Guest Editorial Time to act: The challenges of working during and after cancer, initiatives in research and practice A diagnosis of cancer has a significant impact on work and employment. With improvements in cancer treatments more peo- ple are surviving longer, and it is estimated that there are approxi- mately 700,000 people of working age with cancer in the UK (Maddams et al., 2009). This figure is increasing year on year (Maher and McConnell, 2009), not least because people are working later in life. While many people are able to remain in or return to work, a sizeable number experience problems: research shows that people with cancer are 1.37 times more likely to be unemployed than those without (de Boer et al., 2009). Patients experience a lack of well-timed and appropriate support, both in the acute phase and in the months and years following treatment. Health care profes- sionals, in turn, report that they feel ill-equipped to respond adequately to patients’ work-related difficulties (Amir et al., 2009). For cancer survivors, the ability to work is important to maintain- ing social relationships, self-esteem and psychological well-being. A recent systematic review and meta-synthesis of the qualitative liter- ature on employment and cancer (Wells et al., 2013) found consistent evidence that individuals’ experiences of ‘return to work’ were strongly influenced by the degree to which cancer affected four key factors: self-identity, meaning and significance of work, family and financial context, and work environment. Work often helped people to re-establish normality and a sense of their former selves, but at the same time, self-identity was challenged by the physical and emotional consequences of cancer treatment, as well as others’ reac- tions to changes in appearance, physical or cognitive ability. The meaning and significance that individuals had attached to work before cancer frequently shifted, as they re-evaluated their capabil- ities and priorities. The influence of financial pressures and family or friends towards maintaining or changing work consistently played a part, and the difficulties of negotiating sick pay, benefits and insur- ance were frequently mentioned. Finally, the organisational and interpersonal support received within the work environment played a particularly important role in enabling people to talk about and manage the challenges they faced, negotiate different work patterns and responsibilities, and regain confidence at work. The economic consequences of cancer-related lost productivity are significant. For survivors, being at work maintains financial sta- bility, the loss of which can lead to financial distress and adverse psychological consequences (Sharp and Timmons, 2013). From a societal perspective, a recent cost-analysis across the European Union estimated that 60% of the economic burden of cancer was incurred in non-health-care areas, with almost V43 billion in lost productivity attributable to early death, and 83 million lost working days due to cancer related morbidity (Luengo-Fernandez et al., 2013). Welfare legislation in many western countries makes it the legal responsibility of the employer to make ‘reasonable adjustments’ to allow continuing participation in employment for people with disability including cancer. Yet a large proportion of those completing cancer treatment return to work only to leave within the year, reporting reintegration as too difficult. Cancer survivors identify the role played by employers and co- workers as important in supporting and sustaining a successful re- turn to work and in supporting career development (Wells et al., 2013). There is an increasing trend towards the devolution of human resource (HR) work to line managers. This devolvement means that line managers’ role in the return to work process following illness is likely to be central. However, a UK study (Amir et al., 2010) of line managers’ experiences suggests that employers/line-managers require training, support, and resources to help them facilitate employment and job retention of employees diagnosed with cancer. Furthermore, most respondents in a UK national survey of Occupa- tional Health (OH) physicians (Amir et al., 2009) felt managers treated referral to OH differently for employees with cancer compared to management referral for employees with other diagno- ses. Whether this also holds in other European countries is unknown. Unfortunately, many small and medium sized enterprises (and some large enterprises) lack the necessary resources to adequately support the health and well-being of their employees. In response to this, practical tools have been developed in the UK to help support an employee diagnosed with cancer throughout their cancer journey in relation to work (Munir et al., 2011, Munir et al., 2012, 2013; Yarker et al., 2010). This includes support for an employee taking sick leave and returning to work, or an employee who chooses to continue to work during treatment. The Line Manager Behaviour Checklist (Yarker et al., 2010; Munir et al., 2012) was developed for use with a range of chronic conditions, including cancer, and can be accessed by line managers through the Chartered Institute of Personnel Devel- opment (CIPD). A specific resource for those diagnosed with cancer is the ‘Work it Out’ tool (Munir et al., 2011), part of a Toolkit for