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Am I ready to return to work? Assisting cancer survivors to determine work readiness

Journal of Cancer Survivorship volume 10, pages 699–710 (2016)Cite this article

Abstract

Purpose

A critical initial step in work re-entry involves the determination of work readiness. Cancer survivors have requested increased health care provider involvement in their work readiness decisions. However, there has been no exploration of current practices in determining work readiness, and thus no specific recommendations regarding how to assist survivors in answering the question: Am I ready to return to work?

Methods

To explore return to work following cancer and the workplace supports survivors require, we completed an exploratory qualitative study. We conducted semi-structured interviews with (i) cancer survivors (n = 16) and (ii) health care/vocational service providers (n = 16). Data were analyzed using thematic analysis. Themes specific to work readiness are discussed.

Results

Three key processes were deemed relevant to determining work readiness by health care providers and survivors: (1) assessing functional abilities in relation to job demands; (2) identifying survivor strengths and barriers to return to work; and (3) identifying supports available in the workplace. Challenges to work readiness determinations, were described by survivors and providers, related to: (i) the complexity of cancer, (ii) the accuracy of work readiness determinations, and (iii) the lack of established processes for addressing work goals.

Conclusions

Health care providers need to work collaboratively with survivors to determine if they are physically, cognitively, and emotionally ready to return to work, and with workplaces to determine if they are prepared to provide the necessary supports. Further stakeholder collaboration is also warranted.

Implications for Cancer Survivors

Supports from health care providers in determining work readiness can ensure survivors do not return to work either “too early” or “too late.”

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References

  1. Canadian Cancer Society. Cancer Statistics at a Glance. 2015. Available at http://www.cancer.ca/en/cancer-information/cancer-101/cancer-statistics-at-a-glance/?region=on

  2. Neary D. Epidemiology. In: Feuerstein M, editor. Work and cancer survivors. New York: Springer; 2011. p. 3–23.

    Google Scholar 

  3. Farley Short P, Vasey J, Tunceli K. Employment pathways in a large cohort of adult cancer survivors. Cancer. 2005;103(6):1292–301.

    Article  Google Scholar 

  4. Spelten E, Sprangers M, Verbeek J. Factors reported to influence the return to work of cancer survivors: a literature review. Psycho-Oncology. 2002;11:124–31.

    Article  PubMed  Google Scholar 

  5. Morrison T, Thomas R. “Bored out of my gourd”: a cancer Survivor’s return to work experience. Curr Oncol. 2014;21(1):e169–71. doi:10.3747/co.21.1665.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Amir Z, Neary D, Luker K. Cancer survivors’ views of work 3 years post diagnosis: a UK perspective. Eur J Oncol Nurs. 2008;12(3):190–7.

    Article  PubMed  Google Scholar 

  7. Frazier LM, Miller VA, Horbelt DV, Delmore JE, Miller BE, Averett EP. Employment and quality of survivorship among women with cancer: domains not captured by quality of life instruments. Cancer Control. 2009;16(1):57–65.

    PubMed  PubMed Central  Google Scholar 

  8. Groeneveld IF, de Boer AG, Frings-Dresen MHW. Physical exercise and return to work: cancer survivors’ experiences. J Cancer Surviv. 2013;7(2):237–46.

    Article  PubMed  Google Scholar 

  9. Grunfeld EA, Drudge-Coates L, Rixon L, Eaton E, Cooper AF. “The only way I know how to live is to work”: a qualitative study of work following treatment for prostate cancer. Health Psychol. 2013;32(1):75–82.

    Article  PubMed  Google Scholar 

  10. Grunfeld EA, Cooper AF. A longitudinal qualitative study of the experience of working following treatment for gynaecological cancer. Psychooncology. 2012;21(1):82.

    Article  CAS  PubMed  Google Scholar 

  11. Munir F, Kalawsky K, Lawrence C, Yarker J, Haslam C, Ahmed S. Cognitive intervention for breast cancer patients undergoing adjuvant chemotherapy: a needs analysis. Cancer Nurs. 2011;34(5):385–92.

    Article  PubMed  Google Scholar 

  12. Nachreiner NM, Dagher RK, McGovern PM, Baker BA, Alexander BH, Gerberich SG. Successful return to work for cancer survivors. AAOHN J. 2007;55(7):290–5.

    Article  PubMed  Google Scholar 

  13. Nilsson M, Olsson M, Wennman-Larsen A, Petersson L, Alexanderson K. Return to work after breast cancer: women’s experiences of encounters with different stakeholders. Eur J Oncol Nurs. 2011;15(3):267–74.

