Journal of Cancer Survivorship

, Volume 6, Issue 1, pp 72–81 | Cite as

Work ability of survivors of breast, prostate, and testicular cancer in Nordic countries: a NOCWO study

  • M.-L. Lindbohm
  • T. Taskila
  • E. Kuosma
  • P. Hietanen
  • K. Carlsen
  • S. Gudbergsson
  • H. Gunnarsdottir



Cancer can cause adverse effects on survivors’ work ability. We compared the self-assessed work ability of breast, testicular, and prostate cancer survivors to that of people without cancer. We also investigated the association of disease-related and socio-demographic factors and job-related resources (organizational climate, social support, and avoidance behavior) with work ability and looked at whether these associations were different for the survivors and reference subjects.


Working aged cancer patients diagnosed between 1997 and 2002 were identified from hospital or cancer registries in Denmark, Finland, Iceland, and Norway (Nordic Study on Cancer and Work). A cancer-free reference group was selected from population registries. We collected information on work ability and other factors from 1,490 employed survivors and 2,796 reference subjects via a questionnaire.


The adjusted mean value of work ability was slightly lower among the breast and prostate cancer survivors compared to the cancer-free population. Co-morbidity, chemotherapy, low workplace support, and low organizational commitment were associated with reduced work ability. Avoidance behavior from supervisors or colleagues was only related to work ability among the cancer survivors.

Conclusions and implications

More attention should be paid to assisting cancer survivors in work life, particularly those who have chronic diseases or have undergone chemotherapy. Although most factors affecting the work ability of the survivors and reference subjects were the same, survivors’ work ability seemed to be particularly sensitive to avoidance behavior. The results suggest that there is a need to improve communication at the workplace and develop supportive leadership practices in order to avoid isolating behavior towards cancer survivors.