em- ployees, employers and health professionals, available from the UK Charity Macmillan Cancer Support. This tool allows the employee to feel in control of decision-making by requesting appropriate infor- mation and support not just from their line manager, but also from other relevant stakeholders such as human resources and their oncology nurse or consultant (Munir et al., 2011; 2013). However, although such tools are valuable in minimising some of the undesir- able outcomes of work issues for those diagnosed with cancer, the current literature suggests that much more needs to be done to enable those affected by cancer to sustain employment. Recognising the growing interest and activity in research focussed on cancer and work in the UK and Ireland, a multidisci- plinary group of researchers met at the University of Dundee in May 2011 to share ideas and develop collaborations. The CanWork Contents lists available at ScienceDirect European Journal of Oncology Nursing journal homepage: www.elsevier.com/locate/ejon European Journal of Oncology Nursing 18 (2014) 1e2 1462-3889/$ e see front matter Ó 2014 Published by Elsevier Ltd. http://dx.doi.org/10.1016/j.ejon.2014.01.001
research network was subsequently established, aiming to drive for- ward a programme of research on cancer, employment and finance (CanWork, 2011). More recently, the European Cooperation in Sci- ence and Technology (COST) has funded CANWON - a network of expert scientists, clinicians, economists and patient support groups and other stakeholders on cancer and work (de Boer, 2013). COST is an intergovernmental framework allowing the coordination of nationally-funded research on European level; it does not fund research itself, but it provides support for networking activities and facilitates disseminating research knowledge and best practice worldwide. The CANWON network currently connects 28 re- searchers from 18 EU countries. The network operates through four work groups: (1) prognostic factors for workforce participation in cancer survivors including gender- and country-specific differences; (2) work-related costs of survivorship for both patients and society; (3) the role of employers; and (4) development and evaluation of innovative, interdisciplinary interventions which effectively support employment. The network will make earlier and quicker exchange of new information possible. It also aims to increase the impact of research on cancer and work among policy makers, regulatory bodies and national decision makers as well as the private sector. These initiatives aim to raise awareness of how cancer affects working life, and to draw attention to the need for more research into neglected areas such as: the needs and experiences of partic- ular groups e.g. the self-employed; the views and experiences of line-managers working in small and medium enterprises (SME); the nature of the advice and guidance required by line-managers and employers; potential ways to improve the communication be- tween line-managers, their senior management and relevant occu- pational health advisers and the survivors’ clinical team; and the development and evaluation of effective interventions to support the achievement of work-related goals in cancer survivors. Nurses and other practitioners working in cancer care also need to recognise the importance of work and take opportunities to assess and consider how cancer and its treatment may interfere with a person’s ability to maintain their working life, and as a result, their identity and financial security. Evidence (albeit limited) sug- gests that the clinician team managing the patient can have a key in- fluence on the likelihood of subsequent return to work (Pryce et al., 2007). Implementing the provision of work-related information, advice and support into clinical practice is an important next step. Front line oncology staff need not be experts in this field but need to be prepared to open this dialogue from the outset, asking appro- priate questions, advising on the most likely course of events and how these may impact on work. In order to manage expectations and help individuals plan for their future working life, written and verbal information and support should be provided throughout the cancer pathway, particularly around the time of diagnosis and at the end of treatment. Oncology nurses have a key role to play in signposting to further advice and support, for example to hospital- based social workers (where they exist), vocational rehabilitation services, local cancer support and information centres. Perhaps most importantly, nurses are in a position to ensure that an under- standing of the complexities of work-related decisions and experi- ences becomes integral to the care of people with cancer. References Amir, Z., Wynn, P., Whitaker, S., Luker, K., 2009. Cancer survivorship and return to work e UK Occupational Health Physician experiences. Occupational Medicine 59, 390e396. Amir, Z., Wynn, P., Fong, C., Strauser, D., Whitaker, S., Luker, K., 2010. Return towork after cancer in the UK: attitudes and experiences of line managers. Journal of Occupational Rehabilitation 20, 435e442. CanWork, 2011. CanWork: Establishing a UK/Ireland Network for Research on Can- cer and Employment. Poster presentation at NCRI conference 2011. http://www. richardgkyle.com/wp-content/uploads/2011/10/NCRI-CanWork-Poster.pdf. de