Abstract
Background
Achieving full recovery after colorectal cancer surgery means a return to normal physical and psychological health and to a normal social life. Recovery data focusses on time to discharge rather than longer term functionality including return to work (RTW). We aim to assess return to normal holistic function at 1 year after colorectal cancer surgery.
Method
Questionnaires were created and dispatched to 204 patients who had undergone surgery with curative intent for colorectal cancer, in 2011–2012, in a single teaching hospital.
Results
Response rate was 75 % (153/204), 82 % (129/157) for open surgery (OS) and 51 % (24/47) for laparoscopic surgery (LS). Median age was 68 (48–91) years for OS and 65 (36–84) for LS. Eighty-four per cent of patients felt ‘ready’ and 95 % had adequate pain control upon discharge (no difference between groups). LS reported earlier ‘return to full fitness’ (1–3 months) than OS (>6 months; Mann–Whitney U, p < 0.05). Recovery from LS was ‘better than expected’ compared to OS ‘worse than expected’ (Mann–Whitney U test, p < 0.05). Forty-nine patients were employed preoperatively and 61 % (n = 30) returned to work. RTW was more frequent after LS (Chi-square test, p < 0.05). Length of time to RTW was significantly less after LS [44 (6–84) days] than OS [71 (14–252) days] (t test, p < 0.05). Levels of self-employment were equal between groups.
Conclusions
One-third of patients failed to RTW at 1 year post-surgery. Patients having LS returned to full fitness faster, felt recovery was shorter and returned to work earlier than OS. We must invest more in managing expectations and provide better post-discharge support to improve RTW.
Similar content being viewed by others
References
Schwenk W, Kehlet H (2004) Meta-analysis of short-term outcomes after laparoscopic resection for colorectal cancer. Br J Surg 91:1653–1654
Allvin R, Berg K, Idvall E, Nilsson U (2007) Postoperative recovery: a concept analysis. J Adv Nurs 57:552–558
Smart NJ, Daniels IR (2013) Beyond enhanced recovery. Colorectal Dis 15:1331–1332
Carlsen K, Harling H, Pedersen J, Christensen KB, Osler M (2013) The transition between work, sickness absence and pension in a cohort of Danish colorectal cancer survivors. BMJ Open 3
National Institute for Health and Care Excellence (2011) The diagnosis and management of colorectal cancer: full guideline (CG131). http://guidance.nice.org.uk/CG131. Accessed 5 Nov 2013
Frederiksen BL, Osler M, Harling H, Ladelund S, Jorgensen T (2009) The impact of socioeconomic factors on 30-day mortality following elective colorectal cancer surgery: a nationwide study. Eur J Cancer 45:1248–1256
Cavalli-Bjorkman N, Lambe M, Eaker S, Sandin F, Glimelius B (2011) Differences according to educational level in the management and survival of colorectal cancer in Sweden. Eur J Cancer 47:1398–1406
Gordon L, Lynch BM, Newman B (2008) Transitions in work participation after a diagnosis of colorectal cancer. A N Z J Pub Health 32:569–574
van den Brink M, van den Hout WB, Kievit J et al (2005) The impact of diagnosis and treatment of rectal cancer on paid and unpaid labor. Dis Colon 48:1875–1882
Sanchez KM, Richardson JL, Mason HR (2004) The return to work experiences of colorectal cancer survivors. AAOHN J 52:500–510
Office for National Statistics (2008) Cancer statistics registrations. Registrations of cancer diagnosed in 2005. http://www.statistics.gov.uk/downloads/theme_health/MB1_36/MB1_No36_2005.pdf. Accessed 5 Nov 2013
Taskila T, Martikainen R, Hietanen P, Lindbohm ML (2007) Comparative study of work ability between cancer survivors and their referents. Eur J Cancer 43:914–920
Earle CC, Chretien Y, Morris C et al (2010) Employment among survivors of lung cancer and colorectal cancer. J Clin Onc 28:1700–1705
Amir Z, Moran T, Walsh L, Iddenden R, Luker K (2007) Return to paid work after cancer: a British experience. J Cancer Surviv 1:129–136
Carlsen K, Dalton SO, Diderichsen F, Johansen C (2008) Risk for unemployment of cancer survivors: a Danish cohort study. Eur J Cancer 44:1866–1874
Gordon LG, Lynch BM, Beesley VL et al (2011) The working after cancer study (WACS): a population-based study of middle-aged workers diagnosed with colorectal cancer and their return to work experiences. BMC Pub Health 11:604
Mols F, Thong MS, Vreugdenhil G, van de Poll-Franse LV (2009) Long-term cancer survivors experience work changes after diagnosis: results of a population-based study. Psychooncology 18:1252–1260
Rodriguez-Bigas MA, Chang GJ, Skibber JM (2007) Barriers to rehabilitation of colorectal cancer patients. J Surg Onc 95:400–408
Office of National Statistics (2013) Percentage of public sector employment. http://www.ons.gov.uk/ons/rel/pse/public-sector-employment/q2-2013/sty-public-section-employment.html
Bains M, Yarker J, Amir Z, Wynn P, Munir F (2012) Helping cancer survivors return to work: what providers tell us about the challenges in assisting cancer patients with work questions. J Occup Rehab 22:71–77
Palmer KT, Coc RAF, Brown I (2007) Fitness for work: the medical aspects. Oxford University Press, Oxford
Johnson MVC (1993) Benefits of psychological preparation for surgery: a meta-analysis. Ann Behav Med 15:11
Acknowledgments
The authors would like to thank the research and Governance department, Royal Derby Hospitals NHS Trust for their support.
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Bhalla, A., Williams, J.P., Hurst, N.G. et al. One-third of patients fail to return to work 1 year after surgery for colorectal cancer. Tech Coloproctol 18, 1153–1159 (2014). https://doi.org/10.1007/s10151-014-1232-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10151-014-1232-y