Pension Insurance provides medical rehabilitation for working-age patients with chronic diseases to improve and restore their work ability , and support returning to or staying at work , and thus tries to sustainably avoid health-related early retirement . Past research showed that conventional medical rehabilitation programs do not support returning to work sufficiently and that work-related medical rehabilitation programs report higher return-to-work rates across several health conditions , when compared to medical rehabilitation . Therefore , the current study protocol outlines an effectiveness study of such a program for cancer survivors . Methods To evaluate the effectiveness of work-related medical rehabilitation in cancer patients we conduct a cluster-r and omized multicenter trial . In total , 504 rehabilitation patients between 18 and 60 years with a Karnofsky Performance Status of ≥70 % , a preliminary positive social-medical prognosis of employability for at least 3 h/day within the next 6 months and an elevated risk of not returning to work will be recruited in four inpatient rehabilitation centers . Patients are r and omized to the work-related medical rehabilitation program or the conventional medical rehabilitation program based on their week of arrival at each rehabilitation center .  The work-related medical rehabilitation program comprises additional work-related diagnostics , multi-professional team meetings , an introductory session as well as work-related functional capacity training , work-related psychological groups , and social counseling . All additional components are aim ed at the adjustment of the patients ’ capacity in relation to their individual job dem and s. Role functioning defines the main study outcome and will be assessed with the EORTC-QLQ30 . Secondary outcome measures are the remaining scales of the EORTC-QLQ30 , fatigue , self-rated work ability , disease coping , participation in working life , realization of work-related goals and therapies during rehabilitation , and treatment satisfaction . Discussion A positive evaluation of work-related medical rehabilitation in cancer patients is expected due to the promising findings on the effectiveness of such programs for patients with other health conditions . Results may support the dissemination of work-related medical rehabilitation programs in German cancer rehabilitation . Trial registration German Clinical Trials Register DRKS00007770 . Registered 13 May 2015
Cancer patients are more at risk of being unemployed or having difficulties to return to work ( RTW ) compared to individuals without health concerns , and is thus a major public health issue .
The aim of this systematic review is to identify and describe the interventions developed specifically to help cancer patients to RTW after treatment .