Boer, A.G., Taskila, T., Ojajarvi, A., van Dijk, F.J., Verbeek, J.H., 2009. Cancer survi- vors and unemployment: a meta-analysis and meta-regression. Journal of the American Medical Association 301, 753e762. de Boer, A.G.E.M., September 2013. The European Cancer and Work Network CAN- WON. Journal of Occupational Rehabilitation. http://dx.doi.org/10.1007/s10926- 013-9474-5. Luengo-Fernandez, R., Leal, J., Gray, A., Sullivan, R., 2013. Economic burden of cancer across the European Union: a population-based cost analysis. Lancet Oncology 14, 1165e1174. Maddams, J., Brewster, D., Gavin, A., Steward, J., Elliott, J., Utley, M., Møller, H., 2009. Cancer prevalence in the United Kingdom: estimates for 2008. British Journal of Cancer 101, 541e547. Maher, J., McConnell, H., 2009. New pathways of care for cancer survivors: adding the numbers. British Journal of Cancer 105, S5eS10. Munir, F., Yarker, J., Hicks, B., Donaldson-Feilder, E., 2012. Returningemployees back to work: developing a measure for supervisors to Support Return to Work (SSRW). Journal of Occupational Rehabilitation 22, 196e208. Munir, F., Kalawsky, K., Wallis, D., Donaldson-Feilder, E., 2013. Using intervention mapping to develop a work-related guidance tool for those affected by cancer. BMC Public Health 13, 6. http://dx.doi.org/10.1186/1471-2458-13-6. Munir, F., Wallis, D., Kalawsky, K., Donaldson-Feilder, E., 2011. Work it Out: the Essential Questions to Ask about Work. Macmillan Cancer Support, London. Available from: http://www.macmillan.org.uk/Documents/GetInvolved/Campaigns/Working ThroughCancer/WorkItOut/WorkItOut.pdf (accessed 09.12.13.). Pryce, J., Munir, F., Haslam, C., 2007. Cancer survivorship and work: symptoms, su- pervisor response, co-worker disclosure and work adjustment. Journal of Occu- pational Rehabilitation 17, 83e92. Sharp, L., Timmons, A., 2013. Associations between cancer-related financial stress and strain and psychological wellbeing among individuals living with cancer. Psychooncology 22 (4), 745e755. Wells, M., Williams, B., Firnigl, D., MacGillivray, S., Lang, H., Coyle, J., Kroll,T., 2013. Supporting “work-related goals” rather than “return to work” after cancer? A systematic review and meta-synthesis of 25 qualitative studies. Psychooncology 22, 1208e1219. Yarker, J., Munir, F., Donaldson-Feilder, E., Hicks, B., 2010. Managing Rehabilitation: Competency Framework for Managers to Support Return to Work. BOHRF, London. Authors Mary Wells, Ziv Amir, Tom Cox, Gail Eva, Diana Greenfield, Gill Hubbard, Richard Kyle, Sara McLennan, Fehmidah Munir, Sarah Scott, Linda Sharp, Tyna Taskila, Theresa Wiseman (the CANWORK research group) CANWORK group members (in alphabetical order and by institution) Prof Ziv Amir Honorary Professor e Cancer Rehabilitation, WELLNESS WORKS, University of Salford, C411 Allerton, University of Salford. Salford, M6 6PU Dr Gail Eva, NIHR Post-doctoral Research Fellow, UCL Institute of Neurology, Queen Square, London WC1N 3BG Dr Diana Greenfield, Consultant Nurse & Honorary Senior Lecturer, Sheffield Teaching Hospitals NHS Foundation Trust, Weston Park Hospital, Whitham Road, Sheffield S10 2SJ Dr Gill Hubbard, Reader and Dr Richard Kyle, Lecturer, Cancer Care Research Centre, School of Nursing, Midwifery and Health, University of Stirling, Centre for Health Science, Old Perth Road, Inverness IV2 3JH Dr Fehmidah Munir, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire LE11 3TU Miss Sarah Scott, Professor Tom Cox and Dr Sara Maclennan, Ac- ademic Urology Unit, Health Sciences Building (2nd Floor), Univer- sity of Aberdeen, Foresterhill, Aberdeen AB25 2ZD Prof Linda Sharp, National Cancer Registry Ireland, Building 6800, Cork Airport Business Park, Kinsale Road, Cork, Ireland Dr. Tyna Taskila, Senior Researcher, The Work Foundation, Centre for Workforce Effectiveness, 21 Palmer Street, London SW1H 0AD Prof. Mary Wells, Professor of Cancer Nursing Research & Prac- tice, NMAHP Research Unit, University of Stirling, Stirling FK9 4LA Dr Theresa Wiseman, Lead for Health Service Research, Nursing, Rehab and Quality, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ Guest Editorial / European Journal of Oncology Nursing 18 (2014) 1e2 2
European Journal of Oncology Nursing 18 (2014) 1e2
Contents lists available at ScienceDirect
European Journal of Oncology Nursing
journal homepage: www.elsevier.com/locate/ejon
Guest Editorial
Time to act: The challenges of working during and after cancer, initiatives in
research and practice
A diagnosis of cancer has a significant impact on work and
employment. With improvements in cancer treatments more people are surviving longer, and it is estimated that there are approximately 700,000 people of working age with cancer in the UK
(Maddams et al., 2009). This figure is increasing year on year
(Maher and McConnell, 2009), not least because people are working
later in life. While many people are able to remain in or return to
work, a sizeable number experience problems: research shows
that people with cancer are 1.37 times more likely to be unemployed
than those without (de Boer et al., 2009). Patients experience a lack
of well-timed and appropriate support, both in the acute phase and
in the months and years following treatment. Health care professionals, in turn, report that they feel ill-equipped to respond
adequately to patients’ work-related difficulties (Amir et al., 2009).