Cancer Disability Job resources Social support Survivorship Work ability 


  1. 1.
    de Boer AG, Taskila T, Ojajärvi A, van Dijk FJ, Verbeek JH. Cancer survivors and unemployment: a meta-analysis and meta-regression. JAMA. 2009;301:753–62.PubMedCrossRefGoogle Scholar
  2. 2.
    Taskila T, Lindbohm M-L. Factors affecting cancer suvivors’ employment and work ability. Acta Oncologica. 2007;46:446–51.PubMedCrossRefGoogle Scholar
  3. 3.
    Stein KD, Syrjala KL, Andrykowski MA. Physical and psychological long-term and late effects of cancer. Cancer. 2008;112(11 Suppl):2577–92.PubMedCrossRefGoogle Scholar
  4. 4.
    Bradley CJ, Neumark D, Luo Z, Bednarek H, Schenk M. Employment outcomes of men treated for prostate cancer. J Natl Cancer Inst. 2005;97:958–65.PubMedCrossRefGoogle Scholar
  5. 5.
    de Boer AG, Verbeek JH, Spelten ER, Uitterhoeve AL, Ansink AC, de Reijke TM, et al. Work ability and return-to-work in cancer patients. Br J Cancer. 2008;98:1342–7.PubMedCrossRefGoogle Scholar
  6. 6.
    Oberst K, Bradley CJ, Gardiner JC, Schenk M, Given CW. Work task disability in employed breast and prostate cancer patients. J Cancer Surviv. 2010;4:322–30.PubMedCrossRefGoogle Scholar
  7. 7.
    Taskila T, Martikainen R, Hietanen P, Lindbohm M-L. Comparative study of work ability between cancer survivors and their referents. Eur J Cancer. 2007;43:914–20.PubMedCrossRefGoogle Scholar
  8. 8.
    Gudbergsson SB, Fosså SD, Dahl AA. Are there sex differences in the work ability of cancer survivors? Norwegian experiences from the NOCWO study. Support Care Cancer. 2011;19:323–31.PubMedCrossRefGoogle Scholar
  9. 9.
    Short PF, Vasey JJ, Belue R. Work disability associated with cancer survivorship and other chronic conditions. Psycho-Oncology. 2008;17:91–7.PubMedCrossRefGoogle Scholar
  10. 10.
    Hansen JA, Feuerstein M, Calvio LC, Olsen CH. Breast cancer survivors at work. J Occup Environ Med. 2008;50:777–84.PubMedCrossRefGoogle Scholar
  11. 11.
    Ilmarinen J, Gould R, Järvikoski A, Järvisalo J. Diversity of work ability. In: Gold R, Ilmarinen J, Järvisalo J, Koskinen E, editors. Dimensions of work ability. Helsinki: Finnish Centre for Pensions; 2008. p. 13–24.Google Scholar
  12. 12.
    Gold R, Ilmarinen J, Järvisalo J, Koskinen E. Dimensions of work ability. Results of the Health 2000 Survey. Helsinki: Finnish Centre for Pensions; 2008.Google Scholar
  13. 13.
    Amir Z, Wynn P, Chan F, Strauser D, Whitaker S, Luker K. Return to work after cancer in the UK: attitudes and experiences of line managers. J Occup Rehabil. 2010;20:435–42.PubMedCrossRefGoogle Scholar
  14. 14.
    Gunnarsdottir HK, Rafnsdottir GL, Bernburg JG, Lindbohm M-L. Employment participation and work experience of female breast cancer and lymphoma survicors from the Nordic Study of Cancer and Work (NOCWO). In: Torres VN, editor. Lung cancer in women. New York: Nova Science; 2007. p. 335–57.Google Scholar
  15. 15.
    Gudbergsson S.B. Life after cancer: work experiences, living conditions and impact of cancer in tumour-free cancer survivors. A dissertation, University of Oslo. Oslo: AiT-e-dit AS, 2007.Google Scholar
  16. 16.
    Cull A, Sprangers M, Bjordal K, Aaronson N, West K, Bottomley A on behalf of the EORTC Quality of Life Group. EORTC quality of life group translation procedure. Brussels: EORTC; 2002.Google Scholar
  17. 17.
    Tuomi K, Ilmarinen J, Jahkola A, Katajarinne L, Tulkki A. Work ability index. Helsinki: Finnish Institute of Occupational Health; 1998.Google Scholar
  18. 18.
    Ilmarinen J, Tuomi K. Past, present and future of work ability. People and Work Research Reports. 2004;65:1–25.Google Scholar
  19. 19.
    Ahlstrom L, Grimby-Ekman A, Hagberg M, Dellve L. The work ability index and single-item question: associations with sick leave, symptoms, and health—a prospective study of women on long-term sick leave. Scand J Work Environ Health. 2010;36:404–12.PubMedCrossRefGoogle Scholar
  20. 20.
    Elo A-L, Dallner M, Gamberale L, Hottinen V, Knardahl S, Lindström K, et al. User’s guide for the QPSNordic: general Nordic questionnaire for psychological and social factors at work. Copenhagen: Nordic Council of Ministers; 2001.Google Scholar
  21. 21.
    Fife BL, Wright ER. The dimensionality of stigma: a comparison of its impact on the self of persons with HIV/AIDS and cancer. J Health Soc Behav. 2000;41:50–67.PubMedCrossRefGoogle Scholar
  22. 22.
    SAS Institute Inc. SAS/STAT® 9.1 user’s guide. Cary: SAS Institute; 2004.Google Scholar
  23. 23.
    Bloom JR, Petersen DM, Kang SH. Multi-dimensional quality of life among long-term (5+ years) adult cancer survivors. Psycho-Oncology. 2007;16:691–706.PubMedCrossRefGoogle Scholar
  24. 24.
    Dahl AA, Mykletun A, Fosså SD. Quality of life in survivors of testicular cancer. Urol Oncol. 2005;23:193–200.PubMedCrossRefGoogle Scholar
  25. 25.
    Eakin EG, Youlden DR, Baade PD, Lawler SP, Reeves MM, Heyworth JS, et al. Health status of long-term cancer survivors: results from an Australian population-based sample. Cancer Epidemiol Biomarkers Prev. 2006;15:1969–76.PubMedCrossRefGoogle Scholar
  26. 26.
    Arndt V, Merx H, Stürmer T, Stegmaier C, Ziegler H, Brenner H. Age-specific detriments to quality of life among breast cancer patients 1 year after diagnosis. Eur J Cancer. 2004;40:673–80.PubMedCrossRefGoogle Scholar
