Changes after cancer diagnosis and return to work: experience of Korean cancer patients

Abstract

Background Cancer patients’ return to work is a growing aspect of survivorship care, yet limited studies have been conducted in Korea to understand the work-related experience of cancer patients. The purpose of this study was to understand the unmet needs of cancer patients and identify the necessary factors to develop a vocational intervention program based on cancer patients’ work-related experience after cancer diagnosis. Methods Semi-structured individual in-depth interviews were conducted with 50 cancer patients who were working at the time of diagnosis at a university hospital in Seoul, South Korea from July to September of 2017. Interview data were analyzed using qualitative content analysis. Results ‘The changes patients experienced after cancer diagnosis’ were categorized into Personal and socio-environmental changes. ‘Personal changes’ were changes within the patient that were further divided into ‘physical’, ‘psychological’ and ‘spiritual’ changes while ‘socio-environmental changes’ were changes in either ‘attitude’ and ‘relationship’ of other people cancer patients encountered. In addition to these post-diagnosis changes, the following 4 major factors related to return-to-work were identified to affect patients’ experience: ‘fear of cancer recurrence’, ‘financial status’, ‘informational support’, and ‘job-related work environment’. Conclusion Cancer patients’ working status was determined by personal and socio-environmental changes after the cancer diagnosis which as well as psychological distress and practical issues such as fear of cancer recurrence, financial burden, and work environment. Educational materials and intervention programs informing patients on these changes and factors may facilitate their return-to-work after diagnosis.

Effectiveness of Self-Assessment, TAilored Information, and Lifestyle Management for Cancer Patients’ Returning to Work (START): A Multi-center, Randomized Controlled Trial

“…The START program was developed based on the results of a qualitative study [15], network analyses of online cancer communities [17], and a quantitative survey [18] by the study team, as well as literature review. As more than half of all cancer patients stop working before treatment begins [12], we decided to intervene for newly diagnosed patients.…”

“…For a secondary outcome, we assessed knowledge related to RTW using a questionnaire developed by the research team. To develop the questionnaire, a group of experts-two oncology nurses, two social scientists, two general physicians, and one epidemiologist-reviewed previous qualitative and quantitative literature and semi-structured interviews were conducted with 50 cancer patients about their knowledge of RTW [14]. The expert group developed 10 questions to evaluate common misunderstanding related to working with cancer.…”

“…In our study, the RTW rates were higher in the START group compared to the control group and this might be possible because the intervention was provided at diagnosis before cancer patients decided not to work. Based on results from our preliminary qualitative interviews [15] and quantitative survey [18], many patients decided to stop working as soon as they suspected a diagnosis of cancer, even before it was confirmed. Furthermore, patients reported difficulties in re-employment at the end of treatment.…”

“…There were 2 intervention studies that provided support to patients from diagnosis [10,11], but they were limited to provide either psycho-social support or symptom management. Furthermore, while fear of cancer reucrrence, meaning of work and stigma associated with cancer and cancer patients [12] was associated with RTW [12][13][14], previous interventions did not tackle these issues. According to an observation study, survivors with stigma on impossibility of recovery and stereotypes were 3.10 (95% CI [1.76, 5.44]) and 2.10 (95% CI [1.20, 3.67]) times more likely to lose a job than survivors without cancer stigma [12].…”

“…Base on qualitative and quantitative studies [15,16], we developed a RTW intervention for patients newly diagnosed with different cancers: the Self-assessment, TAilored information, and lifestyle management for Returning To work among cancer patients (START) and evaluated its efficacy in terms of RTW.…”