Involuntariness of job changes is related to less satisfaction with occupational development in long-term breast cancer survivors

Journal of Cancer Survivorship https://doi.org/10.1007/s11764-021-01035-5 Involuntariness of job changes is related to less satisfaction with occupational development in long-term breast cancer survivors Kati Hiltrop 1,2 & Paula Heidkamp 1,2 & Clara Breidenbach 3 & Christoph Kowalski 3 & Anna Enders 4 & Holger Pfaff 5 & Lena Ansmann 6 & Franziska Geiser 2,7 & Nicole Ernstmann 1,2 Received: 26 November 2020 / Accepted: 25 March 2021 # The Author(s) 2021 Abstract Purpose Considering that breast cancer survivors (BCSs) have been dealing with unwanted job changes after diagnosis, this study aimed to investigate involuntary job changes (unwanted modifications in employment since diagnosis) and explore the association between job changes, involuntariness, and occupational development satisfaction in BCSs 5–6 years after diagnosis. Methods Data were drawn from the mixed-methods breast cancer patients’ return to work (B-CARE) study. We surveyed 184 female BCSs who were working at the time of study enrollment during hospitalization (T1), 10 weeks after discharge (T2), 40 weeks after discharge (T3), and 5–6 years after diagnosis (T4) and used descriptive measures and stepwise linear regression models for data analysis. Results The mean age of BCSs was 57 years. A total of 105 participants reported 410 job changes, of which 16.1% were reportedly (rather) involuntary. The most commonly reported involuntary changes were increased workload (15.2%) and increased scope of work (15.2%). In the final model, significant predictors of satisfaction with occupational development 5–6 years after diagnosis were age, state of health ΔT2–T3, state of health ΔT3–T4, and involuntariness of job changes. Conclusions Although the number of job changes alone is not substantially associated with BCSs’ satisfaction with occupational development, experiencing involuntary job changes is. Sociodemographic, disease-related, and work(place)-related factors may influence occupational satisfaction among BCSs. Implications for Cancer Survivors The findings indicate the importance of strengthening one’s ability to work as desired to prevent involuntary job changes and enable desired work participation in long-term support. The significance of workplace characteristics highlights the need for employers to encourage satisfying work participation. Trial registration number German Clinical Trials Register (DRKS00016982), 12 April 2019 Keywords Breast cancer . Return to work . Occupational development . Involuntariness . Job changes . Social capital * Kati Hiltrop Nicole Ernstmann 1 Clara Breidenbach Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany 2 Christoph Kowalski Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Bonn, Germany 3 German Cancer Society (DKG), Berlin, Germany 4 Federal Centre for Health Education (BZgA), Cologne, Germany 5 Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), University of Cologne, Cologne, Germany 6 Division for Organizational Health Services Research, Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany 7 Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany Paula Heidkamp Anna Enders Holger Pfaff Lena Ansmann Franziska Geiser J Cancer Surviv Introduction In Germany, approximately 492,000 new cancer cases were diagnosed in 2016 [1]. The most common cancer type among females is breast cancer, with almost 70,000 newly diagnosed cases per year [1]. Screening programs and therapy improvements contribute to a 5-year survival rate of 88% among female patients with breast cancer [2]. Furthermore, a significant proportion of affected women (30%) are younger than 55 years old when diagnosed [3]. Work-related outcomes are especially important for working-age breast cancer survivors (BCSs), considering that work can give meaning, provide financial security, allow social participation [4], and positively influence their quality of life [5]. In recent years, work-related outcomes, such as the timing and determinants of return to work (RTW), of cancer survivors have been extensively researched [6–10]. Disease-, treatment-, and work-related aspects as well as sociodemographic and psychosocial aspects influence RTW [6–10]. Objective long-term workrelated outcomes such as work performance, absenteeism, and job changes in cancer survivors have also been studied [11–13]. Bijker et al. [11] found that an improved general functional status is associated with less absence, higher productivity, and slightly higher chances of RTW among cancer survivors. According to a systematic review, cancer survivors within 5 years after diagnosis have higher absenteeism than nonaffected individuals [12]. Regarding job changes, more than half of cancer survivor participants reported at least one change 2 years after diagnosis [13]. A multicountry study by Torp et al. [14] described that 6–37% of employed cancer survivors underwent occupational changes up to 6 years following diagnosis, and given that changes in working time were analyzed separately, approximately one-quarter of these respondents reduced their working hours after diagnosis. Moreover, cancer survivors partially attributed changes such as reduced working hours, changed tasks, and changed employers to cancer disease experience [13, 14]. Older age, presence of comorbidities, treatment with chemotherapy, and disease progression were reportedly predictors of experiencing job changes [15]. Reduced physical and mental work abilities were associated with work changes [16]. The insight on how BCSs perceive and evaluate objective work-related outcomes, such as job changes, remains largely unknown. Although using more subjective measures is necessary to determine BCSs’ perspectives, only few studies exist. Mehnert and Koch [17] reported that work satisfaction is associated with sociodemographic characteristics such as older age, higher income, and health-related quality of life. Furthermore, lower levels of satisfaction with the vocational situation could predict no RTW among BCSs [18]. More research on BCSs’ evaluation of work-related outcomes is needed to (1) understand if experienced work-related outcomes are evaluated as burdensome and disadvantageous and to (2) determine the need for support from or improvements in the healthcare and social systems. One aspect that might explain how disadvantageous work-related outcomes are for cancer survivors is probably their involuntariness. In the context of life-event research, stressful work-related events, particularly unintended job disruptions, directly and indirectly (mediated by coping and supportive resources) decrease mental health among working-age adult participants [19]. Cur (...truncated)