Psychological Interventions to Facilitate Employment Outcomes for Cancer Survivors: A Systematic Review and Meta-Analysis

Authors: 
Frank, E., Soreca, I., Swartz, H., Fagiolini, A., Mallinger, A., Thase, M., Grochocinski, V., Houck, P., & Kupfer, D.
Year Published: 
2015
Publication: 
Research on Social Work Practice
Volume: 
28
Number: 
1
Pages: 
84-98
Publisher: 
SAGE
Background: 

The number of cancer survivors continues to increase in the United States and around the world. Cancer survivors typically have a higher rate of unemployment as compared to their healthy counterparts. Additionally, survivors were 4 times more likely to be employed when they received employment related supports. While other reviews of this subject have been conducted, this review includes more recent research, focuses more squarely on psychosocial interventions more broadly, and expands the definition of employment outcomes to include additional interventions.

Purpose: 

This systematic review focuses on examining interventions that facilitate cancer survivors' employment outcomes, including (a) employment status, (b) return to work, (c) absenteeism, and (d) time spent on work disability or sick leave. This review expands the scope of previous reviews to include additional employment outcome measures, across additional databases.

Setting: 

Interventions included in this review typically took place in medical settings.

Sample: 

Twelve studies met the criteria for inclusion in this review and included over 2000 participants who had been diagnosed with cancer. Participants were typically over the age of 50. Only four studies reported ethnicity of participants.

Data Collection: 

Data collection in all included studies was done through a hospital or clinic. Recruitment was typically through referrals or after a medical procedure.

Intervention: 

The interventions, for included studies described in this review, included behavioral, psychological, educational, or vocational content that facilitated cancer survivors' employment outcomes.

Control: 

There was no control group.

Findings: 

There were 20,249 records found after the initial search. After screening, 70 records remained to be evaluated in full-text. Of those 70, 58 records were excluded with reasons. This left 12 studies to be evaluated in the quantitative synthesis. Of the 10 studies that included measures of employment status, those that were randomized controlled trials (RCTs) showed no significant difference when examined alone. When combined with Quasi Experimental Designs (QEDs) the weighted mean effect size for employment status was OR= 2.18, p=.002. Two studies measured number of hours worked, and showed no significant results, OR = 0.89, p =.67. Four RCTs measured sick leave and results were nonsignificant OR = 1.18, p =.39.

Conclusions: 

The multicomponent nature of the interventions in this review make it difficult to pinpoint exactly "what works". Further exploration of employment outcomes in relevant research would allow for a more in-depth analysis of intervention effects. Additional RCTs would also strengthen the field.

URL: 
http://journals.sagepub.com/doi/pdf/10.1177/1049731515604741
Populations: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Rehabilitation Research Policy and Education

Authors: 
Arango-Lasprilla, J. C., da Silva Cardoso, Wilson, L. M., Romero, M. G., Chan, F., & Sung, C.
Year Published: 
2011
Publication: 
Rehabilitation Research Policy and Education
Volume: 
25
Number: 
3
Pages: 
149-162
Publisher: 
Elliott and Fitzpatrick Inc.
Background: 

Employment impacts the quality of life for individuals with spinal cord injury. Most studies that look at vocational service patterns for individuals with spinal cord injury focus on European Americans. Ethnic minority groups within the United State are growing. These changes also impact referrals to Model Spinal Cord Injury Systems. This presents new challenges to rehabilitation professionals.

Purpose: 

The purpose of this study was to identify demographic and service related patterns for Hispanics with spinal cord injury receiving services from state vocational rehabilitation agencies and examine similarities and differences in vocational rehabilitation services and employment outcomes between a group of European Americans and Hispanics with spinal cord injuries.

Setting: 

This study included individuals with SCI served by multiple vocational rehabilitation agencies in various settings.

Sample: 

Data for this study came from the Rehabilitation Services Administration Case Service report %

Control: 
There was no control or comparison condition.
Findings: 

Minor differences in case dollar expenditures and service patterns were noted between the two groups. Vocational rehabilitation services that impacted successful work outcomes included: assistive technology services, basic support services and job placement services.

