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Qualitative meta-synthesis of survivors’ work experiences and the development of strategies to facilitate return to work

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Abstract

Purpose

To review the empirical qualitative literature on cancer survivors’ experiences of the return to work process in order to develop strategies for health and vocational professionals to facilitate return to work.

Methods

A rigorous systematic search of five databases was completed to identify relevant qualitative studies published between Jan 2000 and July 2013. All potentially relevant titles and abstracts were reviewed by two reviewers. For studies that met eligibility, the full-text articles were obtained and assessed for quality. The collected evidence was then synthesized using meta-ethnography methods.

Results

In total, 39 studies met the eligibility criteria and passed the quality assessment. The synthesis of these studies demonstrated that cancer diagnosis and treatment represented a major change in individuals’ lives and often resulted in individuals having to leave full-time work, while undergoing treatment or participating in rehabilitation. Thus, many survivors wanted to return to some form of gainful or paid employment after treatment and rehabilitation. However, there was also evidence that the meaning of paid employment could change following cancer. Return to work was found to be a continuous process that involved planning and decision-making with respect to work readiness and symptom management throughout the process. Nine key factors were identified as relevant to work success. These include four related to the person (i.e., symptoms, work abilities, coping, motivation), three related to environmental supports (i.e., family, workplace, professionals), and two related to the occupation (i.e., type of work/demands, job flexibility). Finally, issues related to disclosure of one’s cancer status and cancer-related impairments were also found to be relevant to survivors’ return to work experiences.

Conclusions

This review reveals that cancer survivors experience challenges with maintaining employment and returning to work following cancer and may require the coordinated support of health and vocational professionals.

Implications for Cancer Survivors

Cancer survivors need integrated support from health and vocational professionals (e.g., assistance with defining work goals, determining work readiness, determining how symptoms may impact work performance, suggesting workplace supports, and accommodations) to maintain and return to work after cancer diagnosis and treatment. These supports need to be provided throughout the recovery and rehabilitation process.

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References

  1. 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(8):1342–7.

    Article  PubMed Central  PubMed  Google Scholar 

  2. Canadian Cancer Society’s Advisory Committee on Cancer Statistics. Canadian Cancer Statistics 2013. Canadian Cancer Society. 2013;2013(01/01/2014).

  3. 2012–2017 Strategic Plan. Sustaining action toward a shared vision. 2011; Available at: http://www.partnershipagainstcancer.ca/wp-content/uploads/Sustaining-Action-Toward-a-Shared-Vision-Full-Document.pdf. Accessed 05 Jan 2013.

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

    Article  PubMed  Google Scholar 

  5. Feuerstein M. Defining cancer survivorship. J Cancer Surviv. 2007;1(1):5–7.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  7. Spelten ER, Sprangers MA, Verbeek JH. Factors reported to influence the return to work of cancer survivors: a literature review. Psychooncology. 2002;11(2):124–31.

    Article  PubMed  Google Scholar 

  8. Kennedy F, Haslam C, Munir F, 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 

  9. de Boer AG, Taskila T, Tamminga SJ, Frings-Dresen MH, Feuerstein M, Verbeek JH. Interventions to enhance return-to-work for cancer patients. Cochrane Database Syst Rev. 2011;16(2), CD007569.

    Google Scholar 

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

    Article  PubMed  Google Scholar 

  11. 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 

  12. Mehnert A. Employment and work-related issues in cancer survivors. Crit Rev Oncol Hematol. 2011;77(2):109–30.

    Article  PubMed  Google Scholar 

  13. Nitkins P, Parkinson M, Schultz I. Cancer and work: a Canadian perspective. 2011; Available at: http://www.capo.ca/pdf/CancerandWork-ACanadianPerspective.pdf. Accessed 05 Jan 2013.

  14. Lindbohm ML, Viikari-Juntura E. Cancer survivors’ return to work: importance of work accommodations and collaboration between stakeholders. Occup Environ Med. 2010;67(9):578–9.

