Long-term work retention after treatment for cancer: a systematic review and meta-analysis

Journal of Cancer Survivorship https://doi.org/10.1007/s11764-020-00862-2 REVIEW Long-term work retention after treatment for cancer: a systematic review and meta-analysis Angela GEM de Boer 1 & Steffen Torp 2 & Adela Popa 3 & Trine Horsboel 4 & Vesna Zadnik 5 & Yakir Rottenberg 6 & Edit Bardi 7 & Ute Bultmann 8 & Linda Sharp 9 Received: 3 December 2019 / Accepted: 29 January 2020 # The Author(s) 2020 Abstract Purpose Almost half of people diagnosed with cancer are working age. Survivors have increased risk of unemployment, but little is known about long-term work retention. This systematic review and meta-analysis assessed work retention and associated factors in long-term cancer survivors. Methods We searched Medline/Pubmed, Embase, PsychINFO, and CINAHL for studies published 01/01/2000–08/01/2019 reporting work retention in adult cancer survivors ≥ 2 years post-diagnosis. Survivors had to be in paid work at diagnosis. Pooled prevalence of long-term work retention was estimated. Factors associated with work retention from multivariate analysis were synthesized. Results Twenty-nine articles, reporting 21 studies/datasets including 14,207 cancer survivors, were eligible. Work retention was assessed 2–14 years post-diagnosis. Fourteen studies were cross-sectional, five were prospective, and two contained both crosssectional and prospective elements. No studies were scored as high quality. The pooled estimate of prevalence of long-term work retention in cancer survivors working at diagnosis was 0.73 (95%CI 0.69–0.77). The proportion working at 2–2.9 years was 0.72; at 3–3.9 years 0.80; at 4–4.9 years 0.75; at 5–5.9 years 0.74; and 6+ years 0.65. Pooled estimates did not differ by cancer site, geographical area, or study design. Seven studies assessed prognostic factors for work retention: older age, receiving chemotherapy, negative health outcomes, and lack of work adjustments were associated with not working. Conclusion Almost three-quarters of long-term cancer survivors working at diagnosis retain work. Implications for Cancer Survivors These findings are pertinent for guidelines on cancer survivorship care. Professionals could focus support on survivors most likely to have poor long-term work outcomes. Keywords Cancer . Work retention . Employment . Work ability . Return-to-work . Longitudinal studies . Prospective studies . Meta-analysis Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11764-020-00862-2) contains supplementary material, which is available to authorized users. * Linda Sharp 1 Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands 2 Department of Health, Social & Welfare Studies, University College of South-Eastern Norway, Notodden, Norway 3 Lucian Blaga University of Sibiu, Sibiu, Romania 4 The Danish Cancer Society Research Center, Copenhagen, Denmark 5 Institute of Oncology Ljubljana, Ljubljana, Slovenia 6 Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel 7 Kepler Universitäts Klinikum, Linz, Austria 8 University Medical Center Groningen, University of Groningen, Groningen, the Netherlands 9 Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, United Kingdom J Cancer Surviv Abbreviations CANWON CANcer and WOrk Network CI confidence interval df degrees of freedom MINORS Methodological Index for Non-Randomised Studies PRISMA Preferred Reporting Items for Systematic Reviews and Meta-Analyses RR relative risk A systematic review on the long-term work status of cancer survivors would be of value both for helping shape expectations of new cancer patients regarding likely long-term outcomes (including work outcomes), and in psychosocial survivorship care, when counselling survivors on the long-term psycho-oncological outcomes after treatment [22]. This type of information can therefore help improve survivors’ quality of life by preventing work loss and distress. The aims of the current study are therefore (i) to systematically assess long-term work retention among cancer survivors 2 years and more after diagnosis and (ii) to assess associated factors for work retention in long-term cancer survivors. Introduction The sustained improvements in detection and treatment of many types of cancer have steadily increased life expectancy after cancer treatment [1]. During the next decade, a further rapid increase in the number of new cancer diagnoses in the population and a growing number of cancer survivors are expected [1]. Almost half of the people diagnosed with cancer are of working age [2] and it is therefore likely that the prevalence of cancer survivors in the work force will increase. In addition, the retirement age is rising in many countries, implying that more cancer survivors will be part of the working population [3]. For both cancer survivors themselves and society, returning to work is important. Survivors often regard returning to work as regaining normality and self-respect [4]. It contributes to their quality of life [5] and provides them with financial security [6]. From the viewpoint of the ageing society, it is an economic and social necessity to encourage survivors to return to work whenever possible [7]. Cancer survivorship is associated with a range of enduring physical and psychological effects including long-lasting fatigue [8, 9], depression [9, 10], physical complaints [9, 11], and neurocognitive limitations [9, 12, 13]. These long-term outcomes of cancer treatment can have persistent impact on the work ability of survivors [14]. As a result, cancer survivors have been shown to have an increased risk of unemployment compared to the general population in long-term follow-up studies [15–17]. Several reviews on the impact of cancer treatment on shortterm work outcomes have been published [18–20]. These reviews showed return to work rates between 39 and 93% within 1–2 years after diagnosis. However, the employment pathways of cancer survivors could change after this point because treatment for cancer can, increasingly, be a long process (taking a year or more) and survivors can have persistent longterm effects which may last well beyond 2-year post-diagnosis [21]. However, the long-term effects of cancer treatment on work outcomes have not been systematically reviewed. In addition, the influence of prognostic factors on long-term work outcomes has not been synthesized. Materials and methods Search strategy We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in conducting this review and preparing the manuscript [23]. We searched four databases (Medline [Pubmed], Embase, PsychINFO, CINAHL) to identify studies reporting workforce retention in long-term cancer survivors, published from 01/01/ 2000 to 08/01/2019. We d (...truncated)