Little is known about return to work (RTW) of cancer survivors (CSs) in Central and Southern Europe. This study investigates the RTW rate of Italian CSs, describes their sick leave (SL) pattern, and explores factors affecting their RTW process.
A population-based cross-sectional survey involving CSs registered at the Cancer Registry of Reggio Emilia Province (Italy) was launched in July 2016. Eligibility was restricted to individuals with first diagnosis of cancer in 2012 (stages I–III), aged 20–59, and employed at the time of diagnosis.
Of the 266 individuals interviewed, 140 (52.6%) were reintegrated without difficulty, 113 (42.5%) returned to work with some difficulty, and 13 did not RTW (4.9%). The majority of CSs (56%) took SL for some periods during treatment. Age > 50 years and higher income seemed to facilitate RTW (RR = 0.65, 95% CI 0.49–0.88 and RR = 0.72, 95% CI 0.54–0.97, respectively), while being divorced acted as a barrier compared to being married (RR = 1.45, 95% CI 1.04–2.01). Individuals uncertain about the type of company they were working for reported greater difficulty in RTW (RR = 1.68, 95% CI 1.03–2.72). Individuals who had undergone chemotherapy and those perceiving physical limitations had a higher risk of difficulty in the RTW process (RR = 1.79, 95% CI 1.42–2.24 and RR = 1.59, 95% CI 1.25–2.02, respectively).
Most CSs did RTW, with 2/3 combining work and treatment. However, almost half reported difficulty in RTW process. Factors affecting this process should be addressed throughout context-specific social and healthcare pathways aimed at preventing difficulties and potential job loss in this population.
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return to work
World Health Organization (2001) International Classification of Functioning, Disability and Health. http://www.who.int/classifications/icf/en/. Accessed 9 April 2019
World Health Organization (2002) Towards a common language for functioning, disability and health: ICF. http://www.who.int/classifications/icf/training/icfbeginnersguide.pdf. Accessed 9 April 2019
Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F (2015) Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 136(5):E359–E386. https://doi.org/10.1002/ijc.29210
The Economist Intelligence Unit (2009) Breakaway: the global burden of cancer-challenges and opportunities. http://graphics.eiu.com/upload/eb/EIU_LIVESTRONG_Global_Cancer_Burden.pdf. Accessed 9 April 2019
European Cancer Patients Coalition and European Cancer Concord (2014) The European Cancer Patient's Bill of Rights (art 3.4). http://www.ecpc.org/activities/policy-and-advocacy/policy-initiatives/european-bill-of-cancer-patients-rights. Accessed 9 April 2019
Duijts SF, Kieffer JM, van Muijen P, van der Beek AJ (2017) Sustained employability and health-related quality of life in cancer survivors up to four years after diagnosis. Acta Oncol 56(2):174–182. https://doi.org/10.1080/0284186X.2016.1266083
Istituto Piepoli (2008) Quel brutto male: il vissuto sociale del cancro; rapporto 286–2007. https://www.aimac.it/download/allegati/Quel_brutto_male.pdf. Accessed 9 April 2019
Kennedy F, Haslam C, Munir F, Pryce J (2007) Returning to work following cancer: a qualitative exploratory study into the experience of returning to work following cancer. Eur J Cancer Care 16(1):17–25. https://doi.org/10.1111/j.1365-2354.2007.00729.x
De Boer AG, Taskila T, Ojajarvi A, van Dijk FJ, Verbeek JH (2009) Cancer survivors and unemployment: a meta-analysis and meta-regression. JAMA 301(7):753–762. https://doi.org/10.1001/jama.2009.187
Zajacova A, Dowd JB, Schoeni RF, Wallace RB (2015) Employment and income losses among cancer survivors: estimates from a national longitudinal survey of American families. Cancer 121(24):4425–4432. https://doi.org/10.1002/cncr.29510
Kobayashi K, Morita S, Shimonagayoshi M, Kobayashi M, Fujiki Y, Uchida Y, Yamaguchi K (2008) Effects of socioeconomic factors and cancer survivors’ worries on their quality of life (QOL) in Japan. Psychooncology 17(6):606–611. https://doi.org/10.1002/pon.1278
CENSIS (2011) L’impatto sociale ed economico dei tumori. https://www.favo.it/osservatorio/secondo-rapporto/secondo-rapporto-download/file/14-primo-capitolo.html. Accessed 9 April 2019
Luengo-Fernandez R, Leal J, Gray A, Sullivan R (2013) Economic burden of cancer across the European Union: a population-based cost analysis. Lancet Oncol 14(12):1165–1174. https://doi.org/10.1016/S1470-2045(13)70442-X
