Abstract
BackgroundCompared to healthy controls, cancer patients have a higher risk of unemployment, which has negative social and economic impacts on the patients and on society at large. Therefore, return-to-work of cancer patients needs to be improved by way of an intervention. The objective is to describe the development and content of a work-directed intervention to enhance return-to-work in cancer patients and to explain the study design used for evaluating the effectiveness of the intervention.Development and content of the interventionThe work-directed intervention has been developed based on a systematic literature review of work-directed interventions for cancer patients, factors reported by cancer survivors as helping or hindering their return-to-work, focus group and interview data for cancer patients, health care professionals, and supervisors, and vocational rehabilitation literature. The work-directed intervention consists of: 1) 4 meetings with a nurse at the treating hospital department to start early vocational rehabilitation, 2) 1 meeting with the participant, occupational physician, and supervisor to make a return-to-work plan, and 3) letters from the treating physician to the occupational physician to enhance communication.Study design to evaluate the interventionThe treating physician or nurse recruits patients before the start of initial treatment. Patients are eligible when they have a primary diagnosis of cancer, will be treated with curative intent, are employed at the time of diagnosis, are on sick leave, and are between 18 and 60 years old. After the patients have given informed consent and have filled out a baseline questionnaire, they are randomised to either the control group or to the intervention group and receive either care as usual or the work-directed intervention, respectively. Primary outcomes are return-to-work and quality of life. The feasibility of the intervention and direct and indirect costs will be determined. Outcomes will be assessed by a questionnaire at baseline and at 6, 12, 18, and 24 months after baseline.DiscussionThis study will provide information about the effectiveness of a work-directed intervention for cancer patients. The intention is to implement the intervention in normal care if it has been shown effective.Trial registrationNTR1658
Highlights
Compared to healthy controls, cancer patients have a higher risk of unemployment, which has negative social and economic impacts on the patients and on society at large
A meta-analysis showed that the risk of unemployment is 37% higher for cancer survivors compared to healthy controls [9]; cancer survivors experience work limitations [10,11]
Content of the intervention Incorporation of the findings described above resulted in a work-directed intervention that encompasses: 1) 4 meetings of 15 minutes each will be held at the hospital as part of the normal consulting hour to start early vocational rehabilitation
Summary
Since the survival rates of cancer have increased considerably in recent years, the long-term side effects of cancer and cancer-related treatments may impact survivors' capabilities to regain normal lives. Cancer survivors get little advice from their treating physicians about return-to-work issues, and they experience a lack of guidance from their general practitioners or occupational physicians as well [13,14]. Considering these negative work-related side effects for cancer survivors and the lack of attention toward these problems, there is ample room to improve return-to-work with an appropriate intervention. A systematic review of the literature [15] concerning work-directed interventions for cancer patients showed that well-developed work-directed interventions are limited and that the methodological quality of these studies is moderate. This model encompasses a work-directed intervention integrated into cancer care as integrated into the occupational physician or general practitioner's care, establishing active communication between these health care professionals
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