    Article  PubMed  Google Scholar 

  14. Picard C, Agretelis J, DeMarco RF. Nurse experiences as cancer survivors: part II—professional. Oncol Nurs Forum. 2004;31(3):537–42.

    Article  PubMed  Google Scholar 

  15. Aziz NM. Cancer survivorship research: state of knowledge, challenges and opportunities. Acta Oncol. 2007;46(4):417–32.

    Article  PubMed  Google Scholar 

  16. Kennedy F, HaslamC MF, Pryce J. Returning to work following cancer: a qualitative exploratory study into the experience of returning to work following cancer. Eur J Cancer Care (Engl). 2007;16(1):17–25.

    Article  CAS  Google Scholar 

  17. McKay G, Knott V, Delfabbro P. Return to work and cancer: the Australian experience. J Occup Rehabil. 2013;23(1):93–105.

    Article  PubMed  Google Scholar 

  18. Tiedtke C, Dierckx de Casterlé B, de Rijk A, Christiaens M, Donceel P. Breast cancer treatment and work disability: patient perspectives. Breast (Edinburgh, Scotland). 2011;20(6):534–8.

    Google Scholar 

  19. Tiedtke C, de Rijk A, Donceel P, Christiaens M, de Casterle BD. Survived but feeling vulnerable and insecure: a qualitative study of the mental preparation for return to work after breast cancer treatment. BMC Public Health. 2012;12(1):538.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Johnsson A, Fornander T, Rutqvist LE, Olsson M. Factors influencing return to work: a narrative study of women treated for breast cancer. Eur J Cancer Care. 2010;19(3):317–23.

    Article  CAS  Google Scholar 

  21. Tamminga SJ, de Boer AG, Verbeek JH, Frings-Dresen MH. Breast cancer survivors’ views of factors that influence the return-to-work process—a qualitative study. Scand J Work Environ Health. 2012;38(2):144–54.

    Article  PubMed  Google Scholar 

  22. Amir Z, Wilson K, Hennings J, Young A. The meaning of cancer: implications for family finances and consequent impact on lifestyle, activities, roles and relationships. Psychooncology. 2012;21(11):1167–74.

    Article  PubMed  Google Scholar 

  23. Blinder VS, Murphy MM, Vahdat LT, Gold HT, de Melo-Martin I, Hayes MK, et al. Employment after a breast cancer diagnosis: a qualitative study of ethnically diverse urban women. J Community Health. 2012;37(4):763–72.

    Article  CAS  PubMed  Google Scholar 

  24. Ferrell BR, Smith SL, Ervin KS, Itano J, Melancon C. A qualitative analysis of social concerns of women with ovarian cancer. Psychooncology. 2003;12(7):647–63.

    Article  PubMed  Google Scholar 

  25. Fu MR. Women at work with breast cancer-related lymphoedema. J Lymphoedema. 2008;3(1):20–5.

    PubMed  PubMed Central  Google Scholar 

  26. Main DS, Nowels CT, Cavender TA, Etschmaier M, Steiner JF. A qualitative study of work and work return in cancer survivors. Psychooncology. 2005;14(11):992–1004.

    Article  PubMed  Google Scholar 

  27. Timmons A, Gooberman-Hill R, Sharp L. The multidimensional nature of the financial and economic burden of a cancer diagnosis on patients and their families: qualitative findings from a country with a mixed public-private healthcare system. Support Care Cancer. 2013;21(1):107–17.

    Article  PubMed  Google Scholar 

  28. Parsons J, Eakin JM, Bell RS, Franche RL, Davis AM. So, are you back to work yet? Re-conceptualizing ‘work’ and ‘return to work’ in the context of primary bone cancer. Soc Sci Med. 2008;67(11):1826–36.

    Article  PubMed  Google Scholar 

  29. Schmalenberger S. Working after breast cancer treatment: lessons from musicians. Med Probl Perform Art. 2012;27(4):175–80.

    PubMed  Google Scholar 

  30. Tan FL, Loh SY, Su TT, Veloo VW, Ng LL. Return to work in multiethnic breast cancer survivors—a qualitative inquiry. Asian Pac J Cancer Prev APJCP. 2012;13(11):5791–7.

    Article  PubMed  Google Scholar 

  31. de Boer AG, Taskila T, Ojajarvi A, Van Dijk FJ, Verbeek JH. Cancer survivors and unemployment: a meta-analysis and meta-regression. JAMA. 2009;301(7):753–62.