For cancer survivors, the ability to work is important to maintaining social relationships, self-esteem and psychological well-being. A
recent systematic review and meta-synthesis of the qualitative literature on employment and cancer (Wells et al., 2013) found consistent
evidence that individuals’ experiences of ‘return to work’ were
strongly influenced by the degree to which cancer affected four key
factors: self-identity, meaning and significance of work, family and
financial context, and work environment. Work often helped people
to re-establish normality and a sense of their former selves, but at the
same time, self-identity was challenged by the physical and
emotional consequences of cancer treatment, as well as others’ reactions to changes in appearance, physical or cognitive ability. The
meaning and significance that individuals had attached to work
before cancer frequently shifted, as they re-evaluated their capabilities and priorities. The influence of financial pressures and family
or friends towards maintaining or changing work consistently played
a part, and the difficulties of negotiating sick pay, benefits and insurance were frequently mentioned. Finally, the organisational and
interpersonal support received within the work environment played
a particularly important role in enabling people to talk about and
manage the challenges they faced, negotiate different work patterns
and responsibilities, and regain confidence at work.
The economic consequences of cancer-related lost productivity
are significant. For survivors, being at work maintains financial stability, the loss of which can lead to financial distress and adverse
psychological consequences (Sharp and Timmons, 2013). From a
societal perspective, a recent cost-analysis across the European
Union estimated that 60% of the economic burden of cancer was
incurred in non-health-care areas, with almost V43 billion in lost
productivity attributable to early death, and 83 million lost working
days due to cancer related morbidity (Luengo-Fernandez et al.,
2013). Welfare legislation in many western countries makes it the
legal responsibility of the employer to make ‘reasonable
1462-3889/$ e see front matter Ó 2014 Published by Elsevier Ltd.
http://dx.doi.org/10.1016/j.ejon.2014.01.001
adjustments’ to allow continuing participation in employment for
people with disability including cancer. Yet a large proportion of
those completing cancer treatment return to work only to leave
within the year, reporting reintegration as too difficult.
Cancer survivors identify the role played by employers and coworkers as important in supporting and sustaining a successful return to work and in supporting career development (Wells et al.,
2013). There is an increasing trend towards the devolution of human
resource (HR) work to line managers. This devolvement means that
line managers’ role in the return to work process following illness
is likely to be central. However, a UK study (Amir et al., 2010) of
line managers’ experiences suggests that employers/line-managers
require training, support, and resources to help them facilitate
employment and job retention of employees diagnosed with cancer.
Furthermore, most respondents in a UK national survey of Occupational Health (OH) physicians (Amir et al., 2009) felt managers
treated referral to OH differently for employees with cancer
compared to management referral for employees with other diagnoses. Whether this also holds in other European countries is unknown.
Unfortunately, many small and medium sized enterprises (and
some large enterprises) lack the necessary resources to adequately
support the health and well-being of their employees. In response
to this, practical tools have been developed in the UK to help support
an employee diagnosed with cancer throughout their cancer journey
in relation to work (Munir et al., 2011, Munir et al., 2012, 2013; Yarker
et al., 2010). This includes support for an employee taking sick leave
and returning to work, or an employee who chooses to continue to
work during treatment. The Line Manager Behaviour Checklist
(Yarker et al., 2010; Munir et al., 2012) was developed for use with
a range of chronic conditions, including cancer, and can be accessed
by line managers through the Chartered Institute of Personnel Development (CIPD). A specific resource for those diagnosed with cancer is
the ‘Work it Out’ tool (Munir et al., 2011), part of a Toolkit for employees, employers and health professionals, available from the UK
Charity Macmillan Cancer Support. This tool allows the employee
to feel in control of decision-making by requesting appropriate information and support not just from their line manager, but also from
other relevant stakeholders such as human resources and their
oncology nurse or consultant (Munir et al., 2011; 2013). However,
although such tools are valuable in minimising some of the undesirable outcomes of work issues for those diagnosed with cancer, the
current literature suggests that much more needs to be done to
enable those affected by cancer to sustain employment.
