Rehabilitation interventions to support return to work for women with breast cancer: a systematic review and meta-analysis

Abstract

Background: Research recommends the development and evaluation of interventions to support women with breast cancer in returning to, or managing, work. Despite this, there has historically been a paucity of rehabilitation interventions to support women with breast cancer to maintain or return to their work role. The aim of this systematic review was to examine key characteristics of rehabilitation interventions, and their effectiveness on work outcomes for women with breast cancer, compared to usual care.

Methods: A systematic review was conducted of controlled studies of rehabilitation interventions with work outcomes for women with breast cancer. Six databases were systematically searched: EMBASE, Web of Science, MEDLINE (OVID), CINAHL, PsycINFO, and the Cochrane Central Register of Controlled Trials (CENTRAL). Results are presented either as pooled odds ratio (OR) or pooled effect size (hedges g) between groups, with 95% confidence intervals (CI). Narrative synthesis was conducted on intervention outcomes not suitable for meta-analysis.

Results: Five thousand, five hundred and thirty-five studies were identified. Nine out of 28 abstracts met inclusion criteria. Heterogeneity of interventions and outcomes precluded meta-analysis for most outcomes. Of the interventions included in meta-analysis, no significant differences compared to usual care were found for sick leave (2 studies (12 months); OR 1.11 (95% CI: 0.66 to 1.87), number of sick days taken (2 studies (six months); difference in effect: - 0.08, (95% CI: - 0.48 to 0.38) or working hours (2 studies (12 months); 0.19, (95% CI: - 0.20 to 0.64). Only one study, with a multidisciplinary intervention, showed a significant difference for work outcomes when compared to usual care. Work-specific content featured in three interventions only, none of which provided conclusive evidence for improvement in work outcomes. Enhanced physical and psychological sequalae, and quality of life was observed in some studies.

Conclusion: There remains a lack of effective and methodologically rigorous rehabilitation intervention studies for breast cancer survivors. The development and evaluation of effective rehabilitation interventions to support return to work is warranted.

Keywords: Employment; Quality of life; activities of daily living; breast neoplasms; survivorship.

Fig. 1

PRISMA Flow Diagram

Fig. 2

Risk of Bias Assessment

Fig. 3

Meta-analysis of number of sick days taken at six months. NC: Non-Chemotherapy Group; C: Chemotherapy Group

Fig. 4

Meta-analysis of number of sick days taken at twelve months. NC: Non-Chemotherapy Group; C: Chemotherapy Group

Fig. 5

Meta-analysis of sick leave (Yes/No) at twelve months

Fig. 6

Meta-analysis of working hours at twelve months