De Boer AGEM, Taskila TK, Tamminga S, Feuerstein M, Frings-Dresen MHW, Verbeek JH (2015) Interventions to enhance return to work for cancer patients. Cochrane Database Syst Rev 9:CD007569. https://doi.org/10.1002/14651858.CD007569.pub3
Duijts SFA, van Egmond MP, Gits M, van der Beek AJ, Bleiker EM (2017) Cancer survivors’ perspectives and experiences regarding behavioural determinants of return to work and continuation of work. Disabil Rehabil 39(21):2164–2172. https://doi.org/10.1080/09638288.2016.1219924
de Boer AG, Verbeek JH, Spelten ER, Uitterhoeve AL, Ansink AC, de Reijke TM, Kammeijer M, Sprangers MA, van Dijk FJ (2008) Work ability and return-to-work in cancer patients. Br J Cancer 98(8):1342–1347. https://doi.org/10.1038/sj.bjc.6604302
Stergiou-Kita M, Grigorovich A, Tseung V, Milosevic E, Hebert D, Phan S, Jones J (2014) Qualitative meta-synthesis of survivors’ work experiences and the development of strategies to facilitate return to work. J Cancer Surviv 8:657–670. https://doi.org/10.1007/s11764-014-0377-z
Feuerstein M, Todd BL, Moskowitz MC, Bruns GL, Stoler MR, Nassif T, Yu X (2010) Work in cancer survivors: a model for practice and research. J Cancer Surviv 4(4):415–437. https://doi.org/10.1007/s11764-010-0154-6
Spelten ER, Sprangers MA, Verbeek JH (2002) Factors reported to influence the return to work of cancer survivors: a literature review. Psychooncology 11(2):124–131. https://doi.org/10.1002/pon.585
Mehnert A (2011) Employment and work-related issues in cancer survivors. Crit Rev Oncol Hematol 77(2):109–130. https://doi.org/10.1016/j.critrevonc.2010.01.004
Paltrinieri S, Fugazzaro S, Bertozzi L, Bassi MC, Pellegrini M, Vicentini M, Mazzini E, Costi S (2018) Return to work in European Cancer survivors: a systematic review. Support Care Cancer 26(9):2983–2994. https://doi.org/10.1007/s00520-018-4270-6
ISTAT (2015) Tasso di Occupazione: Tasso di occupazione – livello provinciale. Rilevazione sulle forze di lavoro. http://dati.istat.it/index.aspx?queryid=22647. Accessed 9 April 2019
Heijmans N, van Lieshout J, Wensing M (2015) Improving participation rates by providing choice of participation mode: two randomized controlled trials. BMC Med Res Methodol 2:15–29. https://doi.org/10.1186/s12874-015-0021-2
Fondazione AIOM (2017) I numeri del cancro in Italia. http://media.aiom.it/userfiles/files/doc/documenti_scientifici/2017_numeri_del_cancro.pdf. Accessed 9 April 2019
Marino P, Teyssier LS, Malavolti L, Le Corroller-Soriano AG (2013) Sex differences in the return to work process of cancer survivors 2 years after diagnosis: results from a large French population-based sample. J Clin Oncol 31(10):1277–1284. https://doi.org/10.1200/JCO.2011.38.5401
Gudbergsson SB, Torp S, Fløtten T, Fosså SD, Nielsen R, Dahl AA (2011) A comparative study of cancer patients with short and long sick-leave after primary treatment. Acta Oncol 50(3):381–389. https://doi.org/10.3109/0284186X.2010.500298
van Muijen P, Duijts SFA, Bonefaas-Groenewound K, van der Beek AJ, Anema JR (2017) Predictors of fatigue and work ability in cancer survivors. Occup Med (Lond) 67(9):703–711. https://doi.org/10.1093/occmed/kqx165
Duijts S, Dalton SO, Lundh MH, Horsboel TA, Johansen (2017) Cancer survivors and return to work: current knowledge and future research. Psychooncology 26(5):715–717. https://doi.org/10.1002/pon.4235
van Egmond MP, Duijts SFA, Loyen A, Vermeulen SJ, van der Beek AJ, Anema JR (2017) Barriers and facilitators for return to work in cancer survivors with job loss experience: a focus group study. Eur J Cancer Care (Engl) 26(5):e12420. https://doi.org/10.1111/ecc.12420
Endo M, Haruyama Y, Muto G, Kiyohara K, Mizoue T, Kojimahara N, Yamaguchi N (2018) Work sustainability among male cancer survivors after returning to work. J Epidemiol 28(2):88–93. https://doi.org/10.2188/jea.JE20160152
van Egmond MP, Anema JR, Singh A, van der Beek AJ, Duijts SF (2016) Factors associated with (non-) participation of cancer survivors with job loss in a supportive return to work program. Support Care Cancer 24(7):3175–3184. https://doi.org/10.1007/s00520-016-3130-5
Presidente della Repubblica Italiana (1970) Statuto dei lavoratori: L. 20 maggio 1970, n. 300. GU della Repubblica italiana, serie generale n.131 del 27 maggio 1970. http://www.gazzettaufficiale.it/eli/gu/1970/05/27/131/sg/pdf. Accessed 9 April 2019
