Introduction
Materials and methods
Search strategy
Eligibility criteria
Data extraction
Analysis
Quality appraisal
Results
Study selection
Author and year | Country, state | Study design and source of patients | Study population | Time-point(s) outcome assesseda | Outcome | Results |
---|---|---|---|---|---|---|
Amir et al., 2007 [28] | UK, England | Cross-sectional survey Source: Population-based cancer registry | N = 267; 48% breast, 14% colorectal, 9% prostate, 6% lung, 23% other; 73% female; mean 48 years | 3 years | Working; Self-reported postal questionnaire | 82% working |
Blinder et al., 2012; [29] Blinder et al., 2013 [30] | USA, California | Prospective survey Source: breast cancer treatment | N = 290 and 274; 100% breast cancer; 100% female; median 49 years | 3 and 5 years | Working/return to work; self-reported by telephone interview | 3 years: 56% working 5 years: 72% returned to work |
Bradley and Bednarek, 2002; [31] Bednarek and Bradley, 2005 [32] | USA, Michigan | Cross-sectional survey Source: Population-based cancer registry | N = 141; 29% breast, 21% colorectal, 23% lung, 27% prostate; 47% female; mean 61 years | 5–7 years | Employed (full or part-time); self-reported in telephone interview | 67% employed |
Dahl et al., 2015 [33] | Norway | Prospective survey Source: 14 urology clinics | N = 330; 100% prostate cancer; 100% male; age not reported | 3 years | Working (full or part-time); self-reported on postal questionnaire | 93% working |
Hamood et al., 2018 [34] | Israel | Cross-sectional survey Source: Health insurance fund | N = 206; 100% breast cancer; 100% female; mean 49 years | 3–14 years (mean 8.5 years) | Working (full or part-time); self-reported on questionnaire | 67% working |
Jagsi et al., 2014 [35] | USA, California, Michigan | Prospective survey Source: Population-based cancer registries | N = 746; 100% breast cancer; 100% female; mean 50 years | 4 years | No longer working; self-reported on postal questionnaire | 32% no longer working |
Jeon, 2016 [36] | Canada | Prospective, linkage of cancer cases and non-cancer comparators Source: Administrative data | N = 2597; 26% breast, 11% cervical, 9% colorectal, 8% prostate; 63% female; mean 48 years N = 82,183 non-cancer comparators; 63% female, mean 48 years | 3 years | Workingb from national statistics | 85% of survivors working vs 94% of non-cancer comparison group |
Johnsson et al., 2007 [37] | Sweden | Observational study, nested in prospective RCT Source: Five hospitals | N = 222 and 204; 100% breast cancer; 100% female; mean 47 years | 2 and 3 years | Return to work; self-reported questionnaire | 2 years: 84% returned to work 3 years: 86% returned to work |
Kiserud et al., 2016 [38] | Norway | Cross-sectional survey Source: Four oncology departments | N = 265; 100% lymphoma; 40% female; mean 42 years | 12 years | Employedc; self-reported by postal questionnaire | 56% employed |
Landeiro et al., 2018 [39] | Brazil | Prospective survey Source: single clinical center | N = 111; 100% breast cancer; 100% female; age not reported | 2 years | Working (full-time or part-time); self-reported by telephone interview | 60% working |
Maunsell et al., 2004 [40]; Drolet et al., 2005a [41]; Drolet et al., 2005b [42] | Canada, Quebec | Cross-sectional survey of survivors and cancer-free controls recruited via provincial healthcare files Source: Population-based cancer registry | N = 646; 100% breast cancer; 100% female; mean 47 years Controls: N = 890; 1000% female, mean 45 years | 3 years | Unemployed; self-reported by telephone interview | 21% of survivors unemployed vs 15% of controls |
Mols et al., 2009 [43] | Netherlands | Cross-sectional survey Source: Population-based cancer registry | N = 403; 25% prostate; 15% endometrial; 25% Hodgkin’s lymphoma; 35% non-Hodgkin’s; 40% female; mean 53 years | 8.5 years | Workingd; self-reported postal questionnaire | 66% working |
Paraponaris et al., 2010 [44]; Marino et al., 2013 [45] | France | Cross-sectional survey Source: National Health Insurance Fund | N = 1424; 41% breast; 5% prostate; 12% other urogenital; 32% other; 65% female; mean 47 years | 2 years | Working; self-reported by telephone interview | 66% working |
