Return-to-work interventions integrated into cancer care: a systematic review

The purpose of this study was to review the literature on the content of interventions focusing on return to work, employment status, or work retention in patients with cancer. Furthermore, the effect of the interventions on return to work was assessed in studies reporting return to work.

A literature search was conducted using the databases MEDLINE, PsycINFO, EMBASE and CINAHL. Articles that described a work-directed intervention focusing on return to work, employment status, or work retention in patients with cancer were included. The content of the work-directed part of the interventions was assessed based on two criteria for content analysis: 1. does the setting fit the shared care model of cancer survivor care? 2. Does the intervention target work ability and physical workload? For studies reporting return-to-work outcomes, the return-to-work rates were assessed. For studies that used a control group the ORs and the 95% CIs were calculated.

Twenty-three articles describing 19 interventions met the inclusion criteria. Seven studies reported return-to-work outcomes of which four used a control group. Only three interventions aimed primarily at enhancing return to work or employment status. The most frequently reported work-directed components were encouragement, education or advice about work or work-related subjects (68%), vocational or occupational training (21%), or work accommodations (11%). One intervention fit the shared care model of cancer survivor care and five interventions enhanced work ability or decreased physical workload. The rate of return to work ranged from 37% to 89%. In one of the four controlled studies the intervention increased return to work significantly and in the other studies the results were insignificant.

Only few interventions are primarily aimed at enhancing return to work in patients with cancer and most do not fit the shared care model involving integrated cancer care. Future studies should be developed with well-structured work-directed components that should be evaluated in randomised controlled trials.