Recognising the growing interest and activity in research
focussed on cancer and work in the UK and Ireland, a multidisciplinary group of researchers met at the University of Dundee in
May 2011 to share ideas and develop collaborations. The CanWork
2
Guest Editorial / European Journal of Oncology Nursing 18 (2014) 1e2
research network was subsequently established, aiming to drive forward a programme of research on cancer, employment and finance
(CanWork, 2011). More recently, the European Cooperation in Science and Technology (COST) has funded CANWON - a network of
expert scientists, clinicians, economists and patient support groups
and other stakeholders on cancer and work (de Boer, 2013). COST is
an intergovernmental framework allowing the coordination of
nationally-funded research on European level; it does not fund
research itself, but it provides support for networking activities and
facilitates disseminating research knowledge and best practice
worldwide. The CANWON network currently connects 28 researchers from 18 EU countries. The network operates through four
work groups: (1) prognostic factors for workforce participation in
cancer survivors including gender- and country-specific differences;
(2) work-related costs of survivorship for both patients and society;
(3) the role of employers; and (4) development and evaluation of
innovative, interdisciplinary interventions which effectively support
employment. The network will make earlier and quicker exchange of
new information possible. It also aims to increase the impact of
research on cancer and work among policy makers, regulatory bodies
and national decision makers as well as the private sector.
These initiatives aim to raise awareness of how cancer affects
working life, and to draw attention to the need for more research
into neglected areas such as: the needs and experiences of particular groups e.g. the self-employed; the views and experiences of
line-managers working in small and medium enterprises (SME);
the nature of the advice and guidance required by line-managers
and employers; potential ways to improve the communication between line-managers, their senior management and relevant occupational health advisers and the survivors’ clinical team; and the
development and evaluation of effective interventions to support
the achievement of work-related goals in cancer survivors.
Nurses and other practitioners working in cancer care also need
to recognise the importance of work and take opportunities to
assess and consider how cancer and its treatment may interfere
with a person’s ability to maintain their working life, and as a result,
their identity and financial security. Evidence (albeit limited) suggests that the clinician team managing the patient can have a key influence on the likelihood of subsequent return to work (Pryce et al.,
2007). Implementing the provision of work-related information,
advice and support into clinical practice is an important next step.
Front line oncology staff need not be experts in this field but need
to be prepared to open this dialogue from the outset, asking appropriate questions, advising on the most likely course of events and
how these may impact on work. In order to manage expectations
and help individuals plan for their future working life, written and
verbal information and support should be provided throughout
the cancer pathway, particularly around the time of diagnosis and
at the end of treatment. Oncology nurses have a key role to play in
signposting to further advice and support, for example to hospitalbased social workers (where they exist), vocational rehabilitation
services, local cancer support and information centres. Perhaps
most importantly, nurses are in a position to ensure that an understanding of the complexities of work-related decisions and experiences becomes integral to the care of people with cancer.
References
Amir, Z., Wynn, P., Whitaker, S., Luker, K., 2009. Cancer survivorship and return to work e
UK Occupational Health Physician experiences. Occupational Medicine 59, 390e396.
Amir, Z., Wynn, P., Fong, C., Strauser, D., Whitaker, S., Luker, K., 2010. Return to work
after cancer in the UK: attitudes and experiences of line managers. Journal of
Occupational Rehabilitation 20, 435e442.
CanWork, 2011. CanWork: Establishing a UK/Ireland Network for Research on Cancer and Employment. Poster presentation at NCRI conference 2011. http://www.
richardgkyle.com/wp-content/uploads/2011/10/NCRI-CanWork-Poster.pdf.
de Boer, A.G., Taskila, T., Ojajarvi, A., van Dijk, F.J., Verbeek, J.H., 2009. Cancer survivors and unemployment: a meta-analysis and meta-regression. Journal of the
American Medical Association 301, 753e762.
de Boer, A.G.E.M., September 2013. The European Cancer and Work Network CANWON. Journal of Occupational Rehabilitation. http://dx.doi.org/10.1007/s10926013-9474-5.
Luengo-Fernandez, R., Leal, J., Gray, A., Sullivan, R., 2013. Economic burden of cancer
across the European Union: a population-based cost analysis. Lancet Oncology
14, 1165e1174.
Maddams, J., Brewster, D., Gavin, A., Steward, J., Elliott, J., Utley, M., Møller, H., 2009.
Cancer prevalence in the United Kingdom: estimates for 2008. British Journal of
Cancer 101, 541e547.
Maher, J., McConnell, H., 2009. New pathways of care for cancer survivors: adding
the numbers. British Journal of Cancer 105, S5eS10.
Munir, F., Yarker, J., Hicks, B., Donaldson-Feilder, E., 2012. Returning employees back
to work: developing a measure for supervisors to Support Return to Work
(SSRW). Journal of Occupational Rehabilitation 22, 196e208.
Munir, F., Kalawsky, K., Wallis, D., Donaldson-Feilder, E., 2013. Using intervention
mapping to develop a work-related guidance tool for those affected by cancer.
BMC Public Health 13, 6. http://dx.doi.org/10.1186/1471-2458-13-6.
