Employment rate and predictors of return to work in European cancer survivors: a systematic review.

SERVIZIO SANITARIO REGIONALE

EMILIA-ROMAGNA

Azienda Unità Sanitaria Locale di Reggio Emilia

IRCCS Is tuto in tecnologie avanzate e modelli assistenziali in oncologia

Employment rate and predictors of return to work

in European cancer survivors: a systematic review.

Sara Paltrinieri

, Elisa Mazzini

, Stefania Fugazzaro

, Martina Pellegrini

, Chiara Bassi

,

Claudio Tedeschi

, Massimo Vicentini

, Stefania Costi

1

_{Local Health Authority – IRCCS of Reggio Emilia;}

2

_{University of Modena and Reggio Emilia, Modena, Italy}

Background

Cancer incidence and survival are both increasing. Over 1/3 of cancer survivors (CSs) are in their working

_age

_{. CSs experience pain, fatigue, cognitive dysfunction, and mood disorders that may adversely affect social}

functioning

. Systematic reviews show a 64% employment rate for CSs, with high variability in different

contexts (range 24% − 94%)

_{. We reviewed the recent literature on the employment rate of CSs in Europe, investigating the factors}

influencing their return to work (RTW).

Methods

Bibliographic searches were conducted in MEDLINE, CINAHL, EMBASE, PsycINFO, and the Cochrane Library (All Databases) from January 2010 to April 2017, with no language re-strictions. Three independent researchers analyzed and critically eval-uated each citation using the Critical Appraisal Skills Programme, 2017. European population-based studies were selected if included patients with cancer and assessed employment status by a follow-up study

de-sign. We excluded studies focusing on a specific cancer diagnosis. This study was supported by the Chamber of Commerce of Reggio

Emilia, Fondazione GRADE Onlus, and Hospital IRCCS-ASMN of Reg-gio Emilia (Italy).

Results

Twelve observational studies, conducted in the United King-dom, France, the Netherlands, Denmark, Norway, Finland, and Iceland, were included (Figure 1). The cohorts investigated were diagnosed with

cancer from 1987 to 2010 and the median follow-up was 2 years (range

0.2−23.4 years). The samples included individuals in their working age

se-lected through cancer registries, occupational registries, health insurance schemes, or hospital departments. The size of the included samples varied from 280 to 46720 individuals; breast cancer was the most represented cancer (n. 7355), followed by genital and prostate (n. 4868), gastrointesti-nal (n. 1973), upper aerodigestive tract/lung (n. 1512), blood cancer (n. 1436), skin cancer (n. 1197) urological not prostate (n. 659), head and neck, including thyroid (n. 245), and unspecified sites (n. 1250).

RTW of CSs in their working age ranged from 39% to 77%. Among the individuals employed at the time of diagnosis, RTW fluc-tuated from 60% to 92%, the latter registered in a sample with good prognosis. Factors associated with RTW are shown in Figure 2: they embrace the crucial areas of personal features, work-related factors and cancer-related factors, and include some support strategies that facilitate reintegration to work. These findings represent the situation in Northern Europe and, only marginally, in Central Europe; Southern Europe is not at all represented.

Citations retrieved through electronic database search,

duplication excluded

(n=1307)

Excluded after revision of title and abstract because not focused on the

research topic of interest (n.852) or based on qualitative design (n.359)

(n=1211)

Iden

tification

Three citations included after screening the reference lists of relevant systematic reviews

Screening

Full texts reviewed for eligibility

(n=99)

Full-text not eligible: • not focused on cancer patients (n.1) • not european population-based (n.30)

• not reporting the occupational status of CSs by a follow-up design (n.24)

• focused on a specific cancer diagnosis (n.31)

(n=86)

One full-text excluded because its cohort was overlapped with another eligible study

Eligibilit

y

Studies assessed for quality

(n=12)

Studies contributing to this review synthesis with their data

(n=12)

Included

Personal Work related Cancer related Support strategies RTW

>50 years

female low income _{or psychological}high physical

workload _{ments, adverse}active treat-effects, futher

di-agnostic phase, poor prognosis: metastasis, dis-ease progression regional or distant cancer cancer sites: upper aerodi-gestive tracts, lung, gential in middle-age/aged individuals support from supervisor discuss the issue with HCT good prognosis self-employed employed at diagnosis medium-high

income living witha partner low age

male

Positive factors

Negative factors

Conclusion

_{whether RTW is problematic in CSs and whether CSs require socio-rehabilitative interventions to mitigate}

There is an urgent need for precise, up-to-date data collected in Southern and Central Europe to understand

the potential negative impact of cancer on individuals and society.

Bibliography

1. Ferlay J., Soerjomataram I., Dikshit R., Eser S., Mathers C., Rebelo M., Parkin D.M., Forman D., Bray F. Cancer incidence and mortality worldwide: Sources, methods and

major patterns in GLOBOCAN 2012. Int J Cancer. 2015; 136(5):E359–E386.

2. Spelten ER, Sprangers MA, Verbeek JH. Factors reported to influence the return to work of cancer survivors: a literature review. Psychooncology. 2002;11:124-131.

3. Mehnert A. Employment and work-related issues in cancer survivors. Crit Rev Oncol Hematol. 2011;77:109-130.

valcavi.luca @ ausl.re.it Figure 2 Figure 1 1