For most cancers, there have been improvements in survival, with close to 60% of adults with a diagnosis of cancer in the developed world now expected to live at least 5 years after diagnosis. Because more cancer survivors receive the diagnosis at working age, it is important for individuals to return to work following treatment so they can lead a normal life. Returning to work is beneficial for both the cancer survivor and society as it can improve quality of life (QoL) and have a positive effect on self-esteem and social or family roles, as well as economical benefits.
Interventions aimed at supporting the return-to-work process for cancer survivors include psychological, vocational, physical, medical, and multidisciplinary components. Oncology and community nurses play an important role in providing support to cancer survivors; however, little is known about whether these interventions are effective.
The objective of this review was to assess the effectiveness of interventions for enhancing return to work in cancer patients compared with usual care.
This is a summary of a Cochrane Review1 containing a meta-analysis of 14 randomized controlled trials (RCTs) and 4 controlled before-after (CBA) studies involving 1652 participants. For each outcome, the quality of the evidence was assessed using the GRADE approach. All studies were conducted in developed countries (United States and Europe), and baseline characteristics of participants were similar in most studies. The participants were limited to adults (≥18 years old) who had a diagnosis of cancer and were in paid employment at the time of diagnosis. There were no limitations to the type or severity of cancer diagnosis. The review included any type of intervention that aimed to enhance return to work carried out either with an individual or in a group and in either a clinical setting or in the community. Interventions were compared with care as usual. The primary outcome, return to work, was measured as event data (eg, return-to-work rates) or time-to-event data (eg, number of days between reporting sick and any work resumption or the number of days on sick leave). Quality of life was the secondary outcome measure.
Four RCTs described adequate sequence generation and allocation concealment. The studies did not report any information on blinding. Twelve RCTs and 3 CBA studies had a low risk of bias, and 2 RCTs and 1 CBA study were assessed as having a high risk of bias.
Psychological Interventions Versus Care as Usual
Of the 5 studies reporting the results of psychological interventions, no differences in the effect of psychological interventions compared with care as usual were found in physical functioning or mental functioning QoL (2 RCTs: odds ratio [OR], 2.32; 95% confidence interval [CI], 0.94–5.71; 3 CBA studies: OR, 4.67; 95% CI, 2.04–10.70).
Physical Interventions Versus Care as Usual
Results showed that physical training was no more effective than care as usual on return to work (OR, 1.20; 95% CI, 0.32–4.54) or QoL (mean difference, −4.60; 95% CI, −11.99 to 2.79).
Medical Function Conserving Treatments Versus More Radical Medical Treatments
Eight pooled RCTs and 1 CBA study demonstrated that a less radical or function-conserving medical intervention (eg, laparoscopy or conservation surgery) had similar return-to-work rates as more radical treatments (OR, 1.53; 95% CI, 0.95–2.45). There was no statistically significant difference in the effect of function-conserving medical interventions compared with more radical treatment on QoL outcomes.
Multidisciplinary Interventions Versus Care as Usual
Three multidisciplinary interventions involving physical training, in combination with patient education, vocational counseling, training of coping skills regarding return to work, or behavioral biofeedback, suggested that multidisciplinary interventions lead to higher return-to-work rates than care as usual (OR, 1.87; 95% CI, 1.07–3.27).
There is evidence of moderate improvement that suggests that cancer patients experience more return-to-work benefits from multidisciplinary interventions than from care as usual.
Implications for Practice
* Multidisciplinary interventions containing a combination of psychological, vocational, and physical interventions may improve return-to-work rates for cancer patients.
* Nurses and social workers should assist where they can to help them to return to work.