Conclusions: 

Hispanic status of vocational rehabilitation clients does not affect employment outcomes. Hispanics appear to have more risk factors than European American clients. Vocational rehabilitation counselors were able to support the needs of Hispanic clients.

URL: 
http://eric.ed.gov/?id=EJ987046
Disabilities: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

"Cancer survivorship and work: Symptoms, supervisor response, co-worker disclosure and work adjustment"

Authors: 
Rabren, K., Dunn, C., & Chambers, D.
Year Published: 
2007
Publication: 
Journal of Occupational Rehabilitation
Volume: 
17
Number: 
1
Pages: 
83-92
Publisher: 
Springer
Background: 

Advances in medicine have increased people's survivorship from cancer and their ability to work both during and after treatment. However, the impact that diagnosis and treatment has on psychosocial factors that may impact an individual's ability to work is not fully understood.

Purpose: 

This purpose of this study was to explore the impact of symptoms, work adjustments, and disclosure of one's disability to supervisors and co-workers on employment both during and after treatment.

Setting: 

The study was conducted in the United Kingdom via mailed questionnaire.

Sample: 

The participants were 328 cancer survivors. Forty five types of cancer were represented and categorized into the eight areas representing the cancers' site. This included: breast, colorectal, genital, head and neck, lymph, prostate, melanoma and other. Treatments included: oral medication, surgery, chemotherapy and radiotherapy. The majority of the participants were female (77%). The age range was between 18 to 68 years. Participants worked in a range of occupations with the majority or 54% working in skilled/operational-non manual.

Data Collection: 

A 33 item questionnaire was used to gather information about demographics, information about cancer, symptoms associated with cancer and its treatment, disclosure of cancer at work, and work supports. Multivariate logistic regressions were run to determine the association of symptoms, disclosure and work adjustments and working during treatment and returning to work following treatment

Intervention: 

Interventions included disclosure of disability and various types of work accommodations, particularly flexible scheduling and paid leave for all medical appointments.

Control: 

There was no control or comparison condition.

Findings: 

Thirty percent of the sample continued to work during treatment. There were no significant differences between cancer groups, type of treatment received or age groups. Flexibility with work arrangements, and disclosure were factors related to working during treatment. Working during treatment was also associated with difficulties managing fatigue. Forty two percent of the respondents returned to work following treatment. Factors related to return to work following treatment included: difficulties managing fatigue, managing the stress of cancer, managing physical changes associated with cancer, receiving advice from their doctor about work and return to work meeting with their employer.

Conclusions: 

The study adds to the scant literature on experiences of cancer survivors. Further research is needed to better understand ways to assist survivors with return to work.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/17318459
Populations: 
Outcomes: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Investigation of factors related to employment outcome following traumatic brain injury: A critical review and conceptual model

Authors: 
O'Brien, L.
Year Published: 
2004
Publication: 
Disability and Rehabilitation
Volume: 
26
Number: 
13
Pages: 
765-783
Publisher: 
Taylor & Francis Ltd
Background: 

Employment outcomes post traumatic brain injury (TBI) result in a financial and social burden. In addition, unemployment may impact the individual's quality of life and emotional well being. The ability to predict vocational outcome using evidenced based guidelines can assist with rehabilitation planning, development of vocational support services and the role adjustment of the individual with a TBI and his or her family members.

Purpose: 

A review of the literature to identify key variables associated with positive employment outcomes post TBI can pave the way for future research and the development of rehabilitation practices.

Data Collection: 

Eighty five studies were identified between 1980 and 2003 that reported on factors associated with employment outcomes post TBI. Among those fifty studies met the inclusion criteria for the second stage review. The criteria used to evaluate and rate the quality of methodology for each study was adapted on guidelines by Sherer 2002 and Pengel et. al. 2003.