Munir, F., Wallis, D., Kalawsky, K., Donaldson-Feilder, E., 2011. Work it Out: the Essential
Questions to Ask about Work. Macmillan Cancer Support, London. Available from:
http://www.macmillan.org.uk/Documents/GetInvolved/Campaigns/Working
ThroughCancer/WorkItOut/WorkItOut.pdf (accessed 09.12.13.).
Pryce, J., Munir, F., Haslam, C., 2007. Cancer survivorship and work: symptoms, supervisor response, co-worker disclosure and work adjustment. Journal of Occupational Rehabilitation 17, 83e92.
Sharp, L., Timmons, A., 2013. Associations between cancer-related financial stress
and strain and psychological wellbeing among individuals living with cancer.
Psychooncology 22 (4), 745e755.
Wells, M., Williams, B., Firnigl, D., MacGillivray, S., Lang, H., Coyle, J., Kroll, T., 2013.
Supporting “work-related goals” rather than “return to work” after cancer? A
systematic review and meta-synthesis of 25 qualitative studies. Psychooncology
22, 1208e1219.
Yarker, J., Munir, F., Donaldson-Feilder, E., Hicks, B., 2010. Managing Rehabilitation:
Competency Framework for Managers to Support Return to Work. BOHRF, London.
Authors
Mary Wells, Ziv Amir, Tom Cox, Gail Eva, Diana Greenfield,
Gill Hubbard, Richard Kyle, Sara McLennan, Fehmidah Munir,
Sarah Scott, Linda Sharp, Tyna Taskila, Theresa Wiseman (the
CANWORK research group)
CANWORK group members (in alphabetical order and by
institution)
Prof Ziv Amir Honorary Professor e Cancer Rehabilitation,
WELLNESS WORKS, University of Salford, C411 Allerton, University
of Salford. Salford, M6 6PU
Dr Gail Eva, NIHR Post-doctoral Research Fellow, UCL Institute of
Neurology, Queen Square, London WC1N 3BG
Dr Diana Greenfield, Consultant Nurse & Honorary Senior
Lecturer, Sheffield Teaching Hospitals NHS Foundation Trust,
Weston Park Hospital, Whitham Road, Sheffield S10 2SJ
Dr Gill Hubbard, Reader and Dr Richard Kyle, Lecturer, Cancer Care
Research Centre, School of Nursing, Midwifery and Health, University
of Stirling, Centre for Health Science, Old Perth Road, Inverness IV2 3JH
Dr Fehmidah Munir, School of Sport, Exercise and Health Sciences,
Loughborough University, Loughborough, Leicestershire LE11 3TU
Miss Sarah Scott, Professor Tom Cox and Dr Sara Maclennan, Academic Urology Unit, Health Sciences Building (2nd Floor), University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD
Prof Linda Sharp, National Cancer Registry Ireland, Building
6800, Cork Airport Business Park, Kinsale Road, Cork, Ireland
Dr. Tyna Taskila, Senior Researcher, The Work Foundation, Centre
for Workforce Effectiveness, 21 Palmer Street, London SW1H 0AD
Prof. Mary Wells, Professor of Cancer Nursing Research & Practice, NMAHP Research Unit, University of Stirling, Stirling FK9 4LA
Dr Theresa Wiseman, Lead for Health Service Research, Nursing,
Rehab and Quality, The Royal Marsden NHS Foundation Trust,
Fulham Road, London SW3 6JJ
Purpose: Over the last several years, the number of working-age patients with cancer in Europe and
Romania has consistently increased. Considerable efforts are made to bring cancer survivors back to the
workforce, generating remarkable individual and societal benefits. Legislation and policies are essential
factors in achieving this goal. The aim of the present article is to analyze the Romanian statutory policies
for returning to work after cancer.
Methods: A comprehensive search using key terms was carried out on the websites of the Ministry of
Labor and Ministry of Health and also within the Romanian Official Gazette, which is the official national
paper-based repository of legal documents. Nine work-related policy documents were found, and recurrent
themes were identified. Within these themes, the authors synthetized the information on provisions,
actors, structures, processes and responsibilities.
Results: Three themes emerged from the analysis: (1) General and cancer-specific provisions; (2) The cancer
survivor’s journey in relation to work; and (3) Work adjustments. The policies contain no measures for
incentivising return to work. The mechanisms for collaboration and coordination among stakeholders are
not described in the policies.
Conclusions: The current policies put an emphasis on compensation but fail to encompass activation
measures. Considering that, for several components of the return to work process, the general principles
are already stated in the law, it is vital to further develop the policies in the sense of specifying the procedures,
roles and responsibilities for the stakeholders involved.