Pearce et al., 2014 [46] | Ireland | Cross-sectional survey Source: Population-based cancer registry | N = 264; 32% larynx, 23% pharynx, 45% other sites in head and neck; 29% female; mean 52 years | 2, 3, 4 and 5 years | Working; self-reported by postal questionnaire | 2 years: 64% working 3 years: 68% working 4 years: 68% working 5 years: 68% working |
Sanchez et al., 2004 [47] | USA, California | Cross-sectional survey Source: Two population-based cancer registries | N = 200; 100% colorectal; 54% female; mean 49 years | 5 years | Employed; Self-reported by postal questionnaire | 71% employed |
Short et al., 2005 [48]; Farley Short et al., 2008 [49]; Moran et al., 2011 [50] | USA, Pennsylvania and Maryland | Cross-sectional interview with 1 year follow-up, and non-cancer comparator populations Source: Hospital tumor registries, and panel/labor market surveyse | N = 1433 and 1511; 31% breast, 8% prostate, 7% colorectal, 54% other sites; 64% female; mean 49 years Non-cancer comparators: N = 4141 (aged 28–54) and 3903 (aged 55–65) | 2.5 years and 3.5 years | Return to work; self-reported by telephone interview | 2.5 years: 81%f returned to work 3.5 years: 84%f returned to work |
Tevaarwerk et al., 2013 [51] | United States, Wisconsin | Cross-sectional survey Source: 38 institutions | N = 225; 75% breast, 14% colorectal, 4% prostate, 7% lung; 84% female; mean 48 years | > 2 years (on average 4 years) | Working (full or part-time); self -reported | 83% working |
Tison et al., 2016 [52]; Alleaume et al. 2018 [53] | France | Cross-sectional survey with comparators Source: Three sickness funds and labor market survey (comparators) | 2 years: N = 2055; various diagnoses; 59% female; mean 56 years; Non-cancer comparators: N = 2055; 52% female; mean 39 years 5 years: N = 969; 58% breast cancer, thyroid 10%, lung 7%; 82% female; 18–54 years at diagnosis | 2 years 5 years | Employed; telephone survey or postal questionnaire (survivors) or face-to-face interview (comparators) | 2 years: salaried individuals: 79% survivors versus 94% controls 2 years: self-employed: 86% survivors versus 96% controls 5 years: 82% cancer survivors |
Van den Brink et al., 2007 [54] | Netherlands | Observational study nested within prospective RCT Source: 84 hospitals | N = 238; 100% rectal; 51% female; mean 52 years | 2 years | Paid labor resumption; self-reported by questionnaire | 70% paid labor resumption (55% completely; 15% partially) |
Vartanian et al., 2006 [55] | Brazil | Cross-sectional survey Source: Single hospital | N = 301; oral cavity 53%, oropharynx 18%, larynx 26%, hypopharynx 3%; 22% female; median 52 years | > 2 years (on average 10 years) | Unable to workg; self-reported in face-to-face interview | 33% unable to work |
Verdonck-de Leeuw et al. 2010 [56] | Netherlands | Cross-sectional survey Source: Single hospital | N = 53; oral cavity/oropharynx 37%, larynx 34%, nasopharynx 18%, other head and neck site 12%; female 36%; median 59 years | > 2 years (on average 4 years) | Return to work; self-reported by postal questionnaire | 83% returned to work |
Study characteristics
Quality assessment
Workforce retention among long-term survivors
Studies with non-cancer comparators
Risk factors for work retention among long-term survivors
Author and year | Risk factors assessed | Resultsa |
---|---|---|
Amir et al., 2007 [28] | • Patient-related: gender, deprivation • Clinical: surgery • Work-related: length of sick leave | Longer sick leave (OR = 1.68, 1.2–2.3) and absence of surgery (OR = 0.28, 0.08–0.9) were significantly associated with working 3 years after diagnosis |
Blinder et al., 2012 [29]; Blinder et al., 2013 [30] | • Patient-related: age, race/ethnicity, birthplace, household income, adequate financial resources, marital status, children living at home, seniors living at home, education, acculturation, social support • Clinical: comorbid conditions, stage at diagnosis, type of surgery, breast reconstruction, axilliary node dissection, chemotherapy, radiotherapy, endocrine therapy • Work-related: job type, full/part-time work at diagnosis | Presence of comorbid conditions (OR = 0.25, 0.08–0.7) was significantly associated with not returning to work 3–5 years postdiagnosis |