Intervention: 

The review highlights demographic, injury and neuropsychological factors associated with return to work. It also examines interventions that focus on modifying the social environment in addition to emotional and metacognitive factors. A conceptual model is presented that outlines the factors associated with employment outcomes.

Control: 

No control or comparison

Findings: 

The most consistent predictors and indicators of employment outcomes included premorbid occupational status, functional status at discharge, global cognitive functioning, perceptual functioning, executive functioning, involvement in vocational rehabilitation services and emotional status. The authors note that although the presence of specific characteristics may be a predictor for failure to return to work the absence of a factor does not guarantee return to work.
There is little evidence to support cognitive rehabilitation. The most successful programs target problems with motivation and emotional disturbance. Interventions to modify the social environment need to occur on multiple levels. A person's preferences for employment impact job retention. Supported employment has been described however, further evaluation of outcomes is needed. At a policy level a major barrier exists in the current service delivery system in which individuals do not have access to long term rehabilitation or specialized vocational support. Changes in public policy and funding could improve service delivery. Developing disability management programs may also assist those at risk for chronic unemployment post TBI.

Conclusions: 

The review of literature reported that the level of empirical support for employment outcome was greatest for: premorbid occupational status, functional status at discharge, global cognitive functioning, perceptual functioning, executive functioning, involvement in vocational rehabilitation services and emotional status. Future research is needed to determine the role of metacognitive, emotional and social environment factors that can be modified with various interventions. Interventions need to be evaluated to determine evidenced based practices.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/15371049
NIDILRR Funded: 
Peer Reviewed: 
Yes

Review of critical factors related to employment after spinal cord injury: Implications for research and vocational services

Authors: 
Ottomanelli, L., Goetz, L. L., Suris, A., McGeough, C., Sinnott, P. L., Toscano, R., Barnett, S. D., Cipher, D. J., Lind, L. M., Dixon, T. M., Holmes, S. A., Kerrigan, A. J., & Thomas, F. P.
Year Published: 
2009
Publication: 
The Journal of Spinal Cord Medicine
Volume: 
32
Number: 
5
Pages: 
503-531
Publisher: 
American Paraplegia Society
Background: 

Unemployment is a serious problem for individuals with spinal cord injury (SCI). According to the authors, unemployment for the population of SCI individuals is ten times greater than the general population. In addition, return to preinjury jobs has been reported as very low for this group of individuals.

Purpose: 

The purpose of this study was to provide a comprehensive summary of the literature regarding predictors of employment, the benefits, and barriers.

Setting: 

This study is a systematic review. The included studies were undertaken in various locations and settings.

Sample: 

The sample consisted of 60 articles that reported on employment rate of individuals with spinal cord injury.

Data Collection: 

Authors identified 579 articles and reviewed to determine presence of reported employment rates. Of these, 60 articles were found to include employment rates for individuals with SCI. These articles were reviewed to identify critical factors related to employment after spinal cord injury.

Intervention: 

The intervention was evidence-based supported employment and traditional vocational rehabilitation.

Control: 

There were no comparison or control conditions.

Findings: 

Results indicated that the average rate of any employment after SCI was approximately 35%. The review of literature indicates that there are 11 factors associated with employability of individuals with SCI. This includes education, type of employment, severity of disability, age, time post injury, sex, marital status, social support, vocational counseling, medical problems associated with SCI, employer role, environment, and professional interests. Individuals with college backgrounds are more likely to return to work. Being younger at the time of injury is associated with the best employment outcomes. The probability of employment after SCI improves with increasing time since injury. Race is also associated with obtaining employment after SCI. Individuals who are white are more likely to be employment than those from minorities. Evidence-based supported employment seems to be the most applicable model for assisting individuals with SCI in restoring meaningful employment.

Conclusions: 

Characteristics associated with employment include demographic variables, injury-related factors, employment history, psychosocial issues and disability benefit status. Evidence-based supported employment practices seem to be the most applicable model for assisting individuals with SCI in restoring meaningful employment. Control studies are needed to test this conclusion.

