Return to work after cancer–the impact of working conditions: A Norwegian Register-based Study.

Abstract

Purpose The purpose of this project is to compare a cohort of cancer survivors with a cohort of cancer-free employees (1) with respect to employment prospects over a 15-year period and (2) with respect to the differential impact of working conditions on employment over this time period. Methods The cancer cohort is retrieved from the Cancer Registry of Norway, while data on the non-cancer cohort are retrieved from register data managed by Statistics Norway. Job exposure matrices were used to remedy the lack of working-conditions information in the register data. We use nearest-neighbor matching to match the non-cancer cohort (the control group) to the cancer-survivor cohort (the treatment group). Cox regression analysis was applied to examine the relationships between working conditions, employment, and cancer. The results are reported separately for mechanical-job exposure and psychosocial exposure, as well as by gender. Results Cancer survivors are more likely to experience reduced employment as compared to individuals without a history of cancer. Male cancer survivors in physically demanding occupations have an increased risk of reduced employment after being diagnosed with cancer. This does not apply to female cancer survivors. Regarding the impact of psychosocial exposures on employment, we find no differences over time between cancer survivors and the non-cancer population. Conclusions Male cancer survivors in physically demanding occupations have an increased risk of reduced employment after being diagnosed with cancer, whereas this is not the case for female cancer survivors. Psychosocial exposures do not impact the relative risk of reduced employment over time. Implications for cancer survivors: We suggest that return to work after cancer should be considered a process rather than only the re-entry step of resuming work. Thus, it is important to provide long-term support for cancer survivors. We recommend providing more attention to working conditions, particularly in occupations that involve a high level of mechanical-job exposure.

Worker and workplace determinants of employment exit: a register study

“…However, the risk of bias is present when survey respondents are asked to rate, for instance, the working conditions of their previous job. A way of combining the two approaches is to use survey data to create a job exposure matrix, and operationalise this as a variable in analyses of register data 19…”

“…In previous register studies, the extent of demand-side policies and workplace adjustments has been approximated by different measures. Administrative registries usually cover the full population, but a drawback is the lack of explicit indicators of working conditions 19. This article draws on previous register studies when we construct proxies for workplaces’ policies to include workers with chronic illness.…”