Effectiveness of a Hospital-Based Work Support Intervention for Female Cancer Patients – A Multi-Centre Randomised Controlled Trial

Abstract

ObjectiveOne key aspect of cancer survivorship is return-to-work. Unfortunately, many cancer survivors face problems upon their return-to-work. For that reason, we developed a hospital-based work support intervention aimed at enhancing return-to-work. We studied effectiveness of the intervention compared to usual care for female cancer patients in a multi-centre randomised controlled trial.MethodsBreast and gynaecological cancer patients who were treated with curative intent and had paid work were randomised to the intervention group (n = 65) or control group (n = 68). The intervention involved patient education and support at the hospital and improvement of communication between treating and occupational physicians. In addition, we asked patient's occupational physician to organise a meeting with the patient and the supervisor to make a concrete gradual return-to-work plan. Outcomes at 12 months of follow-up included rate and time until return-to-work (full or partial), quality of life, work ability, work functioning, and lost productivity costs. Time until return-to-work was analyzed with Kaplan-Meier survival analysis.ResultsReturn-to-work rates were 86% and 83% (p = 0.6) for the intervention group and control group when excluding 8 patients who died or with a life expectancy of months at follow-up. Median time from initial sick leave to partial return-to-work was 194 days (range 14–435) versus 192 days (range 82–465) (p = 0.90) with a hazard ratio of 1.03 (95% CI 0.64–1.6). Quality of life and work ability improved statistically over time but did not differ statistically between groups. Work functioning and costs did not differ statistically between groups.ConclusionThe intervention was easily implemented into usual psycho-oncological care and showed high return-to-work rates. We failed to show any differences between groups on return-to-work outcomes and quality of life scores. Further research is needed to study which aspects of the intervention are useful and which elements need improvement.Trial RegistrationNederlands Trial Register (NTR) 1658

What is the value of occupational therapy in return to work for breast cancer patients? A qualitative inquiry among experts

“…also stress on the need for an early start to enhance results of RTW interventions, without being more precise on the timing or an exact moment in the treatment process: ‘ An early intervention – meaning soon after diagnosis or early in treatment – is most appropriate because the longer the duration of sick leave, the more difficult return‐to‐work is to achieve ’ (Tamminga et al . ). This also aligns with findings of Peterson et al ., who conclude that shortly after BC surgery, most women valued work highly, even as one of the most important things in their lives.…”

Effectiveness of a tailored return to work program for cancer survivors with job loss: results of a randomized controlled trial

“…In other RTW studies for CSs, although not specifically for CSs with job loss, the findings on health-related outcomes are, at best, ambiguous. That is, the study by Tamminga et al (2013) found no significant effect of their RTW program on quality of life [22]. However, the study by Van Waart et al (2015) showed improvements in physical functioning and reduction of symptoms, such as fatigue [21].…”

“…In contrast, in other studies no effect of interventions programs on RTW was found. For instance, a recent study by Tamminga et al (2013), which offered a hospital-based vocational intervention program to CSs, demonstrated no effect of the intervention program on RTW compared to usual care [22]. It should be mentioned that previous studies were not aimed at CSs with job loss.…”

Psychological Interventions to Facilitate Employment Outcomes for Cancer Survivors

“…In a similar way, another study evaluated a case management intervention that tailored individual plans to integrate both physical and counseling components (Hubbard et al, 2013). Only two interventions directly addressed return-to-work or job-related issues by establishing return-to-work plans for cancer survivors combined with informational sessions (Tamminga et al, 2013) or therapy on job-related issues with physical therapy (Bottcher et al, 2013) (see Figure 2 for a checklist of intervention components across studies).…”

“…Risk of detection bias was low for three studies that specified that assessors were blinded to participants' allocation (Hubbard et Attrition bias. Attrition was generally well reported (low risk of bias) in the included studies, which often explained attrition due to one or a combination of the following: cancer recurrence, misdiagnosis, decline, refusal to participate, or death (Berglund et al, 1994;Gordon et al, 1980;Hubbard et al, 2013;Lepore et al, 2003;Maguire et al, 1983;Tamminga et al, 2013). Some studies acknowledged the presence of attrition in their studies but did not discuss reasons (Bottcher et al, 2013;Capone et al, 1980;Granstam-Bjorneklett et al, 2013).…”