URL: 
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2792457/
Populations: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Achieving a successful and sustainable return to the workforce after ABI: A client-centered approach

Authors: 
Phillips, V. L., Temkin, A., Vesmarovich, S., Burns, R., & Idleman, L.
Year Published: 
2007
Publication: 
Brain Injury
Volume: 
21
Number: 
5
Pages: 
465-478
Publisher: 
Informa Healthcare
Background: 

Acquired brain injury (ABI) can be caused by cerebrovascular accident, trauma (such as assault or motor vehicle accident), tumors, hypoxia, infection or degenerative conditions and is a common occurrence [1]. It may result in significant disability and, in people of working age, limit their ability to join or return to the workforce.

Purpose: 

The aim of this study was to describe the services provided (including assessments, interventions and post-job placement support) and outcomes achieved by CRS Australia‚ Victorian ABI team and compare and contrast this with other models.

Setting: 

The study setting was a rehabilitation service organization in Australia.

Sample: 

The study sample consisted of 27 individuals with ABI who had received rehabilitation services at CRS Australia. The sample was randomly selected from cases that had been closed in the previous year with an employment outcome. Additional characteristics of the sample are not provided.

Data Collection: 

A data extraction method was used to audit patient information relevant to the study. Team members were also asked to indicate which of 17 vocational rehabilitation strategies they used with their clients and to rate each in terms of effectiveness in achieving a successful job placement. which of five post job-placement strategies (email to client, weekly or fortnightly phone calls to client, weekly or fortnightly phone calls to employer, support/counseling outside client‚ work hours and regular scheduled workplace visits) they used and to evaluate their perceived effectiveness.

Intervention: 

The intervention is described as client-centered practice. Each client is allocated to a Rehabilitation Consultant (RC) with whom they work one-to-one, wherever possible, throughout the duration of services. Active client involvement in the negotiation of individual rehabilitation plans is standard practice in all cases and clients are informed of their rights, responsibilities and the complaints handling mechanism at the earliest opportunity. Specific interventions are tailored to the individual and can include vocational counseling, skills training, cognitive retraining, job seeking, interview preparation, work behavior coaching, and post-employment services.

Control: 

There was no control or comparison condition. Outcomes for the study group were compared to those of other models.

Findings: 

Of the patient files audited, 42% were placed in professional, managerial, office or administrative work, two were placed in a trade-qualified job, eight were placed in semi-skilled positions, and four were placed in unskilled labor. Of the clients who had jobs to return to (n=10) all returned to their previous role or a similar job following a graded return with professional/clerical jobs figuring highly (50%; n=5). Those clients who did not have a job to return to (n=17) were placed in similar roles to their pre-injury employment, with seven placed in a professional role, six placed in semi-skilled work and four placed in unskilled labor positions. Half were employed more than 13 weeks.

Conclusions: 

The CRS Australia model resulted in higher than average employment outcome rates for this population (50% working at award wage for more than 13 weeks, compared to Australian ABI population estimates of 28–46.5%). This study shows that the CRS Australia model has been successful with people with mild, moderate and severe impairment following an ABI and significantly less time-intensive and therefore less costly than other models.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/17522986
Populations: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

The program without walls: Innovative approach to state agency vocational rehabilitation of persons with traumatic brain injury

Authors: 
Ottomanelli, L., & Lind, L.
Year Published: 
2004
Publication: 
Archives of Physical Medicine and Rehabilitation
Volume: 
85
Number: 
2
Pages: 
68-72
Publisher: 
Elsevier
Background: 

Employment is compromised for individuals with traumatic brain injury (TBI). Rates after TBI range from 10% to 70% .The literature reports on successful work outcomes for some with the use of specialized or intensive rehabilitation intervention. In spite of a number of intensive demonstration projects focusing on vocational rehabilitation (VR) and some research showing the effectiveness of certain program components, many persons with TBI remain unserved or underserved within the VR system. Individuals with TBI access VR services at rates that are much lower than other consumers relative to their prevalence in the general population. In addition to being underrepresented in counselor caseloads, people with TBI are less successful than other consumers in obtaining and maintaining competitive employment.