  27. 27.
    Peuckmann V, Ekholm O, Rasmussen NK, Møller S, Groenvold M, Christiansen P, et al. Health-related quality of life in long-term breast cancer survivors: nationwide survey in Denmark. Breast Cancer Res Treat. 2007;104:39–46.PubMedCrossRefGoogle Scholar
  28. 28.
    DiSipio T, Hayes S, Newman B, Janda M. Health-related quality of life 18 months after breast cancer: comparison with the general population of Queensland, Australia. Support Care Cancer. 2008;16:1141–50.PubMedCrossRefGoogle Scholar
  29. 29.
    Kroenke CH, Rosner B, Chen WY, Kawachi I, Colditz GA, Holmes MD. Functional impact of breast cancer by age at diagnosis. J Clin Oncol. 2004;22:1849–56.PubMedCrossRefGoogle Scholar
  30. 30.
    Ganz PA, Greendale GA, Petersen L, Kahn B, Bower JE. Breast cancer in younger women: reproductive and late health effects of treatment. J Clin Oncol. 2003;21:4184–93.PubMedCrossRefGoogle Scholar
  31. 31.
    Hewitt M, Rowland JH, Yancik R. Cancer survivors in the United States: age, health, and disability. J Gerontol A Biol Sci Med Sci. 2003;58:82–91.PubMedCrossRefGoogle Scholar
  32. 32.
    Minton O, Stone P. How common is fatigue in disease-free breast cancer survivors? A systematic review of the literature. Breast Cancer Res Treat. 2008;112:5–13.PubMedCrossRefGoogle Scholar
  33. 33.
    Rossen PB, Pedersen AF, Zachariae R, von der Maase H. Health-related quality of life in long-term survivors of testicular cancer. J Clin Oncol. 2009;27:5993–9.PubMedCrossRefGoogle Scholar
  34. 34.
    Lund T, Christensen KB, Vaez M, Labriola M, Josephson M, Villadsen E, et al. Differences in sickness absence in Sweden and Denmark: the cross national HAKNAK study. Eur J Public Health. 2009;19:343–9.PubMedCrossRefGoogle Scholar
  35. 35.
    Seitsamo J, Tuomi K, Ilmarinen J. Diversity of work ability and the work ability index. In: Gold R, Ilmarinen J, Järvisalo J, Koskinen E, editors. Dimensions of work ability. Helsinki: Finnish Centre for Pensions; 2008. p. 109–21.Google Scholar
  36. 36.
    Alavinia SM, van Duivenbooden C, Burdorf A. Influence of work-related factors and individual characteristics on work ability among Dutch construction workers. Scand J Work Environ Health. 2007;33:351–7.PubMedCrossRefGoogle Scholar
  37. 37.
    de Croon EM, Sluiter JK, Nijssen TF, Kammeijer M, Dijkmans BA, Lankhorst GJ, et al. Work ability of Dutch employees with rheumatoid arthritis. Scand J Rheumatol. 2005;34:277–83.PubMedCrossRefGoogle Scholar
  38. 38.
    Shaw WS, Robertson MM, Pransky G, McLellan RK. Employee perspectives on the role of supervisors to prevent workplace disability after injuries. J Occup Rehabil. 2003;13:129–42.PubMedCrossRefGoogle Scholar
  39. 39.
    Lysaght RM, Larmour-Trode S. An exploration of social support as a factor in the return-to-work process. Work. 2008;30:255–66.PubMedGoogle Scholar
  40. 40.
    Sinokki M, Hinkka K, Ahola K, Gould R, Puukka P, Lönnqvist J, et al. Social support as a predictor of disability pension: the Finnish Health 2000 study. J Occup Environ Med. 2010;52:733–9.PubMedCrossRefGoogle Scholar
  41. 41.
    Hakanen JJ, Lindbohm ML. Work engagement among breast cancer survivors and the referents: the importance of optimism and social resources at work. J Cancer Surviv. 2008;2:283–95.PubMedCrossRefGoogle Scholar
  42. 42.
    Bouknight RR, Bradley CJ, Luo Z. Correlates of return to work for breast cancer survivors. J Clin Oncol. 2006;24:345–53.PubMedCrossRefGoogle Scholar
  43. 43.
    Paraponaris A, Teyssier LS, Ventelou B. Job tenure and self-reported workplace discrimination for cancer survivors 2 years after diagnosis: does employment legislation matter? Health Policy. 2010;98:144–55.PubMedCrossRefGoogle Scholar
  44. 44.
    Feuerstein M, Luff GM, Harrington CB, Olsen CH. Pattern of workplace disputes in cancer survivors: a population study of ADA claims. Journal of Cancer Survivorship. 2007;1:185–92.PubMedCrossRefGoogle Scholar
  45. 45.
    Yarker J, Munir F, Bains M, Kalawsky K, Haslam C. The role of communication and support in return to work following cancer-related absence. Psycho-Oncology. 2010;19:1078–85.PubMedCrossRefGoogle Scholar
  46. 46.
    Schwartz CE, Bode R, Repucci N, Becker J, Sprangers MA, Fayers PM. The clinical significance of adaptation to changing health: a meta-analysis of response shift. Qual Life Res. 2006;15:1533–50.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • M.-L. Lindbohm
    • 1
  • T. Taskila
    • 2
  • E. Kuosma
    • 3
  • P. Hietanen
    • 4
  • K. Carlsen
    • 5
  • S. Gudbergsson
    • 6
  • H. Gunnarsdottir
    • 7
  1. 1.Centre of Expertise for Health and Work AbilityFinnish Institute of Occupational HealthHelsinkiFinland
  2. 2.Primary Care Clinical Sciences, School of Health and Population SciencesUniversity of BirminghamBirminghamUK
  3. 3.Creating SolutionsFinnish Institute of Occupational HealthHelsinkiFinland
  4. 4.Finnish Medical JournalHelsinkiFinland
  5. 5.Research Center for Prevention and HealthGlostrup University HospitalGlostrupDenmark
  6. 6.Department of Oncology and SurgeryOslo University Hospital, RadiumhospitaletOsloNorway
  7. 7.Center of Public Health SciencesUniversity of IcelandReykjavikIceland

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