    Article  PubMed  Google Scholar 

  32. de Boer A, Verbeek J, Uitternoeve A, Ansink A, de Reijke T, Mameijer M, et al. Work ability and return-to-work in cancer patients. Br J Cancer. 2008;98(8):1342–7.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Mehnert A. Employment and work-related issues in cancer survivors. Clin Rev Oncol Hematol. 2011;77:109–30.

    Article  Google Scholar 

  34. Hoving JL, Broekhulzen ML, Frings-Dresen MH. Return to work of breast cancer survivors: a systematic review of intervention studies. BMC Cancer. 2009;9:117–27.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Morrison T, Thomas R, Guitard P. Physicians’ perspectives of cancer survivors’ work integration. Can Fam Phys. 2015;61:e36–42.

    Google Scholar 

  36. Morrison T, Thomas R. Survivors’ experiences of return to work following cancer: a photovoice study. Can J Occup Ther. 2014;81(3):163–72.

    Article  PubMed  Google Scholar 

  37. Bains M, Yarker J, Amir Z, Wynn P, Munir F. Helping cancer survivors return to work: what providers tell us about the challenges in assisting cancer patients with work questions. J Occup Rehabil. 2012;22(1):71–7.

    Article  PubMed  Google Scholar 

  38. Tiedtke C, Donceel P, Knops L, Désiron H, Désiron H, Dierckx De Casterlé B, et al. Supporting return-to-work in the face of legislation: stakeholders’ experiences with return - to- work after breast cancer in Belgium. J Occup Rehabil. 2012;22(2):241–51.

    Article  PubMed  Google Scholar 

  39. Stergiou-Kita M, Grigorovich A, Tseung V, Milosevic E, Hebert D, Phan S, et al. Qualitative meta-synthesis of survivors’ work experiences and the development of strategies to facilitate return to work. J Cancer Surviv. 2014;8(4):657–70.

    Article  PubMed  Google Scholar 

  40. Stergiou-Kita M, Rappolt S, Kirsh B, Shaw L. Evaluating work readiness following acquired brain injury: building a shared understanding. Can J Occup Ther. 2009;78(4):276–84.

    Article  Google Scholar 

  41. MacEachen E, Ferrier S, Kosny A, Chambers L. A deliberation on ‘hurt versus harm’ logic in early-return-to-work policy. Pol Prac Health Saf. 2007;5(2):41–62.

    Google Scholar 

  42. Eakin JM, MacEachen E, Clarke J. ‘Playing it smart’ with return to work: small workplace experience under Ontario’s policy of self-reliance and early return. Policy Pract Health Saf. 2003;1(2):19–41.

    Google Scholar 

  43. Mansfield E, Stergiou-Kita M, Kirsh B, Colantonio A. After the storm: the social relations of return to work following electrical injury. Qual Health Res. 2014;24(9):1183–97.

    Article  PubMed  Google Scholar 

  44. Mansfield E, Stergiou-Kita M, Cassidy D, Bayley M, Mantis S, Kristman V, et al. Return-to-work challenges following a work-related mild TBI: the injured worker perspective. Brain Inj. 2015;29(11):1362–9.

    Article  PubMed  Google Scholar 

  45. MacMillan Cancer Support. Work and Cancer. Available at http://www.macmillan.org.uk/information-and-support/organising/work-and-cancer

  46. Nitkins P, Parkinson M, Schultz I. Cancer and work: a Canadian perspective. 2011. Available at http://www.capo.ca/pdf/CancerandWork-ACanadianPerspective.pdf.

  47. Munir F, Kalawsky K, Wallis D, Donaldson-Feilder E. Using intervention mapping to develop a work-related guidance tool for those affected by cancer. BMC Public Health. 2013;13(6):1–13.

    Google Scholar 

  48. Verbeek J, de Boer A, Taskila T. Primary and occupational health care pro- viders. In: Feuerstein M, editor. Work and cancer survivors. New York: Springer; 2011. p. 191–209.

    Google Scholar 

  49. Wada K, Ohtsu M, Aizawa Y, Tanaka H, Tagaya N, Takahashi M. Awareness and behavior of oncologists and support measures in medical institutions related to ongoing employment of cancer patients in Japan. Jpn J Clin Oncol. 2012;42(4):295–301.