Purpose: 

The purpose of the paper was to describe the Program Without Walls (PWW), a person-centered, community-based approach for state rehabilitation counselors to provide vocational rehabilitation (VR) services to individuals with traumatic brain injury (TBI). The PWW includes many of the best practices suggested by previous research such as: functional cognitive remediation, job coaching, psychosocial counseling, job development and placement services, and fostering a strong relationship with the counselor via person-centered planning.

Setting: 

The setting included communities and two district vocational rehabilitation offices in the state of New York.

Sample: 

The study sample was made up of 42 individuals who had been accepted by New York State's VR program for services. The majority or (34)were men. Half of the group (21) received traditional services and the other half participated in the PWW. In terms of ethnicity, the majority of participants were nonwhite (i.e.. black and Asian). Related to education, close to half (48%) had not completed high school.

Data Collection: 

The following data were gathered from VESID central files for fiscal years 2001 (October 1, 2000–September 30, 2001) and 2002 (October 1, 2001–September 30, 2002): case status (26 successfully placed for 90 days, 28 closed after IPE-initiated, 30 closed before IPE initiated, 8 closed before IPE developed), weekly earnings at closure, hours worked per week at closure, cost of case services provided to each consumer, consumer demographic characteristics (gender, level of education, employment status at application, ethnicity, age), and name of the state VR counselor serving the consumer. By using case status, the proportion of successful closures (i.e., case status 26) were compared with unsuccessful closures (i.e., case status 8, 28, and 30) for the PWW counselors and other counselors in the catchment areas served by using Pearson chi-square analyses. One-tailed t tests were used to compare weekly earnings at closure, hours worked per week at closure, and cost of services for PWW consumers versus the matched consumers.

Intervention: 

All participants went through the initial VR procedures for eligibility determination and development of an individualized employment plan. Individuals in the receiving traditional services were referred to various outside organizations for services and followed by the vocational rehabilitation counselor. Individuals in the PWW group received person centered, community based services from consultants who were recruited, trained and supervised by a VR counselor.

Control: 

Each PWW participant was matched to a VR client receiving traditional services on gender, age, ethnicity, and education at referral.

Findings: 

Fifty-seven percent of the PWW consumers were successfully closed compared to only 24% of the matched consumers who received traditional services. The proportion of successful closures for PWW versus unsuccessful closures was significantly greater for this group. PWW participants earned 204 dollars more a week and worked an average of 14 hours more than the other group. The cost of services for the PWW participants was 260 dollars more than the group who received traditional services.

Conclusions: 

The PWW approach seems promising. More research is needed to determine its utility in assisting individuals with TBI with employment.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/15083424
Outcomes: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Individual placement and support for individuals with recent-onset schizophrenia: Integrating supported education and supported employment

Authors: 
Nygren, U., Markström, U., Svensson, B., Hansson, L., & Sandlund, M.
Year Published: 
2008
Publication: 
Psychiatric Rehabilitation Journal
Volume: 
38
Number: 
4
Pages: 
340-349
Publisher: 
American Psychological Association
Background: 

In recent years, functional outcome has become a very salient target for intervention for individuals with severe mental illnesses. In particular, supported employment has generated substantial research as a means of facilitating return to competitive jobs for individuals with schizophrenia and other severe mental illnesses. This article summarizes the design of an 18-month longitudinal study of IPS in the early course of schizophrenia. Improving and Predicting Work Outcome in Recent-Onset Schizophrenia and discusses the adaptations of the IPS model that were found important for this phase of the illness.

Purpose: 

The purpose of this study was to describe the adaptation of the Individual Placement and Support model of supported employment to individuals with a recent first episode of schizophrenia or a related psychotic disorder.

Setting: 

All study participants were receiving outpatient psychiatric treatment at the UCLA Aftercare Research Program and were participants in the third phase of the Developmental Processes in Schizophrenic Disorders Project.

