Long-term work retention after treatment for cancer: a systematic review and meta-analysis

Abstract

Purpose Almost half of people diagnosed with cancer are working age. Survivors have increased risk of unemployment, but little is known about long-term work retention. This systematic review and meta-analysis assessed work retention and associated factors in long-term cancer survivors. Methods We searched Medline/Pubmed, Embase, PsychINFO, and CINAHL for studies published 01/01/2000-08/01/2019 reporting work retention in adult cancer survivors ≥ 2 years post-diagnosis. Survivors had to be in paid work at diagnosis. Pooled prevalence of long-term work retention was estimated. Factors associated with work retention from multivariate analysis were synthesized. Results Twenty-nine articles, reporting 21 studies/datasets including 14,207 cancer survivors, were eligible. Work retention was assessed 2-14 years post-diagnosis. Fourteen studies were cross-sectional, five were prospective, and two contained both crosssectional and prospective elements. No studies were scored as high quality. The pooled estimate of prevalence of long-term work retention in cancer survivors working at diagnosis was 0.73 (95%CI 0.69-0.77). The proportion working at 2-2.9 years was 0.72; at 3-3.9 years 0.80; at 4-4.9 years 0.75; at 5-5.9 years 0.74; and 6+ years 0.65. Pooled estimates did not differ by cancer site, geographical area, or study design. Seven studies assessed prognostic factors for work retention: older age, receiving chemotherapy, negative health outcomes, and lack of work adjustments were associated with not working. Conclusion Almost three-quarters of long-term cancer survivors working at diagnosis retain work. Implications for Cancer Survivors These findings are pertinent for guidelines on cancer survivorship care. Professionals could focus support on survivors most likely to have poor long-term work outcomes.

Introduction to special section on: current topics in cancer survivorship and work

“…Adverse work outcome was defined as either underemployment or labour market exit [16]. Their findings corroborate Boer and colleagues [15], while adding that perceived value of work, higher work ability, familial responsibilities and feeling supported at work, also significantly positively affected long-term work outcomes.…”

“…De Boer and colleagues from the CANWON group that study work in cancer survivors with many different types of cancer [14], report on a systematic literature review. The review identified 21 studies investigating cancer survivors' work outcomes 2 years or more postdiagnosis [15]. They report that approximately 73% of the survivors were at work 2-14 years post-diagnosis.…”

“…They report that approximately 73% of the survivors were at work 2-14 years post-diagnosis. Their metaanalysis indicated that a lower probability of working over the long-run was significantly associated with greater age, lower income, receipt of chemotherapy, presence of comorbidities and a lack of work accommodations at the workplace [15].…”

Addressing the needs of cancer survivors during the COVID-19 pandemic

“…As the pandemic takes its toll on the global economy, working-age cancer survivors might lose their job and, in some parts of the world, possibly their health insurance. Being able to work has been shown to affect the quality of life of cancer survivors as having a job contributes to feelings of normalcy, resilience, and meaning [18]. Those individuals who are self-employed or work for small employers may also face unique short-and long-term uncertainties.…”

The associations between late effects of cancer treatment, work ability and job resources: a systematic review

“…The majority of working people diagnosed with cancer re-enter the workplace. The mean rates of return to work reported in reviews are 62% (Spelten et al 2002 ), 64% (Mehnert 2011 ), and 73% (De Boer et al 2020a ). Return to work pathways vary, among others because of differences in reintegration strategies between countries (Kiasuwa Mbengi et al 2018 ), the availability of disability pension (Tikka et al 2017 ), or the effectiveness of programs to support return to work (Boer et al, 2015 ).…”