Return-to-work issues in outpatient palliative care.

Abstract

35 Background: Early integration of palliative care (PC) with oncologic care means return to work (RTW) issues will apply to some patients. There is an extensive literature on RTW after completing definitive treatment but much less is known about RTW in patients with active disease and on treatment. Methods: Cross-sectional survey of patients in two Pain & Palliative Care (PC) clinics at a comprehensive cancer center. Respondents were aged 25-65 and had been in paid employment prior to or during their treatment. The survey consisted of 37 items covering three domains: clinical details and demographics; work status, occupation, and work ability; importance of work and factors interfering with work. Results: 105 surveys were completed. 54% respondents were females, median age 53. 79% had been working at the time diagnosis. The commonest primaries were breast, colorectal, lung, GYN, and melanoma/sarcoma. 80% reported having active disease, median 2 years since diagnosis, and 73% were currently on treatment. In patients with active disease (n=86), 47% were currently working, 63% of them full time, typically RTW after taking < 6 months off. Work was important to 80% them, making 83% "feel normal", and 58% feel like they are “beating the cancer”. 35% would have liked to work more hours. Fatigue interfered with work in 49%, pain in 38%, and side effects of pain medicines in 31%. Almost ¼ were anxious or depressed about their work situation. More than 20% experienced discrimination in the work place, although usually minor. Conclusions: It is not uncommon for patients with advanced cancer to RTW even when they are on treatment and are sick enough to need to be followed in a PC clinic. Work is important to them and many would like to work more. Symptoms and side effects may interfere with their work ability. Some may be experiencing discrimination in the work place. Interventions to overcome these problems should be part of comprehensive, interdisciplinary PC.

Work resumption and retention in patients with advanced cancer: Experiences and perspectives of general and occupational health care professionals

“…A belief in the benefits of RTW, and viewing RTW of cancer patients as a team responsibility of health care professionals, was positively related to assumed role responsibility (Yagil et al, 2019 ). In the Dutch socio‐legal context, as is the case in several other countries, role dispersion might be related to the organisation of general and occupational health care in separate (financial) systems (Glare et al, 2014 ; Petersen et al, 2019 ; Tevaarwerk et al, 2016 ; Tiedtke et al, 2014 ). Specifically, general health care professionals perform (curative) health care tasks, whereas occupational health care professionals provide, for example, sick leave assessments and reintegration guidance.…”

“…However, many cancer patients experience barriers when resuming work during or after treatment, for example, fatigue (Nielsen et al, 2019 ; Paltrinieri et al, 2018 ; Zegers et al, 2022 ). For those with advanced cancer, additional barriers may arise due to disease progression, symptom burden, and/or ongoing (palliative) treatments (Glare et al, 2014 ).…”