Jagsi et al., 2014 [35] | • Patient-related: age, race, education, family income, marital status, area of residence, family income • Clinical: comorbidities, stage at diagnosis, type of surgery, chemotherapy, radiotherapy • Work-related: full/part time work at diagnosis, employment support (sick leave/flexible schedule) | Older age at diagnosis (≥ 56 vs < 46: OR = 1.42, 1.03–1.9), receipt of chemotherapy (OR = 1.42, 1.03–1.98), comorbidities (≥ 2 vs none: OR = 2.16, 1.6–2.9), and lack of work adjustments (none vs sick leave and/or flexible schedule vs: OR = 1.33, 1.1–1.6) were significantly associated with unemployment |
Landeiro et al., 2018 [39] | • Patient-related: education, age, changes in marital status, • Clinical: health status, weight gain, depression, pain, lymphedema, breast conserving surgery, breast reconstruction, axillary dissection, chemotherapy, radiotherapy, endocrine therapy, anti-HER2 therapy, quality of life • Work-related: changes in income, work adjustment, employer discrimination, employer support | Higher household income (OR = 16.6, 1.8–155), work adjustments (OR 37.6, 3.31–427), breast conserving surgery (OR 9.8, 2.0–47), not having depression (OR 14.3, 1.6–100), and not having endocrine therapy (OR 9.1, 1.3–50) were significantly associated with working at 2 years post-diagnosis |
Maunsell et al., 2004 [40]; Drolet et al., 2005a [41]; Drolet et al., 2005b [42] | • Patient-related: age, living with partner, children, education, personal income • Clinical: disease status since diagnosis (disease-free vs recurrence/contralateral breast cancer); radiotherapy, chemotherapy, hormone therapy, affected nodes • Work-related: union member, experience in job, type of job, hours per week, value of work | Significant predictors of not working at 3 years were: older age (50–59 vs 18–39 OR = 4.62, 2.2–9.5), lower personal income (< $20,000 vs ≥ $50,000 OR = 3.18, 1.6–6.3), new cancer event (OR = 2.14, 1.5–3.1), union membership (union membership yes vs no OR = 1.88, 1.3–2.7; self-employed vs not union member OR = 0.60, 0.3–1.05), and value of work since diagnosis (decreased vs increased: OR = 1.83, 1.1–3.0) |
Tison et al., 2016 [52]; Alleaume et al. 2018 [53] | • Patient-related: marital status, gender, age, dependent children • Clinical: cancer prognosis, adverse cancer event, chemotherapy, radiotherapy, comorbidities, mental health, chronic neuropathic pain • Work-related: employment sector at diagnosis, socio-professional status, wages at diagnosis, full-time/part-time at diagnosis, type of employment contract, self-employed versus employee, business sector | Older age, not having children, and poor cancer prognosis, were significantly related to not working at 2 years after cancer diagnosis. Age 18–39 (OR 1.69, 1.00–2.9) or age 50–54 (OR 1.65, 1.06–2.6), not having children (OR 2.1, 1.3–3.4), poor cancer prognosis (OR 3.6, 1.6–8.2), adverse cancer event (OR 2.1, 1.3–3.3), chemotherapy (OR1.6, 1.1–2.4), comorbidities (OR 2.0, 1.2–3.4), mental health (OR 0.96, 0.95–0.98), chronic neuropathic pain (OR 2.6, 1.7–3.9), private sector (OR 2.5, 1.5–4.3), execution function (OR 2.2, 1.4–3.2), and higher wages at diagnosis (OR 1.01, 0.99–1.03) were significantly related to leaving employment at 5 years after cancer diagnosis |
Vartanian et al. 2006 [55] | • Patient-related: gender, age, alcohol use, education, pain, quality-of-life score • Clinical: cancer site, stage, treatment, permanent tracheostomy | More advance stage (VI vs I OR = 3.5, 1.5–8.1), alcohol use before treatment (OR = 2.6, 1.3–5.2), and lower education (high school or college vs illiterate OR = 0.2, 0.5–0.8) were significantly associated with being unable to work > 2 years post-diagnosis |
Other work-related outcomes
Author and year | Work-related outcomes assessed | Results |
---|---|---|
Amir et al., 2007 [28] | • Change in working hours • Change in place of work • Perception of work | • 18% of survivors who took < 6 months sick leave, and 43% of those who took ≥ 18 months sick leave, changed their working hours compared to before diagnosis • 8% of survivors who had returned to work changed to a different place of work • 19% of survivors who returned to work reported that their overall working life had deteriorated due to cancer |
Bradley and Bednarek, 2002 [31]; Bednarek and Bradley, 2005 [32] | • Change in work schedule | • 54% of survivors reduced their workload/working schedule at least once because of cancer |