Paraponaris A, Teyssier LS, Ventelou B (2010) Job tenure and self-reported workplace discrimination for cancer survivors 2 years after diagnosis: does employment legislation matter? Health Policy 98:144–155. https://doi.org/10.1016/j.healthpol.2010.06.013
Torp S, Gudbergsson SB, Dahl AA, Fosså SD, Fløtten T (2011) Social support at work and work changes among cancer survivors in Norway. Scand J Public Health 39(6 Suppl):33–42. https://doi.org/10.1177/1403494810395827
Yagil D, Goldblatt H, Cohen M (2018) Dyadic resources in the return to work of cancer survivors: exploring supervisor-employee perspectives. Disabil Rehabil 10:1–8. https://doi.org/10.1080/09638288.2018.1459885
Caron M, Durand MJ, Tremblay D (2018) Perceptions of breast cancer survivors on the supporting practices of their supervisors in the return-to-work process: a qualitative descriptive study. J Occup Rehabil 28(1):89–96. https://doi.org/10.1007/s10926-017-9698-x
Gegechkori N, Haines L, Lin JJ (2017) Long-term and latent side effects of specific cancer types. Med Clin North Am 101(6):1053–1073. https://doi.org/10.1016/j.mcna.2017.06.003
Van Muijen P, Weevers NL, Anels IA, Duijts S, Brunivels DJ, Schellart AJ, van der Beek AJ (2013) Predictors of return to work employment in cancer survivors: a systematic review. Eur J Cancer Care (Engl) 22(2):144–160. https://doi.org/10.1111/ecc.12033
Moskowitz MC, Todd BL, Chen R, Feuerstein M (2014) Function and friction at work: a multidimensional analysis of work outcomes in cancer survivors. J Cancer Surviv 8:173–182. https://doi.org/10.1007/s11764-013-0340-4
Stein KD, Syrjala KL, Andrykowski MA (2008) Physical and psychological long-term and late effects of cancer. Cancer 112(11 Suppl):2577–2592. https://doi.org/10.1002/cncr.23448
Pryce J, Munir F, Haslam C (2007) Cancer survivorship and work: symptoms, supervisor response, co-worker disclosure and work adjustment. J Occup Rehabil 17(1):83–92. https://doi.org/10.1007/s10926-006-9040-5
van Muijen P, Duijts SF, Bonefaas-Groenewoud K, van der Beek AJ, Anema JR (2014) Factors associated with work disability in employed cancer survivors at 24-month sick leave. BMC Cancer 2(14):236. https://doi.org/10.1186/1471-2407-14-236
Dorland HF, Abma FL, Roelen CAM, Stewart RE, Amick BC, Ranchor AV, Bultmann U (2017) Work functioning trajectories in cancer patients: results from the longitudinal work life after cancer (WOLICA) study. Int J Cancer 141(9):1751–1762. https://doi.org/10.1002/ijc.30876
Brusletto B, Torp S, Ihlebeak CM, Vinje HF (2018) A five-phase process model describing the return to sustainable work of persons who survived cancer: a qualitative study. Eur J Oncol Nurs 34:21–27. https://doi.org/10.1016/j.ejon.2018.03.003
Kelly BJ, Fraze TK, Hornik RC (2010) Response rates to a mailed survey of a representative sample of cancer patients randomly drawn from the Pennsylvania Cancer Registry: a randomized trial of incentive and length effects. BMC Med Res Methodol 10:65. https://doi.org/10.1186/1471-2288-10-65
Pacelli B, Zengarini N, Broccoli S, Caranci N, Spadea T, Di Girolamo C, Cacciani L, Petrelli A, Ballotari P, Cestari L, Grisotto L, Giorgi Rossi P, IN-LiMeS Group (2016) Differences in mortality by immigrant status in Italy. Results of the Italian Network of Longitudinal Metropolitan Studies. Eur J Epidemiol 31(7):691–701. https://doi.org/10.1007/s10654-016-0177-z
We thank Jacqueline M. Costa for the English language editing.
This work was supported by the Chamber of Commerce of Reggio Emilia, the Foundation GRADE Onlus of Reggio Emilia, and the Local Health Authority-IRCCS of Reggio Emilia, Italy.
Ethics approval and consent to participate
The study was approved by the Ethics Committee of the Province of Reggio Emilia (2016/0014896). In accordance with the Italian law, the OT collected the informed consent to participate in this study, together with the consent to personal data processing.
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The authors declare that they have no conflict of interest.
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Paltrinieri, S., Vicentini, M., Mazzini, E. et al. Factors influencing return to work of cancer survivors: a population-based study in Italy. Support Care Cancer 28, 701–712 (2020). https://doi.org/10.1007/s00520-019-04868-0
- Cancer survivors
- Return to work
- Sick leave