    Article  PubMed  Google Scholar 

  15. 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 

  16. Yu M, Ferrucci LM, McCorkle R, Ercolano E, Smith T, Stein KD, et al. Employment experience of cancer survivors 2 years post-diagnosis in the Study of Cancer Survivors-I. J Cancer Surviv. 2012;6(2):210–8.

    Article  PubMed  Google Scholar 

  17. Feuerstein M, Luff GM, Harrington CB, Olsen CH. Pattern of workplace disputes in cancer survivors: a population study of ADA claims. J Cancer Surviv. 2007;1(3):185–92.

    Article  PubMed  Google Scholar 

  18. Hoyer M, Nordin K, Ahlgren J, Bergkvist L, Lambe M, Johansson B, et al. Change in working time in a population-based cohort of patients with breast cancer. J Clin Oncol. 2012;30(23):2853–60.

    Article  PubMed  Google Scholar 

  19. Banning M. Employment and breast cancer: a meta-ethnography. Eur J Cancer Care. 2011;20(6):708–19.

    Article  CAS  Google Scholar 

  20. Wells M, Williams B, Firnigl D, Lang H, Coyle J, Kroll T, et al. Supporting ‘work-related goals’ rather than ‘return to work’ after cancer? A systematic review and meta-synthesis of 25 qualitative studies. Psycho Oncol. 2013;22(6):1208.

    Article  Google Scholar 

  21. Steiner JF, Nowels CT, Main DS. Returning to work after cancer: quantitative studies and prototypical narratives. Psycho Oncol. 2010;19(2):115.

    Article  Google Scholar 

  22. Banning M. Employment and breast cancer: a meta-ethnography. Eur J Cancer Care. 2011;20(6):708–19.

    Article  CAS  Google Scholar 

  23. Gewurtz R, Kirsh B. Disruption, disbelief and resistance: a meta-synthesis of disability in the workplace. Work. 2009;34(1):33–44.

    PubMed  Google Scholar 

  24. MacEachen E, Clarke J, Franche RL, Irvin E, Workplace-based Return to Work Literature Review Group. Systematic review of the qualitative literature on return to work after injury. Scand J Work Environ Health. 2006;32(4):257–69.

    Article  PubMed  Google Scholar 

  25. Roots RK, Li LC. Recruitment and retention of occupational therapists and physiotherapists in rural regions: a meta-synthesis. BMC Health Serv Res 2013;13:59-6963-13-59.

  26. Gewurtz R, Stergiou-Kita M, Shaw L, Kirsh B, Rappolt S. Qualitative meta-synthesis: reflections on the utility and challenges in occupational therapy. Can J Occup Ther. 2008;75(5):301–8.

    Article  PubMed  Google Scholar 

  27. Amir, Wynn P, Whitaker S, Luker K. Cancer survivorship and return to work: UK occupational physician experience. Occup Med. 2009;59(6):390–6.

    Article  Google Scholar 

  28. Carlsen K, Jensen AJ, Rugulies R, Christensen J, Bidstrup PE, Johansen C, et al. Self-reported work ability in long-term breast cancer survivors. A population-based questionnaire study in Denmark. Acta Oncol. 2013;52(2):423–9.

    Article  PubMed  Google Scholar 

  29. Nachreiner NM, Ghebre RG, Virnig B, Shanley R. Early work patterns for gynaecological cancer survivors in the USA. Occup Med. 2012;62(1):23–8.

    Article  CAS  Google Scholar 

  30. Ridner SH, Bonner CM, Deng J, Sinclair VG. Voices from the shadows: living with lymphedema. Cancer Nurs. 2012;35(1):E18–26.

    Article  PubMed Central  PubMed  Google Scholar 

  31. McKibbon KA, Wilczynski NL, Haynes RB. Developing optimal search strategies for retrieving qualitative studies in PsycINFO. Eval Health Prof. 2006;29(4):440–54.

    Article  PubMed  Google Scholar 

  32. Spencer L, Ritchie J, Lewis J, Dillon L. Quality in qualitative evaluation: a framework for assessing research evidence. London: Government Chief Research Office; 2003.