    Article  PubMed  Google Scholar 

  50. Desiron H, Donceel P, de Rijk A, Van Hoof E. A conceptual-practice model for occupational therapy to facilitate return to work in breast cancer patients. J Occup Rehabil. 2013;23(4):516–26.

    Article  PubMed  Google Scholar 

  51. Creswell JW. Research design: qualitative, quantitative, and mixed methods approaches. 3rd ed. Los Angeles: Sage Publications, Inc; 2009.

    Google Scholar 

  52. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.

    Article  Google Scholar 

  53. Seale C. Quality in qualitative research. Qual Inq. 1999;5.

  54. Charmaz K. Constructing grounded theory. Thousand Oaks: Sage; 2006.

    Google Scholar 

  55. Mays N, Pope C. Qualitative research in health care: assessing quality in qualitative research. BMJ. 2000;320(7226):50–2.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  56. Franche R, Krause N. Readiness to return to work following injury or illness: conceptualizing the interpersonal impact on health care, workplace and insurance factors. J Occup Rehabil. 2002;12(4):233–56.

    Article  PubMed  Google Scholar 

  57. Larsson A, Gard G. How can the rehabilitation planning process at the workplace be improved? A qualitative study from employers’ perspective. J Occup Rehabil. 2003;13(3):169–81.

    Article  PubMed  Google Scholar 

  58. Young AE. Return to work stakeholders’ perspectives on work disability. In: Loisel P, Anema JR, editors. Handbook of work disability. New York: Springer; 2013. p. 409–23.

    Chapter  Google Scholar 

  59. Young A, Wasiak R, Roessler R, McPherson T, Anema K, van Poppel J. Return -to- work outcomes following work disability: stakeholder motivations, interests and concerns. J Occup Rehabil. 2005;15(4):543–56.

    Article  PubMed  Google Scholar 

  60. Stahl C, Svensson T, Petersson G, Ekberg K. A matter of trust? A study of coordination of Swedish stakeholders in return-to-work. J Occup Rehabil. 2010;20(3):299–310.

    Article  PubMed  Google Scholar 

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Acknowledgments

This study was supported by a grant through the Dean’s Fund, Faculty of Medicine, University of Toronto. We would like to express our gratitude to the cancer survivors and service providers who shared their time, expertise and experiences to help us understand work readiness. We would also like to acknowledge the assistance of Well spring for their assistance with recruitment.

Author information

Authors and Affiliations

  1. Department of Occupational Science and Occupational Therapy, University of Toronto, 500 University Ave., Toronto, ON, M5G 1V7, Canada

    Mary Stergiou-Kita, Bonnie Kirsh & Andrea Duncan

  2. Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada

    Mary Stergiou-Kita

  3. Institute of Work and Health, Toronto, ON, Canada

    Mary Stergiou-Kita & Dwayne van Eerd

  4. Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada

    Mary Stergiou-Kita

  5. School of Kinesiology and Health Science, York University, Toronto, ON, Canada

    Cheryl Pritlove

  6. Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre University Health Network, Toronto, ON, Canada

    Cheryl Pritlove & Jennifer Jones

  7. Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

    D. Linn Holness

  8. Department of Medicine, Faculty of Medicine, Toronto, ON, Canada

    D. Linn Holness

  9. Department of Occupational and Environmental Health and Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, ON, Canada

    D. Linn Holness

  10. Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    Bonnie Kirsh & Jennifer Jones

  11. School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada

    Dwayne van Eerd

Authors
  1. Mary Stergiou-Kita
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  2. Cheryl Pritlove
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  3. D. Linn Holness
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  4. Bonnie Kirsh
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  5. Dwayne van Eerd
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  6. Andrea Duncan
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  7. Jennifer Jones
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Corresponding author

Correspondence to Mary Stergiou-Kita.

Ethics declarations

All procedures performed in this study, involving human participants, were in accordance with the ethical standards and approval from the ethics review boards at the University of Toronto and the University Health Network, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Funding

This study was supported by a grant through the Dean’s Fund, Faculty of Medicine, University of Toronto (award no. DF-2013-17).

Conflict of interest

All authors of this paper have no conflict of interest to declare.

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Stergiou-Kita, M., Pritlove, C., Holness, D.L. et al. Am I ready to return to work? Assisting cancer survivors to determine work readiness. J Cancer Surviv 10, 699–710 (2016). https://doi.org/10.1007/s11764-016-0516-9

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  • DOI: https://doi.org/10.1007/s11764-016-0516-9

Keywords

  • Cancer
  • Cancer survivors
  • Return to work
  • Work readiness
  • Employment supports