Abstract

Research Questions

• What is the proportion of cancer patients who maintained or returned to regular employment during or after their active treatment?
• What is the effect of clinical and/or demographic factors on this outcome?
• What are the barriers/facilitators in the process of return to paid employment after treatment for cancer?

Methods

Participants were recruited from those registered by the North Western Cancer Intelligence Service (a population-based cancer registry) based in Manchester. Participants were selected if they met the following eligibility criteria:
• A diagnosis of any cancer from June 2002 through to December 2002;
• Aged 18-55 years;
• In paid employment at the time of diagnosis;
• Known to be alive and having a reasonable chance to return to work.

Participants were contacted some three years after their initial diagnosis, in order to allow for the process of return to work to take place. They were asked to complete a self-administered brief 10 item questionnaire containing questions about their employment status before, during and after their cancer diagnosis. With the participants’ consent, clinical (i.e. cancer site and treatment) and demographic (i.e. age, gender, deprivation quintiles [national quintiles of the Index of Multiple Deprivation, 2004]) information was derived from the Cancer Intelligence Service database. Subsequently, forty-one people of working age were purposively selected from the previous phase and interviewed by telephone to explore their cancer journey from their work history, through diagnosis and treatment to returning to work.

Key findings

The postal survey demonstrated that while a high proportion of respondents managed to return to their place of work some 20 per cent were not able to do so. Duration of sick leave absence and treatment modalities were associated with difficulties in returning to work. Despite the fact that males were more likely than females to take no sick leave, those who did were more likely to take longer periods of absence (18 months and over). In addition, length of sick leave was greatest in the most economically deprived group, and in those who did not receive surgery.

Key points from the qualitative phase highlighted that:
• In a ‘typical cancer journey’ the importance attached to returning to work from diagnosis and through treatment was followed by a re-assessment of the work-life balance when back in employment.
• The principle motivations for returning to work were a quest for normality and financial pressures.
• One barrier to returning to work is the lack of worthwhile medical advice from cancer specialists and general practitioners, which can lead to difficulties for cancer survivors in the workplace.
• A good relationship with their employer/manager was a major influence on returning to work and appeared to be due to duration of service rather than occupational status. 

Conclusions

This is the first study in the UK that explores the experiences of returning to work of a range of cancer survivors. This study adds further qualitative insights to previous evidence but raises the need for further research to explore the role of employers, line-managers and occupational health professionals. Each of these stakeholders plays an important part in the transition back to work for cancer survivors, and there is very little research in this area. More systematic research in this area is essential for the development of evidence-based guidelines to support an increased participation in the labour market for an ever-growing population.