    Google Scholar 

  33. MacEachen E, Kosny A, Scott-Dixon K, Facey M, Chambers L, Breslin C, et al. Workplace health understandings and processes in small businesses: a systematic review of the qualitative literature. J Occup Rehabil. 2010;20(2):180–98.

    Article  PubMed  Google Scholar 

  34. Noblit G, Hare D. Meta-ethnography, synthesizing qualitative studies. Newbury Park: Sage Publications; 1988.

    Google Scholar 

  35. Law M, Cooper B, Strong S, Stewart D, Rigby P, Letts L. The person-environment-occupation model: a transactive approach to occupational performance. Can J Occup Ther. 1996;63(1):9–23.

    Article  Google Scholar 

  36. Allen S, Carlson G. To conceal or disclose a disabling condition? A dilemma of employment transition. J Voc Rehabil. 2003;19(1):19–30.

    Google Scholar 

  37. 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 

  38. 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 

  39. Ashing-Giwa KT, Padilla GV, Bohorquez DE, Tejero JS, Garcia M. Understanding the breast cancer experience of Latina women. J Psychosoc Oncol. 2006;24(3):19–52.

    Article  PubMed  Google Scholar 

  40. Ashing-Giwa KT, Chhabra R, Hsiao E, Kagawa-Singer M, Martinez L, Padilla GV, et al. The impact of cervical cancer and dysplasia: a qualitative, multiethnic study. Psychooncology. 2004;13(10):709–28.

    Article  PubMed Central  PubMed  Google Scholar 

  41. 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 

  42. Bennett JA, Brown P, Cameron L, Whitehead LC, Porter D, McPherson KM. Changes in employment and household income during the 24 months following a cancer diagnosis. Support Care Cancer. 2009;17(8):1057–64.

    Article  PubMed  Google Scholar 

  43. 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 

  44. Boykoff N, Moieni M, Subramanian SK. Confronting chemobrain: an in-depth look at survivors’ reports of impact on work, social networks, and health care response. J Cancer Surviv. 2009;3(4):223–32.

    Article  PubMed Central  PubMed  Google Scholar 

  45. Wilmoth MC. The federal nursing services award: enlisted women with breast cancer: balancing demands and expectations. Mil Med. 2003;168(7):514–9.

    PubMed  Google Scholar 

  46. 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 

  47. Fesko SL. Workplace experiences of individuals who are HIV+ and individuals with cancer. Rehabil Couns Bull. 2001;45(1):2–11.

    Article  Google Scholar 

  48. Frazier LM, Miller VA, Miller BE, Horbelt DV, Delmore JE, Ahlers-Schmidt CR. Cancer-related tasks involving employment: opportunities for clinical assistance. J Support Oncol. 2009;7(6):229–36.

    PubMed Central  PubMed  Google Scholar 

  49. 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 Central  PubMed  Google Scholar 

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

    PubMed Central  PubMed  Google Scholar 

  51. Gray RE, James P, Manthorne J, Gould J, Fitch MI. A consultation with Canadian rural women with breast cancer. Health Expect. 2004;7(1):40–50.

    Article  PubMed  Google Scholar 

  52. 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 

  53. 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 

  54. 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 

  55. Hubbard G, Kidd L, Kearney N. Disrupted lives and threats to identity: the experiences of people with colorectal cancer within the first year following diagnosis. Health (London). 2010;14(2):131–46.

    Article  Google Scholar 

  56. Johnson SR, Finifrock D, Marshall CA, Jaakola J, Setterquist J, Burross HL, et al. Cancer, employment, and american Indians: a participatory action research pilot study. Rehabil Couns Bull. 2011;54(3):175–80.

    Article  Google Scholar 

  57. 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 

  58. Lopez-class M, Perret-gentil M, Kreling B, Caicedo L, Mandelblatt J, Graves KD. Quality of life among immigrant Latina breast cancer survivors: realities of culture and enhancing cancer care. J Cancer Educ. 2011;26(4):724–33.

    Article  PubMed Central  PubMed  Google Scholar 

  59. Lydon A. Cancer in the workplace: evaluation of a resource to help those affected by cancer, return to work in the UK. Int J Ther Rehabil. 2012;19(12):689–95.

