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. 2024 Mar 5;3(3):CD007569.
doi: 10.1002/14651858.CD007569.pub4.

Non-medical interventions to enhance return to work for people with cancer

Angela Gem de Boer  1 , Sietske J Tamminga  1 , Julitta S Boschman  2 , Jan L Hoving  2
Affiliations

Non-medical interventions to enhance return to work for people with cancer

Angela Gem de Boer et al. Cochrane Database Syst Rev. .

Abstract

Background: People with cancer are 1.4 times more likely to be unemployed than people without a cancer diagnosis. Therefore, it is important to investigate whether programmes to enhance the return-to-work (RTW) process for people who have been diagnosed with cancer are effective. This is an update of a Cochrane review first published in 2011 and updated in 2015.

Objectives: To evaluate the effectiveness of non-medical interventions aimed at enhancing return to work (RTW) in people with cancer compared to alternative programmes including usual care or no intervention.

Search methods: We searched CENTRAL (the Cochrane Library), MEDLINE, Embase, CINAHL, PsycINFO and three trial registers up to 18 August 2021. We also examined the reference lists of included studies and selected reviews, and contacted authors of relevant studies.

Selection criteria: We included randomised controlled trials (RCTs) and cluster-RCTs on the effectiveness of psycho-educational, vocational, physical or multidisciplinary interventions enhancing RTW in people with cancer. The primary outcome was RTW measured as either RTW rate or sick leave duration measured at 12 months' follow-up. The secondary outcome was quality of life (QoL).

Data collection and analysis: Two review authors independently assessed RCTs for inclusion, extracted data and rated certainty of the evidence using GRADE. We pooled study results judged to be clinically homogeneous in different comparisons reporting risk ratios (RRs) with 95% confidence intervals (CIs) for RTW and mean differences (MD) or standardised mean differences (SMD) with 95% CIs for QoL.

Main results: We included 15 RCTs involving 1477 people with cancer with 19 evaluations because of multiple treatment groups. In this update, we added eight new RCTs and excluded seven RCTs from the previous versions of this review that were aimed at medical interventions. All included RCTs were conducted in high-income countries, and most were aimed at people with breast cancer (nine RCTs) or prostate cancer (two RCTs). Risk of bias We judged nine RCTs at low risk of bias and six at high risk of bias. The most common type of bias was a lack of blinding (9/15 RCTs). Psycho-educational interventions We found four RCTs comparing psycho-educational interventions including patient education and patient counselling versus care as usual. Psycho-educational interventions probably result in little to no difference in RTW compared to care as usual (RR 1.09, 95% CI 0.96 to 1.24; 4 RCTs, 512 participants; moderate-certainty evidence). This means that in the intervention and control groups, approximately 625 per 1000 participants may have returned to work. The psycho-educational interventions may result in little to no difference in QoL compared to care as usual (MD 1.47, 95% CI -2.38 to 5.32; 1 RCT, 124 participants; low-certainty evidence). Vocational interventions We found one RCT comparing vocational intervention versus care as usual. The evidence was very uncertain about the effect of a vocational intervention on RTW compared to care as usual (RR 0.94, 95% CI 0.78 to 1.13; 1 RCT, 34 participants; very low-certainty evidence). The study did not report QoL. Physical interventions Four RCTs compared a physical intervention programme versus care as usual. These physical intervention programmes included walking, yoga or physical exercise. Physical interventions likely increase RTW compared to care as usual (RR 1.23, 95% CI 1.08 to 1.39; 4 RCTs, 434 participants; moderate-certainty evidence). This means that in the intervention group probably 677 to 871 per 1000 participants RTW compared to 627 per 1000 in the control group (thus, 50 to 244 participants more RTW). Physical interventions may result in little to no difference in QoL compared to care as usual (SMD -0.01, 95% CI -0.33 to 0.32; 1 RCT, 173 participants; low-certainty evidence). The SMD translates back to a 1.8-point difference (95% CI -7.54 to 3.97) on the European Organisation for Research and Treatment of Cancer Quality of life Questionnaire Core 30 (EORTC QLQ-C30). Multidisciplinary interventions Six RCTs compared multidisciplinary interventions (vocational counselling, patient education, patient counselling, physical exercises) to care as usual. Multidisciplinary interventions likely increase RTW compared to care as usual (RR 1.23, 95% CI 1.09 to 1.33; 6 RCTs, 497 participants; moderate-certainty evidence). This means that in the intervention group probably 694 to 844 per 1000 participants RTW compared to 625 per 1000 in the control group (thus, 69 to 217 participants more RTW). Multidisciplinary interventions may result in little to no difference in QoL compared to care as usual (SMD 0.07, 95% CI -0.14 to 0.28; 3 RCTs, 378 participants; low-certainty evidence). The SMD translates back to a 1.4-point difference (95% CI -2.58 to 5.36) on the EORTC QLQ-C30.