Non-communicable diseases (NCDs) have large economic impact at multiple levels. To systematically review the literature investigating the economic impact of NCDs [including coronary heart disease (CHD), stroke, type 2 diabetes mellitus (DM), cancer (lung, colon, cervical and breast), chronic obstructive pulmonary disease (COPD) and chronic kidney disease (CKD)] on macro-economic productivity. Systematic search, up to November 6th 2014, of medical databases (Medline, Embase and Google Scholar) without language restrictions. To identify additional publications, we searched the reference lists of retrieved studies and contacted authors in the field. Randomized controlled trials, cohort, case-control, cross-sectional, ecological studies and modelling studies carried out in adults (>18 years old) were included. Two independent reviewers performed all abstract and full text selection. Disagreements were resolved through consensus or consulting a third reviewer. Two independent reviewer...
Patients who have completed initial cancer treatment (cancer survivors) have been relatively neglected. We need data to help us better understand the needs of this group and to underpin evidence-based service development. Scoping reviews of research published in the last two decades focussing on the problems faced by cancer survivors, and the effectiveness of interventions for these problems were undertaken. The aim was to identify what we know, what we do not know and opportunities where research could provide new information. We searched for, retrieved and rapidly appraised systematic reviews sourced from the most common electronic databases supplemented by more recently published individual studies. The research evidence is surprisingly limited. We have some knowledge of the prevalence and nature of depression, pain and fatigue in cancer survivors. We know much less about cognitive and physical impairment, employment, financial well-being and relationships. Even where we have evi...
To identify the specific management behaviours associated with the effective management of stress in nursing; and to build a stress management competency framework that can be integrated and compared with nurse management frameworks. Workplace stress is a significant problem in healthcare, especially within nursing. While there is a reasonable consensus regarding the sources of stress and its impact on health and well-being, little is known about the specific line manager behaviours that are associated with the effective and ineffective management of stress. Semi-structured interviews using critical incident technique were conducted with 41 employees working within 5 National Health Service (NHS) trusts within the United Kingdom. Data were transcribed and analysed using content analysis. 19 competencies (or sets of behaviour) were identified in the management of stress in employees. The 3 most frequently reported competencies: managing workload and resources, individual consideration and participative approach, are discussed in detail with illustrative quotes. Managers are vital in the reduction and management of stress at work. Importantly, the 2 of the 3 dominant competencies, managing workload and resources and individual consideration, do not feature in the UK's NHS Knowledge and Skills Framework, suggesting there are important skills gaps with regard to managing workplace stress. The implications of this approach for training and development, performance appraisal and assessment are discussed. Interventions to support managers develop effective behaviours are required to help reduce and manage stress at work.
Achieving full recovery after colorectal cancer surgery means a return to normal physical and psychological health and to a normal social life. Recovery data focusses on time to discharge rather than longer term functionality including return to work (RTW). We aim to assess return to normal holistic function at 1 year after colorectal cancer surgery. Questionnaires were created and dispatched to 204 patients who had undergone surgery with curative intent for colorectal cancer, in 2011-2012, in a single teaching hospital. Response rate was 75 % (153/204), 82 % (129/157) for open surgery (OS) and 51 % (24/47) for laparoscopic surgery (LS). Median age was 68 (48-91) years for OS and 65 (36-84) for LS. Eighty-four per cent of patients felt 'ready' and 95 % had adequate pain control upon discharge (no difference between groups). LS reported earlier 'return to full fitness' (1-3 months) than OS (>6 months; Mann-Whitney U, p < 0.05). Recovery from LS was 'better t...
Background: Many patients with life limiting illnesses continue to work because of financial reasons and because work provides good psychosocial support. A lack of appropriate advice/support through patient education could, however, make having a job detrimental to wellbeing (e.g., symptom worsening).
Aim: This study investigated the frequency with which patients received information that empowers their understanding of their condition, treatment, side effects of treatment and the likely impact on occupational functioning.
Design: A cross-sectional study.
Setting/participants: An analysis of survey data from 3457 cancer patients in employment. Results: Logistic regression showed that patients who received information about the impact of cancer on work life or education are 1.72 times more likely to have a positive treatment outcome. Patients who receive written information about the type of cancer are 1.99 times more likely to have a positive treatment outcome. Patients who receive written information before a cancer-related operation are 1.90 more likely to have a positive treatment outcome. Information about the side effects of cancer treatment produces worse odds of a positive treatment outcome (0.65 to 1). A stepwise logistic regression analysing the effects irrespective of current employment status in 6710 patients showed that preparing them produces nearly twice better odds of cancer treatment responsiveness.
Conclusions: Palliative care teams should consider ways of actively advising patients who work. Whereas the results showed evidence of good practice in cancer care, there is a need to ensure that all working patients with potentially life-limiting illnesses receive similar support.
