Return to work following laparoscopic‐assisted resection or open resection for rectal cancer: Findings from AlaCaRT—Australasian Laparoscopic Cancer of the Rectum Trial

Abstract

Background Maintaining employment for adults with cancer is important, however, little is known about the impact of surgery for rectal cancer on an individual's capacity to return to work (RTW). This study aimed to determine the impact of laparoscopic vs. open resection on RTW at 12 months. Methods Analyses were undertaken among participants randomized in the Australian Laparoscopic Cancer of the Rectum Trial (ALaCaRT), with work status available at baseline (presurgery), and 12 months. Multivariable logistic regression, adjusted for sociodemographic and clinical characteristics estimated the effect of surgery on RTW in any capacity, or return to preoperative work status at 12 months. Results About 228 of 449 (51%) surviving trial participants at 12 months completed work status questionnaires; mean age was 62 years, 66% males, 117 of these received laparoscopic resection (51%). Of 228, 120 were employed at baseline (90 full‐time, 30 part‐time). Overall RTW in 120 participants in paid work at baseline was 78% (84% laparoscopic, 70% open surgery). Those employed full‐time were more likely to RTW at 12 months (OR, 3.55; 95% CI, 1.02–12.31). Those with distant metastases at baseline were less likely to RTW (OR, 0.07; 95% CI, <0.01–0.83). Laparoscopic surgery was associated with a higher rate of RTW but did not reach statistical significance (OR 2.88; 95% CI, 0.95–8.76). Conclusions Full‐time work presurgery and the presence of metastatic disease predicts RTW status at 12 months. A laparoscopic‐assisted surgical approach to rectal cancer may facilitate more patients to RTW, however, larger sample sizes are likely needed to confirm this result.

Employment Status of Patients With Colorectal Cancer After Surgery: A Multicenter Prospective Cohort Study in Japan

“…Previous studies reported an RTW time of 2.2 to 9.1 months, and the proportion of employed patients after surgery was 49% to 89%. 12–19 This is partial because most patients in this study were treated using minimally invasive surgery, which was reported to facilitate RTW. 18 In addition, in Japan, there is no public social support system ensuring absence owing to sickness for employees who are unable to work, although almost all large Japanese companies have their own sickness insurance system for their employees.…”

“…12–19 This is partial because most patients in this study were treated using minimally invasive surgery, which was reported to facilitate RTW. 18 In addition, in Japan, there is no public social support system ensuring absence owing to sickness for employees who are unable to work, although almost all large Japanese companies have their own sickness insurance system for their employees. 19 Thus, Japanese patients may be more motivated to RTW than in other countries, such as the United Kingdom and the Netherlands, where state-funded welfare is available.…”

“…20 Second, most previous studies were conducted in Western countries, and it has been noted that results may vary across countries. 10,11,18 This finding is especially true for Japan, where there have been few studies on the employment of patients with cancer. 21 A worksite-based study reported that 84% of patients with CRC could RTW after diagnosis, but the study only covered full-time workers of large companies.…”

“…8–10 The employment of patients with CRC was 49% to 89%, the time taken to RTW was 2.2 to 9.1 months, and the risk factors for unemployment were older age, comorbidity, complications, adjuvant therapy, extensive surgical resection, and lower socioeconomic status. 11–19…”

“…First, there are few studies based on clinical settings. 13,18 Population- or worksite-based studies struggle with setting target patients on treatment courses or collecting detailed clinical data. 15,19 In addition, these studies did not consider the willingness of patients to RTW.…”