Authors' conclusions: Physical interventions (four RCTs) and multidisciplinary interventions (six RCTs) likely increase RTW of people with cancer. Psycho-educational interventions (four RCTs) probably result in little to no difference in RTW, while the evidence from vocational interventions (one RCT) is very uncertain. Psycho-educational, physical or multidisciplinary interventions may result in little to no difference in QoL. Future research on enhancing RTW in people with cancer involving multidisciplinary interventions encompassing a physical, psycho-educational and vocational component is needed, and be preferably tailored to the needs of the patient.

PubMed Disclaimer

Conflict of interest statement

AdB: no relevant interests; involved in conducting Tamminga 2013 (GAK (social insurance) Foundation), Greidanus 2021 (Dutch Cancer Society), Zaman 2021 (Dutch Cancer Society); Tamminga 2013: co‐author, academic medical hospital Amsterdam; Greidanus 2021: co‐author, academic medical hospital Amsterdam; Zaman 2021: co‐author, academic medical hospital Amsterdam.

ST: no relevant interests; involved in conducting Tamminga 2013 (GAK (social insurance) Foundation), Greidanus 2021 (Dutch Cancer Society); Tamminga 2013: co‐author; academic medical hospital Amsterdam; Greidanus 2021: co‐author, academic medical hospital Amsterdam.

JB: Knowledge Institute of the Dutch Association of Medical Specialists (Senior Advisor); former Managing Editor of Cochrane Work, Amsterdam UMC, Amsterdam, Netherlands.

JH: no relevant interests; currently Coordinating Editor of Cochrane Work, Amsterdam UMC, Amsterdam, Netherlands.

JB and JH excluded themselves entirely from the editorial process to ensure independence. Review authors were not involved in the study selection, data extraction, risk of bias or GRADE assessment for studies where they were also involved as study co‐authors.

Figures

1
1
PRISMA flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1: Psycho‐educational interventions versus care as usual, Outcome 1: Return to work
1.2
1.2. Analysis
Comparison 1: Psycho‐educational interventions versus care as usual, Outcome 2: Quality of life
2.1
2.1. Analysis
Comparison 2: Vocational interventions versus care as usual, Outcome 1: Return to work
3.1
3.1. Analysis
Comparison 3: Physical interventions versus care as usual, Outcome 1: Return to work
3.2
3.2. Analysis
Comparison 3: Physical interventions versus care as usual, Outcome 2: Quality of life
4.1
4.1. Analysis
Comparison 4: Multidisciplinary interventions versus care as usual, Outcome 1: Return to work (odds ratios)
4.2
4.2. Analysis
Comparison 4: Multidisciplinary interventions versus care as usual, Outcome 2: Quality of life
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References to ongoing studies

NCT01780064 {published data only}
    1. NCT01780064. Psychosocial support to facilitate the return to employment of women with breast cancer (APAPI). clinicaltrials.gov/study/NCT01780064 (first received 29 January 2013).
NCT03666936 {published data only}
    1. NCT03666936. Facilitate the return to work of cancer survivors. clinicaltrials.gov/study/NCT03666936 (first received 20 August 2018).
NCT04214912 {published data only}
    1. NCT04214912. Personalized survivor care plan for oral cancer patients – effects on physical-psychological functions and return-to-work. clinicaltrials.gov/study/NCT04214912 (first received 27 November 2018).
NCT04322695 {published data only}
    1. NCT04322695. A rehabilitation education care program on return to work among head and neck cancer survivors. clinicaltrials.gov/study/NCT04322695 (first received 23 March 2020).
NCT04469205 {published data only}
    1. NCT04469205. Study to assess the impact of personalized coaching on the time period and quality of return to work after breast cancer (OPTICOACH). clinicaltrials.gov/study/NCT04469205 (first received 8 June 2020).
NCT04846972 {published data only}
    1. NCT04846972. Facilitate and sustain return to work after breast cancer (FASTRACS-RCT). clinicaltrials.gov/study/NCT04846972 (first received 14 April 2021).
Sheppard 2019 {published data only}
    1. Sheppard DM, Frost D, Jefford M, O'Connor M, Halkett G. 'Beyond Cancer': a study protocol of a multimodal occupational rehabilitation programme to support breast cancer survivors to return work. BMJ Open 2019;6(12):e032505. - PMC - PubMed
Touillaud 2021 {published data only}
    1. Touillaud M, Fournier B, Perol O, Delrieu L, Maire A, Belladame E, et al. Connected device and therapeutic patient education to promote physical activity among women with localised breast cancer (DISCO trial): protocol for a multicentre 2x2 factorial randomised controlled trial. BMJ Open 2021;11(9):e045448. - PMC - PubMed
Zegers 2021 {published data only}
    1. Zegers AD, Coenen P, Bultmann U, Retel V, Kieffer JM, Beek AJ, et al. Supporting participation in paid work of cancer survivors and their partners in the Netherlands: protocol of the SusTained Employability in cancer Patients and their partnerS (STEPS) multi-centre randomized controlled trial and cohort study. BMC Public Health 2021;21(1):1844. - PMC - PubMed

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References to other published versions of this review

de Boer 2009b
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