Sample: 

The study sample consisted of 69 individuals that were recruited from a variety of local Los Angeles area psychiatric hospitals and psychiatric clinics and through referrals from the UCLA outpatient service at the Resnick Neuropsychiatric Hospital at UCLA.

Data Collection: 

A comparison of individuals who were randomized (n=69) to IPS or the Brokered treatment with those who were not randomized (n=18) reveals no statistically significant demographic differences between the two samples. Similarly the randomized individuals did not differ significantly from those who were not randomized in prior illness indicators or symptom severity at screening.

Intervention: 

Given that the vocational goals of persons with a recent onset of schizophrenia often involve completion of schooling rather than only competitive employment, the principles of Individual Placement and Support were extended to include supported education. This extension involved initial evaluation of the most appropriate goal for individual participants, having the IPS specialist working on placement either with the participant or directly with educational and employment settings (depending on permitted disclosure and individual need), and follow-along support that included work with teachers and aid in study skills and course planning as well as typical supported employment activities. Work with family members also characterized this application of IPS.

Control: 

The condition was Vocational rehabilitation through referral to traditional separate agencies(Brokered Vocational Rehabilitation.

Findings: 

A randomized controlled trial is comparing the combination of Individual Placement and Support and skills training with the Workplace
Fundamentals Module with the combination of brokered vocational rehabilitation and broad-based social skills training. Participants in the IPS condition have returned to school, competitive work, and combined school and work with approximately equal frequency.

Conclusions: 

Individual Placement and Support principles can be successfully extended to integrate supported education and supported employment within one treatment program. The distribution of return to school, work, or their combination in this group of individuals with recent-onset schizophrenia supports the view that an integrated program of supported education and supported employment fits this initial period of illness.

URL: 
http://psycnet.apa.org/journals/prj/31/4/340/
Disabilities: 
NIDILRR Funded: 
Peer Reviewed: 
Yes

Enhanced provider communication and patient education regarding return to work in cancer survivors following curative treatment: A pilot study

Authors: 
Noel, V. A., Oulvey, E., Frake, R. E., & Bond, G. R.
Year Published: 
2006
Publication: 
Journal of Occupational Rehabilitation
Volume: 
16
Number: 
4
Pages: 
647-657
Publisher: 
Springer Science+Business Media, LLC
Background: 

Return to work continues to be a challenge among providers and cancer survivors. Cancer patients are a risk for unemployment, due to the long term side effects of cancer and related treatments. Some forms of cancer are chronic diseases and can negatively impact a person's quality of life and lead to long term problems such as fatigue, pain, depression and other functional limitations. The loss of work can further impact quality of life due to loss of income and negative impact on self esteem. Employers and society are also impacted. Cancer survivors tend to get little advice on return to work from the medical community. Work related interventions are limited and the quality of existing studies is only moderate. Interventions are needed to improve return to work outcomes for cancer survivors.

Purpose: 

The purpose of this study is to determine if enhancing communication between the attending and the occupational physicians about a patient's status or providing educational materials with advice on return to work to a patient will enhance the individual's employment outcome.

Setting: 

Patients were recruited from the radiotherapy department at the a large medical center in the Netherlands.

Sample: 

Thirty five patients, who had a prognosis of at least 80% chance of two year survival and who were employed at the time of diagnosis, were enrolled in the study. Twenty six were able to be interviewed.

Data Collection: 

A self administered baseline questionnaire was completed by patients. The overall score on 8 items that were predictive of return to work, according to a previous cohort study, was treated as a predictor of return to work. Variables included:age, gender, diagnosis, type of cancer treatment, depressed mood, physical complaints, physical workload and fatigue. Additionally, satisfaction on the advice from the educational materials was gained during a semi-structured interview. At this time the participants rated the materials on a scale of one (very poor) to 10(very good). Satisfaction with each of the 10 steps, (ie.adherence to the advice), was also rated as useful, somewhat useful, not useful or redundant. Occupational physicians were also interviewed about their satisfaction and perceived influence of the letters and educational material.