Dahl et al., 2015 [33] | • Reduced working hours • Influence of prostate cancer on working life | • 66% of survivors worked full-time at 3 years compared to 75% at diagnosis • 34% of survivors reported that prostate cancer had influence their working life to some/great extent. In multivariable analysis among men active in the workforce, adjuvant/salvage treatment, chronic fatigue, physical work and bother with urinary leakage were significantly associated with believing prostate cancer had influenced working life to some/great extent. |
Hamood et al., 2018 [34] | • Change in working hours | • At a mean of 8.5 years post-diagnosis, 48% of survivors had changed from full-time to part-time employment. In multivariate analyses, immigration status (country of birth not Israel) was significantly associated with changing from full-time to part-time employment |
Jagsi et al., 2014 [35] | • Seeking work | • At 4 years post-diagnosis, 39% of survivors who were not employed were actively looking for work |
Jeon, 2016 [36] | • Income | • During 25–47 months post-diagnosis, survivors earned 9.0% less than comparators. The difference was greatest for those with cancers of low survival. |
Kiserud et al., 2016 [38] | • Work changes due to cancer • Work ability | • 13% of survivors who returned to work reported work changes due to cancer • Work ability was higher among those working at survey than not working (mean = 7.3 vs 3.6); 11% of those working vs 59% of those not working had poor physical work ability; 6% of those working vs 33% of those not working had poor mental work ability; change in work ability was lower among those working than those not working |
Landeiro et al., 2018 [39] | • Change in working hours • Income • Perceived employer discrimination | • Among survivors who returned to work, 12% decreased and 3% increased working hours • 21% reported a reduction in monthly income • 11% reported perceived employer discrimination |
Maunsell et al., 2004 [40]; | • Change in working hours • Change in job • Income • Sickness absence | • Among survivors employed at 3 years, hours worked per week in main/only and any second job were significantly lower than at diagnosis • 19% of survivors (20% of those disease-free and 13% of those not disease-free) vs 20% of comparators were employed in a different job than at diagnosis • At 3 years, the increase in the proportion who earned $30,000+ per annum (compared to at diagnosis) was similar in survivors and comparators • In the third year from diagnosis, 23% of survivors were absent from work for ≥ 4 weeks vs 19% of comparators. Average duration of absence was longer in survivors who were not disease free, compared to those who were disease free (4.1 weeks vs 2.1 weeks). |
Mols et al., 2009 [43] | • Change in working hours | • At survey, 17% of survivors worked fewer hours than at diagnosis |
Paraponaris et al., 2010 [44]; Marino et al., 2013 [45] | • Sickness absence | • 20% of survivors who were employed at diagnosis and at 2 years took no sick leave |
Pearce et al., 2013 [46] | • Change in working hours | • Among survivors who returned to work, 52% reduced and 3% increased working hours compared to at diagnosis |
Sanchez et al., 2004 [47] | • Sickness absence | • Of survivors who resumed working, 36% returned after ≥ 60 days absence. In multivariate analyses, receipt of chemotherapy was significantly related to returning after 60 days |
Moran et al., 2011 [50] | • Hours worked | • At 2–6 years post-diagnosis, female survivors aged 28–54 worked 3–4 hours less per week than similarly-aged females in comparison population; male survivors aged 28–54 worked 5–6 hours less than similarly-aged males in comparison population. Female survivors aged 55–65 worked 3–4 hours less per week than similarly-aged females in comparison population; male survivors aged 55–65 worked 3.5–5 hours less than similarly-aged males in comparison population |
• Change in working hours | • Of survivors who had returned to work at 5 years, 32% had reduced working hours compared to diagnosis. In multivariate analysis, wages at diagnosis, sector of employment at diagnosis, chemotherapy, mental health score and chronic neuropathic pain were significantly associated with reduced working hours at 5 years | |
Verdonck-de Leeuw et al., 2010 [56] | • Change in work | • Of survivors who resumed working, 36% had changed work (i.e. returned to adapted work or to other work). |