The extent to which self-assessed work ability collected during treatment can predict return-to-work in cancer patients is unknown. In this prospective study, we consecutively included employed cancer patients who underwent treatment with curative intent at 6 months following the first day of sick leave. Work ability data (scores 0-10), clinical and sociodemographic data were collected at 6 months, while return-to-work was measured at 6, 12 and 18 months. Most of the 195 patients had been diagnosed with breast cancer (26%), cancer of the female genitals (22%) or genitourological cancer (22%). Mean current work ability scores improved significantly over time from 4.6 at 6 months to 6.3 and 6.7 at 12 and 18 months, respectively. Patients with haematological cancers and those who received chemotherapy showed the lowest work ability scores, while patients with cancer of urogenital tract or with gastrointestinal cancer had the highest scores. Work ability at 6 months strongly predicted r...
Background: Cognitive impairment, colloquially termed ''chemobrain'', occurs in 10–40% of all cancer patients, and is an emerging target of cancer survivorship research.
With the recent changes in the world of work psychosocial risks are increasingly prevalent, causing work stress and physical and mental illnesses, which have a tremendous impact on public health and social participation. Supervisors' behaviour development was proposed as an innovative intervention that can reduce psychosocial risks. The "Stress Management Competency Indicator Tool" is one of the most important questionnaires that assess managers' preventive behaviour. However, its psychometric properties have never been evaluated and the length of the questionnaire (66 items) limits its practical applicability. The aim of this study was to contribute to the development of the questionnaire by providing psychometric evidence on a brief version of the tool focusing on the "Managing and Communicating existing and future Work" cluster of behaviours, which has been found to be the crucial one in terms of stress prevention. A questionnaire was administered to 1...
Cancer patients often report cognitive changes after chemotherapy. The Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog) is a self-report questionnaire that assesses these changes. The aims of the present study were (1) to establish normative data, and (2) to compare the scores of patients and healthy controls to assess whether or not the questionnaire is able to discriminate between these populations. The normative sample included 213 healthy participants. The patient group included 63 cancer patients treated with chemotherapy, who were compared to a subsample of 63 matched healthy controls. The questionnaire had good internal consistency reliability (Cronbach's alphas = .74-.91). The oldest patients had significantly more cognitive complaints (p < .001). Cognitive complaints were significantly related with Trail Making Test scores (p < .001). Furthermore, the FACT-Cog subscales correlated significantly with anxiety and depression. Patients had more co...
Stigma and workplace discrimination have been identified as prominent challenges to employment following cancer. However, there has been limited examination of how stigma develops in work contexts and how it influences cancer survivors' return to work process and their disclosure decisions. In the broader study from which this paper emerges, we used an exploratory qualitative design to examine the return to work process (including workplace supports and accommodations) of cancer survivors. We conducted 40 semi-structured interviews with (i) cancer survivors (n = 16), (ii) health care/vocational service providers (n = 16), and (iii) employer representatives (n = 8). We used thematic analysis methods to analyze the data. In this paper, we present data related specifically to workplace stigma, discrimination, and disclosure. Contrasting perspectives were identified among our stakeholder groups regarding the existence and impact of stigma in the workplace. While most provider and em...
Introduction: Burnout is usually defined as a combination of emotional exhaustion, depersonalization, and reduced personal accomplishment resulting from chronic occupational stress. Because of etiological similarities and shared features, distinguishing burnout from depression is challenging. The objective of the present study was to examine whether changes in burnout symptoms are relatively independent from changes in depressive symptoms or systematically accompany them. Method: A total of 5,575 teachers were included in the study. Burnout was assessed with the Maslach Burnout Inventory (MBI). The MBI is considered the ‘gold standard’ for the measurement of burnout. Depression was assessed with the 9-item depression-dedicated module of the Patient Health Questionnaire (PHQ-9). The PHQ-9 directly targets the nine major depression diagnostic criteria specified by the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; American Psychiatric Association, 2013). The teachers ...
Introduction: The distinction between burnout and depression notably relies on the idea that burnout is job-related whereas depression is context-free. Despite its popularity, this idea is not beyond question and requires further testing. The objective of the present study was twofold. First, we sought to determine whether major life stress (MLS), a context-free variable, was more strongly related to depression than to burnout. Second, we examined whether job-related stress (JRS) and social support at work (SSW) were more strongly related to burnout than to depression. Method: The present study involved 277 Northern American teachers. The Shirom-Melamed Burnout Measure was used to assess burnout. The 9-item depression-dedicated module of the Patient Health Questionnaire was used to assess depression. MLS was assessed with a 7-item scale. Teachers had to indicate whether or not they had experienced a series of personal life events in the past 12 months (e.g. death of a close family m...