    Article  Google Scholar 

  60. 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 

  61. McGrath PD, Hartigan B, Holewa H, Skarparis M. Returning to work after treatment for haematological cancer: findings from Australia. Support Care Cancer. 2012;20(9):1957–64.

    Article  PubMed  Google Scholar 

  62. 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 

  63. Munir F, Burrows J, Yarker J, Kalawsky K, Bains M. Women’s perceptions of chemotherapy-induced cognitive side affects on work ability: a focus group study. J Clin Nurs. 2010;19(9–10):1362–70.

    Article  PubMed  Google Scholar 

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

    Article  PubMed Central  PubMed  Google Scholar 

  65. 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 

  66. 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 

  67. 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 

  68. 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 

  69. 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 

  70. Rasmussen DM, Elverdam B. The meaning of work and working life after cancer: an interview study. Psychooncology. 2008;17(12):1232–8.

    Article  PubMed  Google Scholar 

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

    PubMed  Google Scholar 

  72. Semple CJ, Dunwoody L, George Kernohan W, McCaughan E, Sullivan K. Changes and challenges to patients’ lifestyle patterns following treatment for head and neck cancer. J Adv Nurs. 2008;63(1):85–93.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  74. Thomas-Maclean R, Towers A, Quinlan E, Hack TF, Kwan W, Miedema B, et al. “This is a kind of betrayal”: a qualitative study of disability after breast cancer. Curr Oncol. 2009;16(3):26–32.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  75. 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 

  76. 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 

  77. 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 RTW after breast cancer treatment. BMC Public Health. 2012;12(1):538.

    Article  PubMed Central  PubMed  Google Scholar 

  78. Tighe M, Molassiotis A, Morris J, Richardson J. Coping, meaning and symptom experience: a narrative approach to the overwhelming impacts of breast cancer in the first year following diagnosis. Eur J Oncol Nurs. 2011;15(3):226–32.

    Article  CAS  PubMed  Google Scholar 

  79. 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 

  80. Von Ah D, Habermann B, Carpenter JS, Schneider BL. Impact of perceived cognitive impairment in breast cancer survivors. Eur J Oncol Nurs. 2013;17(2):236–41.

    Article  Google Scholar 

  81. Yarker J, Munir F, Bains M, Kalawsky K, Haslam C. The role of communication and support in return to work following cancer-related absence. Psychooncology. 2010;19(10):1078–85.

    Article  CAS  PubMed  Google Scholar 

  82. 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 

  83. 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 

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Acknowledgments

Funding for this meta-synthesis was provided by the Judith Friedland Fund for Occupational Therapy in Oncology and Palliative Care, through the Department of Occupational Science and Occupational Therapy, University of Toronto.

Conflict of interest

The authors have no conflict of interest to declare.

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Authors and Affiliations

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

    Mary Stergiou-Kita & Debbie Hebert

  2. Department of Occupational Science and Occupational Therapy, University of Toronto, Room 914, 160-500 University Ave, Toronto, ON, M5G 1V7, Canada

    Mary Stergiou-Kita & Alisa Grigorovich

  3. Graduate Department of Rehabilitation Science, Toronto, ON, Canada

    Victrine Tseung

  4. Cancer Survivorship Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada

    Elizabeth Milosevic, Stephanie Phan & Jennifer Jones

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  1. Mary Stergiou-Kita
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  2. Alisa Grigorovich
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  3. Victrine Tseung
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  4. Elizabeth Milosevic
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  5. Debbie Hebert
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  6. Stephanie Phan
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  7. Jennifer Jones
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Correspondence to Mary Stergiou-Kita.

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Stergiou-Kita, M., Grigorovich, A., Tseung, V. et al. Qualitative meta-synthesis of survivors’ work experiences and the development of strategies to facilitate return to work. J Cancer Surviv 8, 657–670 (2014). https://doi.org/10.1007/s11764-014-0377-z

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  • DOI: https://doi.org/10.1007/s11764-014-0377-z

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