Intervention: 

There were 2 interventions. First the radiation oncologist sent two letters to the general practitioner. The first letter was sent at the onset of treatment. The second letter was sent at the conclusion of the treatment and included information on the patient's outcome. Copies of the two letters were also sent to the occupational physician. In the second intervention the radiation oncologist gave the patient educational material that offered ten steps to enhance a patient's return to work. A copy of the leaflet was also sent to the occupational physician along with the second letter sent by the radiation oncologist.

Control: 

In this study the subjects served as their own comparison group in pretest/post-test.

Findings: 

Among the 24 occupational physicians interviewed, 22 considered the information provided in the letters as "helpful". Fifty percent indicated the information influenced their rehabilitation efforts. In particular, this group noted the information on diagnosis and treatment as particularly useful. The educational leaflet was rated on a scale of 1 to 10 as 7.3 with SD of 1.0. Patients were also interviewed after treatment. They gave the educational leaflet a mean score of 7.9 with SD of 0.6. Scores ranges for this group from 6.5 to 10. Not all who rated the advice as useful, acted upon it. Time from ending treatment to return to work ranged from 0 to 133 days. After 6 months 65% of the patients had returned to work. And by month 18,92% of the sample had returned to work.

Conclusions: 

The pilot shows encouraging results on the use of the interventions to assist individuals with cancer with returning to work. Large randomized controlled trials are needed.

URL: 
http://www.ncbi.nlm.nih.gov/pubmed/17063404
Populations: 
Outcomes: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes

Successful return to work for cancer survivors

Authors: 
Nicholas, D. B., Attridge, M Zwaigenbaum, L., & Clarke, M.
Year Published: 
2007
Publication: 
American Association of Occupational Health Nurses Journal
Volume: 
55
Number: 
7
Pages: 
290-295
Publisher: 
Europe Pubmed Central
Background: 

Advances in diagnosis and treatment has increased the 5 year survival rate among individuals with cancer. With this improvement, comes and increase in individuals who will return to work. Return to work is important in order to improve quality of life, a sense of normalcy and in terms of economic well being. The Americans with Disabilities Act (ADA) may offer legal protections to survivors both before and after treatment. Few studies have looked at return to work experiences among cancer survivors and how the ADA provisions may related to that experience.

Purpose: 

The purpose of this study is to determine factors (related to the ADA) that influence a successful return to work for cancer survivors.

Setting: 

Patients were recruited from an oncology department in a metropolitan hospital in Minnesota and a focus group was held.

Sample: 

Seven individuals attended a 2 hour focus group help at the hospital. All were female and four were breast cancer survivors. The majority were white, married and had a Bachelor's degree or higher level of education. Participants had been employed 8 to 20 months prior to diagnosis.

Data Collection: 

A focus group was help to identify common themes about health, health care, economic security, and return to work. Analysis were descriptive and qualitative. Transcripts of the group meeting were read along with moderator notes. General themes were pulled from this material.

Intervention: 

The intervention in the study included job accommodations and supports.

Control: 

There was no control or comparison condition.

Findings: 

For the majority of participant (N=5) the reason for returning to work was an essential part of their healing. All members of the group were aware of the ADA however, none had engaged in formal conversations with their employers about its provisions. Factors aiding in return to work included: job flexibility, coworker support,and health care provider support. Factors hindering return to work were: ignorance about cancer in the workplace, lack of emotional support, physical effects of cancer, and the impact of cancer on the person's priorities.

Conclusions: 

Occupational nurses have an important role to play in the return to work of individuals who survive cancer. They need to be aware of the positive and negative factors that influence return to work and understand the legal requirements such as the ADA.

URL: 
http://whs.sagepub.com/content/55/7/290.full.pdf
Outcomes: 
NIDILRR Funded: 
Research Design: 
Peer Reviewed: 
Yes