Investigating how cancer-related symptoms influence work outcomes among cancer survivors: a systematic review

Journal of Cancer Survivorship https://doi.org/10.1007/s11764-021-01097-5 REVIEW Investigating how cancer‑related symptoms influence work outcomes among cancer survivors: a systematic review Chia Jie Tan1 · Samantha Yin Ching Yip1 · Raymond Javan Chan2 · Lita Chew1,3 · Alexandre Chan3,4 Received: 20 June 2021 / Accepted: 9 August 2021 © The Author(s) 2021 Abstract Purpose The purpose of this study is to investigate how different cancer-related symptoms influence work outcomes among cancer survivors. Methods A literature search was performed in PubMed, EMBASE, CINAHL, PsycINFO, and Scopus to identify studies published between 1st January 1999 and 30th October 2020 that investigated the impact of specific cancer-related symptoms on work outcomes among cancer survivors who have completed primary antineoplastic treatment. Study findings were extracted and grouped by symptoms and work outcomes, allowing comparison of associations between these outcomes. Results Seventy-three articles representing 68 studies were eligible for inclusion. From these studies, 27 cancer-related symptoms, 9 work outcomes, and 68 unique associations between specific symptoms and work outcomes were identified. Work status (return to work and employment rates) was most commonly studied, and symptom burden was mainly measured from the patient’s perspective. Higher symptom burden was generally associated with trends of poorer work outcomes. Significant associations were reported in most studies evaluating body image issues and work status, oral dysfunction and work status, fatigue and work ability, and depression and work ability. Conclusion Several cancer-related symptoms were consistently associated with inferior work outcomes among cancer survivors. Body image issues and oral dysfunction were shown to be associated with poorer employment rates, while fatigue and depression were linked to lower levels of work performance. Implications for Cancer Survivors Failure to return to work and decreased productivity post-cancer treatment can have negative consequences for cancer survivors and society at large. Findings from this review will guide the development of work rehabilitation programs for cancer survivors. Protocol registration PROSPERO identifier CRD42020187754 Keywords Employment rate · Return to work · Absenteeism · Presenteeism · Work productivity · Symptom burden Introduction * Alexandre Chan 1 Department of Pharmacy, National University of Singapore, Singapore, Singapore 2 Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia 3 Department of Pharmacy, National Cancer Centre Singapore, Singapore, Singapore 4 Department of Clinical Pharmacy Practice, School of Pharmacy & Pharmaceutical Sciences, University of California, 101 Theory, Suite 100, Irvine, CA 92612, USA With improved long-term survival rates of cancer, work and employment have emerged as increasingly prominent issues among cancer survivors. Across a range of various cancers, approximately 40% of cancer survivors do not return to work after completion of treatment [1]. Cancer survivors who remain employed are also more likely to miss work, reduce working hours, or report limitations at work compared to their non-cancer counterparts [1, 2]. Furthermore, cancer survivors have been reported to be less productive in unpaid components of work, such as homemaking and volunteering [3]. The ability of cancer survivors to resume normal levels of productivity is crucial for both survivors and society at large. From a societal 13 Vol.:(0123456789) Journal of Cancer Survivorship perspective, inferior work outcomes among cancer survivors lead to productivity loss, which was estimated to cost US$3593 per capita annually in the USA [4]. Among cancer survivors, inferior work outcomes posttreatment result from a mismatch between an individual’s functional capabilities and work demands [5]. We speculate that cancer survivors often suffer from impaired functional capabilities due to lingering symptoms from cancer and antineoplastic treatment. This is supported by empirical evidence from published studies that have reported that cancer survivors continue to face mental and physical difficulties at work and were more likely to quit due to cancerrelated disabilities [6, 7]. These issues could be addressed by rehabilitative care, which has been shown to facilitate return-to-work (RTW) and reduce early retirement among cancer survivors [8, 9]. Rehabilitative care encompasses a wide range of services that aim to mitigate symptom burden and functional impairments among cancer survivors. While rehabilitative care is specific to the individual needs of patients, survivorship services targeting cancer-related symptoms that strongly impact work outcomes should be prioritized when developing work rehabilitation programs, especially in resource-constrained healthcare settings. A comprehensive understanding and comparison of how specific cancerrelated symptoms influence work outcomes is therefore crucial. Despite the abundance of observational studies that have examined the relationship between specific cancer-related symptoms and work outcomes, most systematic reviews have not focused on symptom burden [10–12] or did not identify the impact of specific symptoms [13, 14]. This systematic review, therefore, aims to describe and compare how different cancer-related symptoms affect work outcomes among cancer survivors based on findings reported in the primary literature, allowing the identification of symptoms that are closely linked to poor work outcomes. Besides guiding the prioritization of survivorship services for work rehabilitation programs, the findings of this review will also provide insights into the current state of research on the relationship between symptom burden and work outcomes, identifying gaps in the field that need to be addressed. Methods The protocol for this systematic review has been registered on PROSPERO (ID: CRD42020187754) and reporting of the review is in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [15]. 13 Search strategy Literature search was performed in the PubMed, EMBASE, CINAHL, PsycINFO, and Scopus databases for studies published from 1st January 1999 to 30th October 2020 with the final search performed prior to data analysis. Initial searches were conducted using a combination of MeSH terms and free-text terms related to cancer survivors and work-related outcomes separately, with each term combined with “or.” Subsequently, the results of both searches were collectively combined with “and.” The search syntax was then adopted per database (Supplementary Material 1). Eligibility criteria Studies that quantified the impact of symptom burden on work outcomes among adult cancer survivors who had completed primary treatment (surgery, cytotoxic chemotherapy, and/or radiotherapy) were e (...truncated)